97166 Medicaid reimbursement rate by state (2026)
Occupational therapy evaluation, level 2 of 3. Medicaid pays a median of $82.41 for 97166 across 48 states, from $19.63 in Illinois to $153.02 in Alaska.
- States publishing
- 48
- National median
- $82.41units vary by state
- Lowest
- $19.63Illinois
- Highest
- $153.02Alaska
What does Medicaid pay for 97166?
48 state Medicaid programs publish a fee-for-service rate for 97166. The national median is $82.41 (units differ between states). Alaska pays the most, $153.02, and Illinois the least, $19.63, a 7.8x spread. Where the billing unit matches Medicare's, Medicaid pays 37% of the 2026 Medicare physician fee schedule amount for the state.
Medicare (non-facility, 2026 physician fee schedule): $93.50–$129.28 depending on the state's Medicare locality.
97166 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 48 states with every variant, modifier and effective date.
Frequently asked questions
What does Medicaid pay for 97166?
It depends on the state. Of the 48 states with a published fee-for-service rate, the median is $82.41. Alaska pays the most ($153.02) and Illinois the least ($19.63).
Which state pays the highest Medicaid rate for 97166?
Alaska, at $153.02, effective 2026-07-01.
How do Medicaid rates for 97166 compare with Medicare?
Where the billing units match, Medicaid pays 37% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97166?
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.