Therapy Medicaid rates in Rhode Island were reset on October 1, 2026, and the new schedule pays more for evaluations than for treatment. Rhode Island Medicaid now pays $98.32 an hour for code 97110, therapeutic exercise, which ranks 22nd of 49 states and is 2.4% above the national median of $96.04. The speech-language evaluation on code 92521 pays $119.55, 5th of 44 states, and the PT and OT evaluations both rank in the top seven.
The reset matters because Rhode Island also pays therapy directly, outside managed care, and manages treatment visits tightly through prior authorization. The result is a state where getting a patient evaluated is easy and well paid, and keeping a plan of care authorized is the real work. Every rate below is compiled from official Rhode Island Medicaid publications, and each links to its source document.
Rhode Island publishes code 97110 with the GP modifier at $24.58 per 15-minute unit, effective October 1, 2026. Four units make $98.32 an hour, just above the national median.
The October 2026 schedule follows the OHIC Rate SPAs: Physical Therapy, Occupational Therapy, and Speech Therapy Services, published September 1, 2026 with an October 1, 2026 effective date. Practices should make sure claims for dates of service from October 1 onward price at the new rates, and that the GP modifier is on every PT line.
| Service | Code | Rhode Island rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97110 | $98.32 / hour | 22 of 49 | +2.4% |
| Occupational therapy | 97530 | $116.20 / hour | 20 of 48 | +5.1% |
| Speech-language therapy | 92507 | $31.51 | 31 of 39 | -48.9% |
| PT evaluation | 97164 | $105.04 | 6 of 46 | +28.5% |
| OT evaluation | 97168 | $105.04 | 7 of 46 | +27.5% |
| Speech-language evaluation | 92521 | $119.55 | 5 of 44 | +30.9% |
The evaluation codes are the standout. The PT and OT evaluations both pay $105.04 and have been in effect since October 1, 2024; the 92521 speech evaluation at $119.55 carries the new October 1, 2026 date.
Rhode Island's therapy rates come out of a rate review by the Office of the Health Insurance Commissioner (OHIC), followed by state plan amendments (SPAs) that put the recommended rates into effect. That process produced the October 2026 therapy rates, and it also produced companion SPAs for children's services, EPSDT, Early Intervention, home health and other lines on the same date.
For a therapy practice, the practical point is timing. Rhode Island's rates tend to move in deliberate steps tied to the review cycle, with public SPA notices a month or so before the effective date. Watching the OHIC review and the SPA notices is the most reliable way to see a rate change coming.
Rhode Island attaches modifiers to most of its ranked therapy lines. PT on 97110 carries GP; OT on 97530 carries HM, GO and HA; speech treatment on 92507 carries L9. A modifier is a two-character suffix that identifies the discipline, provider level or setting, and the claim must match the published line to pay at that rate.
Practices should build the correct modifiers into charge templates for each discipline and provider type. A claim with the wrong or missing modifier can price at a different line or deny outright, and with 40 authorization rules on 97110, a modifier error can compound an authorization problem.
Occupational therapy on code 97530 pays $29.05 per unit, or $116.20 an hour, 5.1% above the national median. It is the strongest treatment rate on the schedule and the line with the widest margin. The 97165 OT evaluation family is also strong, with the ranked re-evaluation figure on 97168 at $105.04.
Speech treatment is the weak line. Code 92507 with the L9 modifier pays $31.51, 48.9% below the national median of $61.64. A Rhode Island speech practice earns a strong evaluation fee and a weak treatment fee.
That gap is unusually wide. A speech evaluation pays close to four times a treatment visit, so the economics of a speech caseload depend on how many treatment visits follow each evaluation. Practices offering long courses of weekly speech treatment to Medicaid children will find the line hard to sustain on the fee schedule alone.
Federal occupational data for May 2025 gives these Rhode Island median hourly wages, with US medians in parentheses: physical therapists $47.79 ($49.40), occupational therapists $48.10 ($48.24), speech-language pathologists $50.00 ($47.05), physical therapist assistants $33.00 ($32.88) and occupational therapy assistants $32.07 ($34.76).
Most roles sit near the national median. Speech-language pathologists are the exception, earning above it, which is the opposite of what the 92507 rate would need.
