Therapy Medicaid rates in Idaho sit precisely in the middle of the country. Idaho Medicaid pays $96.04 an hour for physical therapy under code 97110, which ranks 25th of 49 states and is exactly the national median of $96.04. The rate is $24.01 per 15-minute unit, billed with the GO or GP modifier and effective 2026-07-01.
The rest of Idaho's schedule follows suit: the PT, OT and speech evaluations all sit within a few points of their national medians. What distinguishes Idaho is less the rate level than the rules around it. Two recent Idaho Medicaid information releases address therapy caps and service limitations, and those shape how many of these median-priced units a practice can actually bill. All rates are compiled from official Idaho Medicaid publications, and the Idaho Medicaid rates hub links each to its source document.
| Service | Code | Idaho rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97110 GO/GP | $96.04/hour | 25 of 49 | 0.0% |
| Occupational therapy | 97533 EP | $96.04/hour | 29 of 48 | -13.2% |
| Speech-language therapy | 92507 GN | $63.41 | 18 of 39 | +2.9% |
| PT evaluation | 97161 GP | $81.22 | 24 of 46 | -0.6% |
| OT evaluation | 97165 GO | $83.34 | 23 of 46 | +1.1% |
| Speech-language evaluation | 92522 GN | $92.85 | 20 of 44 | +1.7% |
No Idaho therapy rate is more than a few points from its national median except occupational therapy treatment. That makes Idaho a useful reference state: a practice that wants to know what a typical Medicaid program pays for therapy can look at the Idaho schedule and see something close to the national middle.
Idaho publishes therapy rates in its numerical fee schedule, issued quarterly; the current edition is the Idaho Medicaid Numerical Fee Schedule for July to September 2026. Most rates on this page carry a 2026-07-01 effective date for that reason.
Discipline modifiers
Idaho bills therapy with discipline modifiers (GP, GO and GN) on most codes, and the occupational therapy rate on file carries the EP modifier. Billing staff should match each line's modifier to the schedule, since the rate is tied to the code-and-modifier pair. A 97110 line, for example, can be billed by a physical or an occupational therapist, and the modifier tells Idaho Medicaid which discipline delivered it.
Units versus services
Treatment codes such as 97110 and 97533 are timed and billed in 15-minute units; the hourly figures above are four units. Speech therapy under 92507 and all three evaluations are priced per service, so session length does not change the payment.
Idaho pays $24.01 per unit of 97110, or $96.04 an hour. Being exactly at the median has a practical meaning: Idaho is neither a state where therapists chase Medicaid volume nor one where practices avoid it. The decision to take Idaho Medicaid patients comes down to local cost structure and the therapy caps, not to the rate itself.
For a clinic budgeting a full Medicaid treatment hour, $96.04 is the revenue line. The labor section below shows how much of it remains after wages, and it is more than in most states with similar rates, because Idaho wages are lower.
The evaluations tell the same story. The PT evaluation pays $81.22, the OT evaluation $83.34 and the speech-language evaluation $92.85, each within two points of its national median. An Idaho episode of care therefore has no unusually rich or unusually thin step: intake, treatment and re-assessment are all priced close to what a typical Medicaid program pays, so the length of the episode and the cap on visits decide its value.
Idaho pays $24.01 per 15 minutes for both 97110 physical therapy and 97533 occupational therapy, or $96.04 an hour for each. Because the national OT median ($110.60) is higher than the PT median, the same Idaho rate lands at the median for PT and 13.2% below it for OT. The OT rate dates from 2025-09-01, while the PT rate carries the newer 2026-07-01 date.
The September 2025 date matches the Idaho Medicaid 4% Provider Rate Reductions fee schedules, which set rates projected from 2025-09-01. For mixed PT and OT clinics, the practical result is that the OT hour is relatively less well paid in Idaho than in a typical state, even though the dollar figure is identical to PT.
The most important recent items for Idaho therapy providers are policy, not price:
- Information Release MA25-04: Therapy Cap Limits, enacted 2025-02-06.
- Information Release MA26-05: Therapy Service Limitations, enacted 2026-01-08.
The coverage data shows no prior-authorization rule and no code-level unit limit on any of the listed therapy codes, including 92507, 92521, 92522, 92523, 92524, 97110, 97112 and 97161. The caps and limitations in those information releases are therefore the controls to track.
