97163 Medicaid reimbursement rate by state (2026)
Physical therapy evaluation, level 3 of 3. Medicaid pays a median of $81.22 for 97163 across 49 states, from $10.27 in Illinois to $197.76 in Arkansas.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 49
- National median
- $81.22units vary by state
- Lowest
- $10.27Illinois
- Highest
- $197.76Arkansas
What does Medicaid pay for 97163?
49 state Medicaid programs publish a fee-for-service rate for 97163 at the therapist pt level. The national median is $81.22 (units differ between states). Arkansas pays the most, $197.76, and Illinois the least, $10.27, a 19.3x spread. Where the billing unit matches Medicare's, Medicaid pays between 38% and 38% of the 2026 Medicare physician fee schedule amount for the state.
Medicare (non-facility, 2026 physician fee schedule): $91.20–$126.43 depending on the state's Medicare locality.
97163 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 49 states with every variant, modifier and effective date.
Frequently asked questions
What does Medicaid pay for 97163?
It depends on the state. Of the 49 states with a published fee-for-service rate, the median is $81.22. Arkansas pays the most ($197.76) and Illinois the least ($10.27).
Which state pays the highest Medicaid rate for 97163?
Arkansas, at $197.76, effective 2024-12-04.
How do Medicaid rates for 97163 compare with Medicare?
Where the billing units match, Medicaid pays between 38% and 38% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97163?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The workspace shows the rule for each state, cited to the contract or statute.