Therapy Medicaid rates in West Virginia were reset on April 1, 2026, and they remain below the national median on every measure. West Virginia Medicaid pays $79.04 an hour for code 97110, therapeutic exercise, which ranks 40th of 49 states and is 17.7% below the national median of $96.04.
What sets the state apart is that therapy is paid directly by the state, so this rate applies to managed-care members too. A West Virginia practice therefore works with one schedule, one set of rules and wages that are also below the national median, which keeps the line workable even at a low rank. Every rate below is compiled from official West Virginia Medicaid publications, and each one links to its source document.
For physical, occupational and speech therapy, West Virginia's rule is that services are paid directly by the state, outside managed care. West Virginia contracts with Aetna Better Health of West Virginia, Highmark Health Options West Virginia, The Health Plan of West Virginia, UniCare Health Plan of West Virginia and Wellpoint West Virginia, and the state's coverage data names 5 plans in all. None of them sets therapy rates.
For a therapy practice, that means one rate, one payer and one set of rules. The West Virginia Medicaid (fee-for-service, Bureau for Medical Services) schedule is the rate, there is no plan contract to negotiate above it, and there is no risk of a plan discounting below it. It also means a single change to the state schedule reaches every Medicaid therapy claim at once, which is why the April release deserves attention each year. See the West Virginia managed care page for how other lines are handled.
West Virginia publishes code 97110 at $19.76 per 15-minute unit, with no modifier, effective April 1, 2026. Four units make $79.04 an hour. Every therapy rate in this comparison carries the same April 2026 date.
| Service | Code | West Virginia rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97110 | $79.04 / hour | 40 of 49 | -17.7% |
| Occupational therapy | 97112, GO | $88.80 / hour | 36 of 48 | -19.7% |
| Speech-language therapy | 92583 | $39.04 | 29 of 39 | -36.7% |
| PT evaluation | 97162 | $66.37 | 34 of 46 | -18.8% |
| OT evaluation | 97166 | $68.08 | 34 of 46 | -17.4% |
| Speech-language evaluation | 92522 | $76.86 | 35 of 44 | -15.8% |
The pattern is consistent: every therapy line sits between 15.8% and 36.7% below its median.
West Virginia's Bureau for Medical Services (BMS) publishes fee schedules on an annual cycle that runs from April 1 to March 31; the current editions cover April 1, 2026 through March 31, 2027. That is why every therapy rate here carries the same April date.
Timed treatment codes
97110 and 97112 pay per 15-minute unit, so revenue follows documented treatment time. Units per visit is the productivity measure that matters.
Modifiers by discipline
The ranked OT figure is on code 97112 with the GO modifier, at $22.20 per unit. A modifier is a two-character suffix that identifies which version of a service is billed; GO marks occupational therapy. The same code can carry a different rate depending on the discipline modifier, so OT claims must carry GO to price at the OT line.
OT practices billing code 97530 should check that rate on the West Virginia Medicaid rates hub, since the ranked figure is on 97112. At $88.80 an hour, OT pays more than PT on the ranked lines, and occupational therapists earn slightly less than physical therapists, so OT carries the wider margin.
The evaluations follow the same shape. The PT evaluation on 97162 pays $66.37 and the OT evaluation on 97166 pays $68.08, both 34th of 46. Because evaluations and treatment are both below median by similar margins, a West Virginia clinic's blended revenue per visit does not depend much on its mix of new and returning patients.
That is a modest advantage. In states where evaluations pay far below treatment, intake-heavy clinics lose ground; in West Virginia, they do not lose more than anyone else. A practice can therefore plan its intake capacity around referral demand and clinical need rather than around the rate, and use re-evaluations freely where the plan of care requires them.
West Virginia's ranked speech figure is on code 92583 at $39.04, 29th of 39 states. Speech practices billing code 92507 should look up that rate on the state hub, because 92507 is also the most tightly managed therapy code: the schedule attaches four prior authorization rules to it.
Code 92508, the speech evaluation codes 92521 through 92524, 92583 and 97032 carry no prior authorization rule, and none of the listed codes has a published unit limit. For a pediatric speech practice, the four rules on 92507 mean treatment plans need authorization tracking from the first visit. The 92522 speech-language evaluation pays $76.86, 15.8% below the national median of $91.32, and needs no authorization on the schedule.
