97763 Medicaid reimbursement rate by state (2026)
Follow-up visit for a brace or artificial limb. Medicaid pays a median of $41.20 for 97763 across 40 states, from $17.37 in Kentucky to $72.32 in New Mexico.
- States publishing
- 40
- National median
- $41.20units vary by state
- Lowest
- $17.37Kentucky
- Highest
- $72.32New Mexico
- Median per hour
- $163.9239 time-based states
What does Medicaid pay for 97763?
40 state Medicaid programs publish a fee-for-service rate for 97763. The national median is $41.20 (units differ between states). New Mexico pays the most, $72.32 per 15 min, and Kentucky the least, $17.37 per 15 min, a 4.2x spread. Converted to an hour of service in the 39 states that bill it by time, the median is $163.92 per hour. Where the billing unit matches Medicare's, Medicaid pays between 37% and 153% of the 2026 Medicare physician fee schedule amount for the state.
Medicare (non-facility, 2026 physician fee schedule): $45.33–$60.16 depending on the state's Medicare locality.
97763 rate by state: highest, middle and lowest
One like-for-like fee-for-service rate per state, ranked. The workspace lists all 40 states with every variant, modifier and effective date.
How to read this table
- Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 39 of the 40 states publish 97763 per 15 min, enough to rank them against each other.
- Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 24 of the 40 states list more than one rate for 97763, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
- Unit. Of the 40 states, 39 publish 97763 per 15 min and 1 per unit.
- Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 39 of the 40 states bill 97763 by time, with a median of $163.92 per hour.
- Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
- % of Medicare. Shown only where the Medicaid rate uses the code's own billing unit and a Medicare amount exists: 37 states for 97763, at between 37% and 153%.
- Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.
Why 97763 rates differ between states
Published rates for 97763 run from $17.37 in Kentucky to $72.32 in New Mexico, a 4.2x gap in the same unit. Half the states pay more than the median of $41.20 and half pay less. The usual reasons for a spread like this in therapy (PT/OT/speech) rates:
- Visit limits, prior authorization and annual caps vary by state and change how much a single code is worth to a practice.
- States pay therapy by CPT code, but many pay therapy assistants a reduced percentage and some pay differently in outpatient hospital, private practice and home settings.
- Children's therapy is driven by the EPSDT benefit, so some states maintain separate pediatric rates or programs.
Timing matters too. 26 states set the current rate for 97763 in 2026 or later, while 8 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.
What managed-care plans pay for 97763
No managed-care plan publishes what it pays for 97763. What is public is the rule each state's plan contracts set, and that rule decides how much the published rate matters when you contract with a plan.
In 9 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 20 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 10 states is not classified yet.
- Plans negotiate; the published rate applies out of network (20 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
- Plans must pay at least the published rate (9 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.
- Paid by the state, outside the plans (1 state). Bill the state's Medicaid program, not the plan, at the published rate. There is no plan contract to negotiate for this service.
Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example New Mexico managed care.
Units and billing for 97763
97763 is a CPT medicine code in the therapy (PT/OT/speech) line, billed mostly by physical, occupational and speech therapists and therapy practices. The medicine section runs from vaccines and psychiatry to dialysis, cardiology and therapy. Some of its codes are timed in 15-minute units, others are billed once per session or per test, so the unit matters more here than in most sections.
Many treatment codes are timed in 15-minute units, while evaluations and re-evaluations are billed once per session. Medicare applies a rule for counting timed minutes into units; Medicaid programs may follow it or set their own, so check the state's therapy manual.
Medicare's 2026 physician fee schedule pays $45.33–$60.16 for 97763 (non-facility), depending on the Medicare locality. That is a useful reference point, but Medicare and Medicaid can define the unit differently, so compare only where the units match.
Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.
Frequently asked questions
What does Medicaid pay for 97763?
It depends on the state. Of the 40 states with a published fee-for-service rate, the median is $41.20. New Mexico pays the most ($72.32 per 15 min) and Kentucky the least ($17.37 per 15 min).
Which state pays the highest Medicaid rate for 97763?
New Mexico, at $72.32 per 15 min ($289.28 per hour), effective 2025-01-01.
Which state pays the lowest Medicaid rate for 97763?
Kentucky, at $17.37 per 15 min ($69.48 per hour), effective 2026-01-01.
What unit is 97763 billed in?
Of the 40 states, 39 publish 97763 per 15 min and 1 per unit. 39 of the 40 states bill it by time, and their rates are also shown per hour.
How do Medicaid rates for 97763 compare with Medicare?
Where the billing units match, Medicaid pays between 37% and 153% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97763?
Not necessarily. In 9 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 20 states, plans negotiate and the published rate is a benchmark or out-of-network default. In 1 state, the service is paid outside the plans or through a state-directed payment. The rule for the remaining 10 states is not classified yet. Each rule is cited to the plan contract, statute or notice in the workspace.