Therapy (PT/OT/speech) Medicaid rates by code
44 therapy (PT/OT/speech) codes with published Medicaid rates in five or more states. Each page compares every state's rate, unit and managed-care rule.
- Codes
- 44
- In 40+ states
- 24
All therapy (PT/OT/speech) codes
| Code | Service | States | Median rate |
|---|---|---|---|
| 0274 | Orthotic and prosthetic fitting and training | 5 | $2.62 |
| 90901 | Other therapy services | 17 | $31.90 |
| 92507 | Speech therapy session (one person) | 50 | $62.13 |
| 92521 | Stuttering evaluation | 50 | $103.07 |
| 92522 | Articulation evaluation | 50 | $87.11 |
| 92523 | Articulation and language evaluation | 50 | $174.30 |
| 92524 | Voice evaluation | 50 | $84.60 |
| 92526 | Swallowing and feeding therapy | 48 | $68.79 |
| 92607 | Assessment for a communication device | 44 | $100.34 |
| 92608 | Speech-generating device evaluation | 42 | $37.39 |
| 92610 | Swallowing assessment | 49 | $66.55 |
| 97110 | Exercise therapy for strength and range of motion | 49 | $24.36 |
| 97112 | Balance and coordination retraining | 47 | $26.47 |
| 97129 | Cognitive skills therapy, first unit | 38 | $18.97 |
| 97130 | Cognitive skills therapy, each added unit | 38 | $18.52 |
| 97161 | Physical therapy evaluation, level 1 of 3 | 48 | $78.25 |
| 97162 | Physical therapy evaluation, level 2 of 3 | 48 | $80.78 |
| 97163 | Physical therapy evaluation, level 3 of 3 | 49 | $81.22 |
| 97164 | Physical therapy follow-up assessment | 47 | $56.26 |
| 97165 | Occupational therapy evaluation, level 1 of 3 | 48 | $81.28 |
| 97166 | Occupational therapy evaluation, level 2 of 3 | 48 | $82.41 |
| 97167 | Occupational therapy evaluation, level 3 of 3 | 49 | $83.99 |
| 97168 | Occupational therapy follow-up assessment | 47 | $58.02 |
| 97530 | Functional activity training | 49 | $28.40 |
| 97532 | Cognitive rehabilitation therapy | 6 | $22.56 |
| 97533 | Sensory processing therapy | 41 | $47.60 |
| 97760 | Brace fitting and training | 40 | $37.06 |
| 97761 | Artificial limb training | 39 | $32.26 |
| 97763 | Follow-up visit for a brace or artificial limb | 40 | $41.20 |
| 97802 | Nutrition counseling, first visit | 40 | $28.20 |
| 97803 | Nutrition counseling, follow-up visit | 38 | $24.03 |
| G0454 | Physical therapy | 7 | $8.61 |
| G0471 | Physical therapy | 12 | $10.65 |
| G0472 | Physical therapy | 21 | $41.72 |
| G0473 | Physical therapy | 12 | $10.55 |
| G0476 | Physical therapy | 20 | $34.65 |
| G0477 | Physical therapy | 6 | $9.35 |
| G0478 | Physical therapy | 6 | $11.89 |
| G2211 | Physical therapy | 15 | $15.24 |
| G2212 | Occupational therapy | 22 | $29.43 |
| H2032 | Activity therapy, per 15 minutes | 14 | $13.45 |
| S9470 | Nutritional counseling, dietitian visit | 23 | $26.66 |
| V5362 | Speech screening | 6 | $24.62 |
| V5363 | Language screening | 6 | $24.62 |
What the therapy (PT/OT/speech) line covers
The therapy (PT/OT/speech) line groups the codes billed mostly by physical, occupational and speech therapists and therapy practices. Across the 51 state programs we cover, 44 codes in this line have a published fee-for-service rate in five or more states. By code set, the line is made up of 30 CPT medicine codes, 9 HCPCS Level II professional services codes, 2 HCPCS Level II vision, hearing and speech codes and 1 revenue code and a few others.
How to read the index
- Code opens the code's page: every state's rate ranked, the unit, a per-hour figure for timed codes, the managed-care rule and a Medicare comparison where the units match.
- States is the number of state Medicaid programs that publish a fee-for-service rate for the code. A higher count makes the median more representative.
- Median rate is the middle published amount across those states, in the units they use. When states publish a code in different units, the median mixes them, so open the code before relying on it.
Why therapy (PT/OT/speech) rates differ between states
- 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.
- Visit limits, prior authorization and annual caps vary by state and change how much a single code is worth to a practice.
Billing and units
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.
Frequently asked questions
How many therapy (PT/OT/speech) codes have Medicaid rates here?
44 codes with a published fee-for-service rate in at least five state Medicaid programs, 24 of them in 40 or more states. The typical code in this line is published by 40 states.
Which therapy (PT/OT/speech) codes are published by the most states?
92507 (50 states), 92521 (50 states), 92522 (50 states), 92523 (50 states) and 92524 (50 states).
Can I compare the median rates in this list?
Only with care. Each median is taken across the states that publish the code, in the units they publish it in. Open a code to see the unit each state uses and whether the code is ranked like-for-like.
How are therapy (PT/OT/speech) services billed?
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.
Where do these rates come from?
From each state's official Medicaid fee schedules, rate notices and provider bulletins. Every rate on a code page links to its source document and effective date.