West Virginia pairs below-median rates with below-median wages. Federal occupational data for May 2025 gives these medians, with US figures in parentheses:
- Physical therapist: $46.44 ($49.40)
- Occupational therapist: $46.25 ($48.24)
- Speech-language pathologist: $38.93 ($47.05)
- Physical therapist assistant: $29.05 ($32.88)
- Occupational therapy assistant: $29.02 ($34.76)
Every role earns less than its national median, and speech-language pathologists earn well below it.
Against the hourly rates:
- Physical therapy. The PT wage is 83.5% of the $79.04 rate, leaving a margin of $13.03 an hour after a loaded wage.
- Occupational therapy. The OT wage is 74.0% of the $88.80 rate, leaving $23.06 an hour.
The PT margin is thin enough that documentation, travel and cancellations can consume it. Assistants are the lever: West Virginia physical therapist assistants and occupational therapy assistants both earn several dollars below their national medians. Where West Virginia Medicaid allows assistant-delivered treatment, that is how a practice keeps its Medicaid line above water. In rural parts of the state, travel time between home visits adds unbillable hours, so routing matters as much as staffing.
West Virginia also runs West Virginia Medicaid School-Based Health Services (SBHS), which matters to therapists who work in or contract with schools. School-based services follow their own program rules, so a therapist working in both settings should keep the two billing tracks separate.
Several 1915(c) waivers also reach therapy populations: the Intellectual/Developmental Disabilities Waiver (IDDW), the Traumatic Brain Injury Waiver (TBIW), the Aged and Disabled Waiver (ADW) and the Children with Serious Emotional Disorder Waiver (CSEDW). These carry their own rates and rules. Confirm which program pays for a service before billing, and record it in the patient file.
A schedule below the national median does not make Medicaid therapy unworkable in West Virginia; it makes efficiency decisive. Three habits separate practices that sustain a Medicaid caseload from those that retreat from it.
Protect units per visit
Because timed codes pay per 15-minute unit, each undocumented or unbilled unit is a larger share of a thin margin. Templates that capture start and stop times, and regular audits of units billed against time documented, recover revenue without changing a single rate.
Keep the schedule full
Cancellations hurt more at a low rate. Reminder calls, a short waitlist for same-day openings and clear attendance policies all help keep therapist time billable.
Match staff to tasks
Licensed therapists should spend their time on evaluations, re-evaluations and complex treatment, with assistants delivering routine treatment where the program allows. In a state where both assistant roles earn several dollars below their national medians, that division of work is the most reliable margin lever available.
No recent notice targets outpatient therapy rates; the April 2026 schedule is the change that matters. Other recent notices cover nursing facility reimbursement, value-based payments for substance use disorder providers effective July 1, 2027, and HCBS and personal care rate increases from October 1, 2025. For therapists, the next scheduled reset is the April 2027 fee schedule release.
West Virginia sits in the lower part of the national ranking. Alaska pays $176.68 an hour for 97110 and New Mexico $165.64. West Virginia stays above the very bottom, where New Jersey pays $58.80, California $48.88 and Maine $46.64. Neighbors Virginia, Ohio and Pennsylvania are the natural comparisons for practices near the state lines.
- Budgeting. Use the April 2026 rates through March 2027 and update tables when the next schedule is released.
- Staffing. Plan assistant-delivered treatment where permitted to protect the PT margin.
- Benchmarking. Compare your blended Medicaid revenue per therapist hour with the $79.04 PT and $88.80 OT figures; a gap usually means missing units, missing modifiers or late cancellations.
- Authorization. Track 92507 authorizations from intake; the evaluation codes need none on the schedule.
The full dataset covers all 88,707 current West Virginia Medicaid rates, with history back to 2017. See pricing for access.
Rates on this page are compiled from official West Virginia Medicaid publications from the Bureau for Medical Services, and each rate links to its source document. For the national overview, see therapy Medicaid rates by state. Our methodology explains how 15-minute units are converted to hourly rates and how states are ranked.