Building plans of care around a cap
A cap reached mid-episode stops further billable visits regardless of the median-level rate. Practices should:
- Record each patient's cumulative therapy use at intake, including services from other providers where known.
- Pace visit frequency so the plan of care reaches its goals before the cap.
- Flag patients approaching the limit early, so discharge planning or a request for additional services can happen before visits become unbillable.
Idaho wages run below the national medians for every therapy role. In May 2025, physical therapists earned a median $47.60 an hour against $49.40 nationally, and occupational therapists $47.00 against $48.24. The speech-language pathologist gap was widest: $40.57 against $47.05. Physical therapist assistants earned $29.34 against $32.88, and occupational therapy assistants $31.41 against $34.76.
Median rates and below-median wages give Idaho practices reasonable margins:
- Physical therapy (97110): wages take 70.4% of the $96.04 hourly rate, leaving $28.39 an hour after a loaded wage.
- Occupational therapy (97533): wages take 69.6% of the same $96.04 rate, leaving $29.24.
For speech practices, an above-median 92507 rate paired with an SLP wage well below the national figure is the most favorable combination in Idaho's therapy schedule.
Lower wages help margins but can make hiring harder, particularly in rural Idaho, where a practice may compete with neighboring states for the same therapists. A margin near $28 to $29 an hour gives a practice some room to pay above the local median to recruit, while still covering overhead.
Assistants earn markedly less than therapists in Idaho, at $29.34 for physical therapist assistants and $31.41 for occupational therapy assistants. Where Idaho rules allow assistants to deliver treatment under a therapist's plan of care, assistant-heavy models widen the margin further. The binding constraint for many Idaho practices is not price but the cap on how many visits each patient can receive.
Idaho Medicaid's core program is fee-for-service, run by the Division of Medicaid. Its managed-care arrangements are targeted: the Idaho Behavioral Health Plan (Magellan of Idaho), Idaho Smiles for dental (MCNA Insurance Company), a transportation broker, and the MMCP and IMPlus programs for dual-eligible members, with Molina Healthcare of Idaho and UnitedHealthcare Community Plan of Idaho among the plans. Our data counts 7 plans and entities in total.
No managed-care service-line rule for therapy is on file, so the published Idaho fee schedule is the reference rate for therapy claims. Idaho also lists Medicaid School-Based Services billed by school districts as a separate program. The Idaho managed-care page lists the plans on file.
House Bill 345 (2025) moves Idaho Medicaid to comprehensive managed care, with the start delayed to January 1, 2030. Until then, therapy claims price against the fee-for-service schedule. When the transition happens, the question for therapy providers will be the rule plans must follow: whether they pay the published rate, negotiate their own, or are held to a floor.
Practices have time to prepare. Clean claims data, documented outcomes and a clear picture of cost per visit will all be useful when plan contracting begins.
Idaho's $96.04 PT hour sits well below the regional leaders Montana ($147.04) and New Mexico ($165.64), and far below Alaska at $176.68. At the bottom of the table, New Jersey pays $58.80, California $48.88 and Maine $46.64. On speech, Washington leads at $144.10, while Idaho's $63.41 is just above the median. Neighboring Utah therapy rates offer another Mountain-region comparison.
- Budgeting: use $96.04 an hour for PT and OT treatment, and the per-service rates for speech and evaluations, then layer in wage and overhead costs.
- Benchmarking: because Idaho sits at the median, it is a fair yardstick for judging whether another state's offer is high or low.
- Cap management: build visit pacing into each plan of care so caps do not cut episodes short.
- Monitoring: follow the quarterly numerical fee schedule and new information releases on therapy.
Rates on this page are compiled from official Idaho Medicaid publications, including the Idaho Medicaid Numerical Fee Schedule for July to September 2026 and Information Releases MA25-04 and MA26-05. Each rate links to its source document. Hourly figures convert 15-minute units to an hour; ranks compare the same service across states. Wages are May 2025 medians.
This page covers therapy only; the Idaho Medicaid rates hub covers all 23,716 current Idaho Medicaid rates. See the national therapy rates hub, our methodology and pricing for full-dataset access.