Therapy Medicaid rates in Pennsylvania are among the lowest in the country and among the oldest. Pennsylvania Medical Assistance pays $52.00 an hour for occupational therapy on code 97530, 46th of 48 states and 53.0% below the national median of $110.60, on a rate that has been in effect since July 1, 2006. Physical therapy, ranked on code 97112, pays $67.00 an hour, 46th of 49 and 30.2% below the median.
Both fall short of what Pennsylvania therapists earn. Because HealthChoices plans negotiate their own therapy rates, the fee schedule mostly matters as an out-of-network price and a negotiating anchor, and a practice's real Medicaid economics depend on its plan contracts. All rates here are compiled from official Pennsylvania Medicaid publications, and each one links to its source document.
Pennsylvania publishes code 97530 at $13.00 per 15-minute unit, with no modifier. That rate still carries a July 1, 2006 effective date, the oldest date on Pennsylvania's therapy list. Only Maine ($45.76) and New Jersey ($31.56) rank lower for OT.
When a rate has stood this long, the practical question for a clinic is not when it will rise but how much of its Medicaid volume runs through plan contracts priced above it. A fee-for-service OT hour in Pennsylvania earns less than half the national median, and two decades of wage growth have widened the gap each year.
The ranked PT figure is on code 97112, at $16.75 per 15-minute unit, or $67.00 an hour, effective September 1, 2021. Practices that bill code 97110 for therapeutic exercise should also check that code on the Pennsylvania Medicaid rates hub; the schedule attaches a prior authorization rule to both.
Pennsylvania's other therapy dates are newer than the OT rate but still not recent. The PT and OT evaluations date from August 7, 2017, and speech therapy from September 5, 2023.
| Service | Code | Pennsylvania rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97112 | $67.00 / hour | 46 of 49 | -30.2% |
| Occupational therapy | 97530 | $52.00 / hour | 46 of 48 | -53.0% |
| Speech-language therapy | 92507 | $21.70 | 37 of 39 | -64.8% |
| PT evaluation | 97164 | $43.12 | 44 of 46 | -47.2% |
| OT evaluation | 97168 | $40.69 | 45 of 46 | -50.6% |
| Speech-language evaluation | 92521 | $88.31 | 26 of 44 | -3.3% |
Everything but the speech evaluation sits in the bottom tier. The ranked PT and OT evaluation figures are on the re-evaluation codes 97164 and 97168, and both sit among the three lowest in the country.
Pennsylvania publishes its fee-for-service rates in the PA DHS PROMISe Outpatient Fee Schedule, a lookup organized by provider type. The same code can carry different rates for different provider types, so a therapy practice should look up its rates under its own enrollment rather than assume a single figure applies.
Timed codes
97110, 97112 and 97530 pay per 15-minute unit, so revenue follows documented treatment time. At Pennsylvania's rates, each unit is small, and a missed or undocumented unit costs proportionally more of a visit's revenue.
Modifiers
The ranked speech evaluation is published with the U9 modifier. A modifier is a two-character suffix that identifies the version of a service, and the claim must carry it to pay at the published line. Billing staff should confirm modifier requirements code by code.
The one line near the median is the speech-language evaluation, billed on 92521 with the U9 modifier at $88.31, only 3.3% below the national median of $91.32. Speech treatment on code 92507 pays $21.70, alongside Nebraska ($20.57) and New Hampshire ($19.57) at the bottom of the country.
That split shapes a pediatric speech practice. The evaluation pays close to the national market; each treatment visit pays a fraction of it. A Medicaid speech caseload in Pennsylvania therefore leans heavily on plan contracts for treatment, and on careful evaluation billing for the one line where fee-for-service is competitive.
Federal occupational data for May 2025 gives these Pennsylvania median hourly wages, with US medians in parentheses:
- Physical therapist: $48.74 ($49.40)
- Occupational therapist: $47.33 ($48.24)
- Speech-language pathologist: $44.69 ($47.05)
- Physical therapist assistant: $30.09 ($32.88)
- Occupational therapy assistant: $34.42 ($34.76)
Wages sit just under the national medians. The problem in Pennsylvania is not an expensive labor market; it is a fee schedule far below the market for every therapy role.
Set against the rates, the numbers do not work at the median wage:
- Physical therapy. The PT wage is 103.4% of the $67.00 hourly rate, a loss of $2 an hour after a loaded wage.
