Therapy Medicaid rates in Virginia favor occupational therapy and evaluations. Virginia Medicaid pays $151.72 an hour for occupational therapy on code 97530, which ranks 6th of 48 states and is 37.2% above the national median of $110.60. Physical therapy on code 97110 pays $100.68 an hour, a more modest 18th of 49 and 4.8% above the median.
The PT and OT evaluations both rank 5th in the country, and all of the therapy rates discussed here took effect on July 1, 2026. Because PT and OT therapists earn almost the same in Virginia, the gap between the two rates translates directly into a gap in margins. Every rate below is compiled from official Virginia Medicaid publications, and each one links to its source document.
Virginia publishes code 97530 at $37.93 per 15-minute unit, with no modifier, which converts to $151.72 an hour. Only a handful of states pay more, led by Alaska, New Mexico and Montana.
The gap between Virginia's OT and PT rates is wide. The OT unit pays $37.93 while code 97110 pays $25.17. A Virginia practice with both disciplines earns substantially more per occupational therapy hour than per physical therapy hour, which should shape hiring and referral development. It also means the payer mix matters differently by discipline: a Virginia OT caseload can lean on Medicaid, while a PT caseload at $100.68 an hour benefits more from a balance of other payers.
| Service | Code | Virginia rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97110 | $100.68 / hour | 18 of 49 | +4.8% |
| Occupational therapy | 97530 | $151.72 / hour | 6 of 48 | +37.2% |
| PT evaluation | 97162 | $105.84 | 5 of 46 | +29.5% |
| OT evaluation | 97166 | $108.73 | 5 of 46 | +31.9% |
The evaluations stand out. Virginia's PT evaluation on 97162 at $105.84 and OT evaluation on 97166 at $108.73 both appear among the five highest-paying states, alongside Alaska, New Mexico, Texas and North Dakota.
Virginia's fee-for-service program is run by the Department of Medical Assistance Services (DMAS), which publishes rates in its procedure fee files. Virginia states some therapy rates in units that differ from the national convention, which matters when comparing.
Timed PT and OT codes
97110 and 97530 pay per 15-minute unit. Revenue follows documented treatment time, so units per visit drive PT and OT income.
Per-session and per-evaluation codes
Speech treatment on 92507 is published per treatment session and the speech evaluation on 92524 per evaluation. A per-session rate does not depend on unit counting, which makes speech revenue simpler to model.
Evaluations are where an episode of care begins, and in many states they pay well below treatment relative to the market. Virginia reverses that. Both the PT and OT evaluations rank 5th nationally, so a clinic with frequent new patients carries real revenue on each intake visit.
That suits orthopedic practices with short episodes, pediatric clinics that assess many children and refer some on, and any practice that re-evaluates regularly to keep plans of care current. For PT in particular, the evaluation is better positioned against the national market than the treatment code, which ranks 18th.
Virginia publishes speech treatment on code 92507 at $82.36 per treatment session and the speech evaluation on 92524 at $118.48 per evaluation. For context, the national medians are $61.64 for speech treatment and $91.32 for the speech evaluation.
At $82.36 per session, the revenue of a speech visit does not depend on unit counting, only on whether the session is billed. Virginia's median speech-language pathologist wage was $46.27 an hour in May 2025, against $47.05 nationally. A speech practice that keeps sessions focused captures the full session rate in less clinician time, and the evaluation rate supports a complete assessment at intake.
Federal occupational data for May 2025 gives these Virginia median hourly wages, with US medians in parentheses:
- Physical therapist: $48.78 ($49.40)
- Occupational therapist: $48.42 ($48.24)
- Speech-language pathologist: $46.27 ($47.05)
- Physical therapist assistant: $35.46 ($32.88)
- Occupational therapy assistant: $36.04 ($34.76)
Licensed therapists earn close to the national median. Assistants earn above it, which makes Virginia a relatively expensive state for assistant-heavy staffing models.
Against the hourly rates:
- Physical therapy. The PT wage is 68.9% of the $100.68 rate, leaving a margin of $31.35 an hour after a loaded wage.
- Occupational therapy. The OT wage is only 45.4% of the $151.72 rate, leaving $82.90 an hour.