- Physical therapy. The PT wage is 69.1% of the $98.32 hourly rate, leaving a margin of $30.40 an hour after a loaded wage.
- Occupational therapy. The OT wage is 58.8% of the $116.20 rate, leaving $47.84 an hour.
Those margins are workable for PT and comfortable for OT. Speech is the squeeze: pathologists earn above the national median while 92507 pays well below it. That is the main financial risk for speech-heavy practices in the state.
Rhode Island manages therapy treatment heavily. Code 97110 carries 40 prior authorization rules and 92507 carries 20, and both have a daily limit. The evaluation codes, the 97161 PT evaluation and the speech evaluation codes 92521 through 92524, carry no prior authorization rule and are limited per claim line, as are 97112 and 97530.
In practice, the evaluation is easy to bill and the treatment plan is not. Practices should build authorization tracking into intake, because a treatment visit billed without the right authorization can be denied even when the evaluation was paid. Track each authorization by member, discipline, approved units and end date, and schedule re-authorization well before it lapses so treatment is never interrupted.
For physical, occupational and speech therapy, Rhode Island's rule is that services are paid directly by the state, outside managed care. The Rhode Island Medicaid (fee-for-service) schedule is the rate, even for members enrolled with Neighborhood Health Plan of Rhode Island, Tufts Health Public Plans or UnitedHealthcare Community Plan of Rhode Island. The state's coverage data names 12 plans and program arrangements.
That makes the October 2026 reset the rate every Medicaid therapy patient brings, with no plan contract above or below it. See the Rhode Island managed care page for how other lines are handled.
Besides the October 2026 therapy SPAs, two changes matter for pediatric therapists:
- The EI Claims Reimbursement Guidebook set new Early Intervention rates effective October 1, 2024, a 13.36% change following an OHIC rate review for the SFY25 budget.
- RI Early Intervention Medicaid rates effective July 1, 2022 carried a 44.99% change.
A companion OHIC SPA covering EPSDT, Early Intervention, Home Health, Hospice and Targeted Case Management Services was published alongside the therapy SPA with the same October 1, 2026 effective date. ### Early Intervention and children's services
For pediatric therapists, the Early Intervention changes matter as much as the outpatient reset. Rhode Island Medicaid Early Intervention (Part C) services are paid fee-for-service on their own schedule, and children with complex needs may also be served through Rhode Island Medicaid children's services, which include CEDARR, home-based therapeutic services and Katie Beckett. A child's therapy can therefore be billed under different programs depending on age and setting, and each program has its own rates and rules. Practices that serve young children should know which program a family is enrolled in before scheduling.
State plan approvals
CMS also approved RI SPA 25-0017, effective October 1, 2025, and RI SPA 25-0005, effective February 13, 2025, both amending the state plan payment attachments.
On treatment, Rhode Island is mid-table: Alaska pays $176.68 an hour for 97110, while New Jersey pays $58.80. On evaluations, Rhode Island sits with the leaders, behind Alaska, New Mexico, North Dakota and Nebraska on the speech evaluation. Among New England neighbors, New Hampshire and Vermont are the nearest comparisons.
The shape of Rhode Island's schedule is what sets it apart. Its evaluations rank between 5th and 7th nationally, while its treatment codes rank between 20th and 31st, so the state rewards the first visit of an episode far more than the visits that follow. For a group comparing states, that means Rhode Island suits intake-heavy and assessment-focused models better than long-course treatment models, especially in speech.
- Re-price from October 1. Update fee tables for the October 2026 rates and check that remittances match.
- Invest in authorization. With 40 rules on 97110, authorization accuracy protects more revenue than any negotiation, since there is no plan contract to negotiate.
- Plan speech carefully. Expect evaluations to carry the speech line, and design treatment frequency with the low 92507 rate in mind.
The full dataset covers all 76,101 current Rhode Island Medicaid rates, with history back to 1993. See pricing for access.
Rates on this page are compiled from official Rhode Island Medicaid publications, including the RI Medicaid Interactive Fee For Service Fee Schedule, and each rate links to its source document. For the national overview, see therapy Medicaid rates by state. Every other code is on the Rhode Island Medicaid rates hub, and our methodology explains how units are converted to hourly rates.