- Occupational therapy. The OT wage is 129.4% of the $52.00 rate, a loss of $15 an hour.
Pennsylvania therapy practices with Medicaid patients depend on other payers, plan contracts or assistant staffing to make the line viable. Physical therapist assistants, at a median of $30.09, offer real relief on PT. Occupational therapy assistants earn $34.42, near the national median, so the OT gap is harder to close.
For physical, occupational and speech therapy, Pennsylvania's rule is that plans negotiate; the published rate applies out of network. The Pennsylvania Medical Assistance (fee-for-service) schedule is therefore the out-of-network rate, and in-network therapy rates are whatever a practice negotiates with each plan.
That makes contracting the most important lever a Pennsylvania therapy practice has. The state's coverage data names 18 plans and program arrangements, including AmeriHealth Caritas Pennsylvania, Keystone First, Geisinger Health Plan, Jefferson Health Plans EverWell, PA Health & Wellness and UPMC for You, plus the Community HealthChoices plans for long-term services. A plan contract priced well above a 2006 fee schedule can change the economics entirely. The Pennsylvania managed care page shows how each plan fits.
Negotiating above a 2006 schedule
Because the published rate is so low, a plan offer framed as a percentage of the Medical Assistance schedule can look generous and still fall short of cost. Translate every offer into dollars per hour for PT and OT and compare it with your loaded wage cost, not with the schedule.
Useful evidence in a negotiation includes wait times for new Medicaid patients, pediatric capacity, rural coverage and outcomes. Plans that need therapy access in a region have room to pay above the schedule; the schedule itself gives them no reason to. Ask also how evaluations and re-evaluations are paid, since the fee-for-service evaluation rates are among the lowest in the country.
The Pennsylvania schedule attaches one prior authorization rule each to 92507, 97110, 97112 and 97530. The evaluation codes, including the 97161 PT evaluation and the speech evaluations 92521 through 92524, carry none, and no therapy code has a published unit limit. Managed-care members are subject to each plan's own authorization process, so a practice contracted with several HealthChoices plans should keep a plan-by-plan record of requirements.
Not every Medicaid therapy dollar in Pennsylvania flows through the outpatient fee schedule. People with intellectual disabilities or autism may receive services through the Pennsylvania ODP intellectual disability and autism waivers, including the Consolidated, Community Living and Person/Family Directed Support waivers and the ODP Adult Autism Waiver. Adults with developmental physical disabilities may be served through the Pennsylvania OBRA Waiver.
These programs run on their own rate structures and authorization processes. A therapist who serves waiver participants should confirm which program is paying for each service before billing, because a waiver service and an outpatient therapy claim under Medical Assistance follow different rules. Keeping the two billing paths separate in the practice management system prevents claims going to the wrong payer.
No recent Pennsylvania notice changes outpatient therapy rates directly. The broadest recent item is the 2026 Healthcare Common Procedure Coding System Updates; Fee Adjustments and Other Procedure Code Changes, effective August 1, 2026, which updated codes and fees across the schedule; therapy practices should confirm whether any of their codes were touched. Other recent notices focus on nursing facility rates, hospital supplemental payments and supports coordination for the Office of Developmental Programs waivers.
The distance to the top is large. Alaska pays $176.68 an hour for 97110 and $338.72 for OT on 97533. Montana pays $197.20 an hour on 97530, the same code Pennsylvania pays at $52.00. On speech, Washington pays $144.10 for 92507.
Pennsylvania stays above the very bottom on PT, where New Jersey ($58.80), California ($48.88) and Maine ($46.64) rank lower. Neighbors Ohio and New York pay more on PT, which matters for groups with locations across state lines.
- Contracting. Treat the fee schedule as the floor of the conversation, not the target, and negotiate each HealthChoices contract in dollars per hour.
- Service mix. Expect speech evaluations and assistant-delivered PT to be the most sustainable Medicaid lines.
- Budgeting. Do not assume the 2006 OT rate or the 2017 evaluation rates will move; plan around plan contracts instead.
The full dataset covers all 49,804 current Pennsylvania Medicaid rates, with history back to 1983. See pricing for access.
Rates on this page are compiled from official Pennsylvania Medicaid publications, chiefly the PA DHS PROMISe Outpatient Fee Schedule, and each rate links to its source document. For the national overview, see therapy Medicaid rates by state. Our methodology explains how units are converted to hourly rates.