The OT margin is far wider than the PT margin, and that reflects the rate gap rather than any difference in wages: Virginia PTs and OTs earn almost the same. Assistants in Virginia earn more than the national median, so assistant staffing narrows the margin advantage less than it would in lower-wage states. For a group deciding where to add a therapist, an OT hire generally improves the Medicaid book more than a PT hire, provided local referral volume can keep the new caseload consistently full.
Virginia's managed-care program is Virginia Cardinal Care Managed Care (CCMC), which combined Virginia's earlier managed-care programs from October 1, 2023 and covers both acute care and MLTSS. Plans include Aetna Better Health of Virginia and Anthem HealthKeepers Plus, and the state's coverage data names 123 plans and program arrangements, including many PACE sites.
For physical, occupational and speech therapy, Virginia's rule is that plans negotiate; the published rate applies out of network. The rates here come from Virginia Medicaid (fee-for-service, DMAS), and they are the benchmark when reviewing Cardinal Care plan offers. A plan contract below the DMAS rate gives away much of Virginia's OT and evaluation advantage, so translate every offer into dollars per hour and per evaluation before signing. See the Virginia managed care page for the rule on each service line.
The Virginia schedule attaches one prior authorization rule each to 97530 and the group therapy code 97150. Codes 92507, 92508, 97110, 97112 and the speech evaluation codes 92521 through 92524 carry none, and no therapy code has a published unit limit.
The rule on 97530 matters because it is Virginia's most valuable treatment code. An OT practice should build authorization into intake for every Medicaid patient whose plan of care relies on 97530. Cardinal Care plans run their own authorization processes as well, so plan rules still apply to managed-care members.
Two parts of Virginia's therapy picture sit outside the headline codes. The first is group therapy. Code 97150, used when a therapist treats more than one patient at the same time, carries a prior authorization rule on the Virginia schedule. Practices that run group sessions, common in pediatric OT and in some rehabilitation programs, should seek authorization before the first group session rather than treat 97150 as a routine add-on.
The second is waiver services. People with developmental disabilities may receive services through Virginia's developmental disability waivers, including the Building Independence, Family and Individual Supports and Community Living waivers, and through the Commonwealth Coordinated Care Plus (CCC Plus) HCBS waiver. These programs carry their own rates, some priced once for both the DD waivers and CCC Plus. A therapist serving waiver participants should confirm which program pays for each service before billing, because the therapy schedule on this page may not be the rate that applies.
Virginia's 2026 Appropriation Act (Special Session I, HB30) includes Medicaid rate provisions with effective dates running from July 1, 2026 into future years, and DMAS posted a procedure fee file rate update on September 1, 2026. Virginia also filed SPA 26-014, Removal of Inflation Adjustments, with CMS in August 2026. Therapy practices should check whether any of these touch their codes, since the current therapy rates carry a July 1, 2026 effective date and the next change would most likely arrive through the same budget and fee file process.
On OT and the evaluations, Virginia is near the top. Alaska leads with $338.72 an hour for OT on 97533 and $149.65 for a PT evaluation, followed by New Mexico. On PT, Virginia is in the upper-middle, well ahead of New Jersey at $58.80 and Maine at $46.64. Neighbors North Carolina and West Virginia are the natural comparisons for practices working across state lines.
- Authorization. Build prior authorization into intake for every plan of care that relies on 97530 or group sessions on 97150; these are the only therapy codes with a schedule-level rule.
- Hiring. Weight new hires toward OT where referral demand supports it; the Medicaid margin is far wider.
- Contracting. Use the DMAS rates as the anchor with each Cardinal Care plan, especially for 97530 and the evaluations.
- Benchmarking. Compare your blended Medicaid revenue per therapist hour with the $100.68 PT and $151.72 OT figures; a gap usually points to plan discounts, authorization denials on 97530 or low units per visit.
The full dataset covers all 68,591 current Virginia Medicaid rates, with history back to 1972. See pricing for access.
Rates on this page are compiled from official Virginia Medicaid publications from DMAS, and each rate links to its source document. For the national picture, see therapy Medicaid rates by state. Every other Virginia code is on the Virginia Medicaid rates hub, and our methodology explains how units are converted to hourly rates.