Therapy Medicaid rates in Wisconsin are below the national median for treatment and above it for one evaluation. Wisconsin Medicaid pays $81.16 an hour for its ranked physical therapy code, 97112 with the TF modifier, placing the state 37th of 49 and 15.5% below the national median of $96.04. The speech-language evaluation on code 92521, by contrast, pays $103.44, 12th of 44 and 13.3% above the median.
Most of the therapy rates date from January 1, 2022, and the PT and OT evaluations from 2017. Combined with negotiated HMO rates and modifier-specific billing, that makes Wisconsin a state where billing accuracy and contracting matter as much as the published figures. Every rate below is compiled from official Wisconsin Medicaid publications, and each one links to its source document.
Wisconsin's ranked PT figure is code 97112, billed with the TF modifier at $20.29 per 15-minute unit, which converts to $81.16 an hour. Practices billing code 97110 for therapeutic exercise should check that code's rate on the Wisconsin Medicaid rates hub as well.
The rate has been in effect since January 1, 2022. Nearly five years of wage growth have passed without a change, so the PT line is tighter now than when the rate was set.
For a PT clinic, the practical meaning is a Medicaid hour that covers a therapist's wage with a modest cushion, provided every unit is documented and billed. Four units of 97112 in an hour of one-on-one treatment produce the $81.16 shown here. Hours with fewer units, because of late starts, documentation time or cancellations, produce less, and at this rate those gaps decide whether the line makes money.
| Service | Code | Wisconsin rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97112 | $81.16 / hour | 37 of 49 | -15.5% |
| Occupational therapy | 97533 | $80.00 / hour | 40 of 48 | -27.7% |
| Speech-language therapy | 92507 | $59.16 | 23 of 39 | -4.0% |
| PT evaluation | 97164 | $62.66 | 38 of 46 | -23.3% |
| OT evaluation | 97166 | $62.66 | 39 of 46 | -24.0% |
| Speech-language evaluation | 92521 | $103.44 | 12 of 44 | +13.3% |
The ranked OT figure is on code 97533 at $20.00 per unit, or $80.00 an hour, 40th of 48. OT practices billing code 97530 should compare that code on the state hub.
Wisconsin publishes its fee-for-service rates as ForwardHealth maximum allowable fees, in schedules grouped by service type, such as the Medical-Medical Services schedule. A maximum allowable fee is the most ForwardHealth will pay for a service; providers bill their usual charge and are paid the lesser of that charge and the maximum.
Modifiers change the rate
The modifiers matter in Wisconsin. The ranked PT figure carries TF, while 92507 and the PT and OT evaluations carry TL. A modifier is a two-character suffix that identifies a version of a service, and in Wisconsin the same code can carry different maximum fees under different modifiers. A claim without the modifier the ForwardHealth schedule expects may not price at the rates on this page.
Timed and per-visit codes
PT and OT treatment codes pay per 15-minute unit. Evaluations and 92507 pay once per visit.
The 97164 PT evaluation and the 97166 OT evaluation both pay $62.66 with the TL modifier, and both carry January 1, 2017 effective dates, the oldest on Wisconsin's therapy list. A clinic with many short episodes, and therefore many evaluations, will see its blended Medicaid revenue per visit fall below what the treatment rates alone suggest.
The speech evaluation is the exception. The 92521 evaluation pays $103.44, 12th of 44 and well above the PT and OT evaluations. A speech practice in Wisconsin is paid better for intake than for any other single therapy service on the schedule.
Speech is where Wisconsin comes closest to the national market. Code 92507 with the TL modifier pays $59.16, 23rd of 39 ranked states and only 4.0% below the median of $61.64.
Wisconsin speech-language pathologists earn a median of $39.90 an hour, well below the US median of $47.05. That makes speech the Wisconsin therapy discipline where rates and wages align best for a provider, and a reasonable Medicaid line for pediatric speech practices that can recruit and keep pathologists. A well-run speech caseload, with a strong evaluation rate and a near-median treatment rate, is the most sustainable Medicaid therapy business in the state.
Federal occupational data for May 2025 gives these Wisconsin median hourly wages, with US medians in parentheses:
- Physical therapist: $48.96 ($49.40)
- Occupational therapist: $44.42 ($48.24)
- Speech-language pathologist: $39.90 ($47.05)
- Physical therapist assistant: $30.81 ($32.88)
- Occupational therapy assistant: $28.83 ($34.76)
Every role earns below its national median, most of all speech-language pathologists and occupational therapy assistants. Lower wages soften the effect of below-median rates, which is why Wisconsin's margins stay positive despite the low ranks.
Against the hourly rates:
- Physical therapy. The PT wage is 85.7% of the $81.16 rate, leaving a margin of $11.57 an hour after a loaded wage.
- Occupational therapy. The OT wage is 78.9% of the $80.00 rate, leaving $16.87 an hour.
Both margins are thin. The most useful lever is the occupational therapy assistant wage, a median of $28.83 against $34.76 nationally. Where Wisconsin Medicaid allows assistant-delivered OT, that gap does much of the work of making the OT line viable. For PT, the physical therapist wage sits almost at the national median, so the PT line depends more on productivity than on staffing mix.
Wisconsin's rates come from Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees). Managed care runs through BadgerCare Plus HMO, which covers children, families and childless adults, and Wisconsin Medicaid SSI HMO for SSI adults.
For physical, occupational and speech therapy, Wisconsin's rule is that plans negotiate; the published rate applies out of network. The ForwardHealth schedule is the out-of-network rate and the benchmark for contracts with plans such as Anthem Blue Cross and Blue Shield, Chorus Community Health Plans, Dean Health Plan, Independent Care (iCare), MHS Health Wisconsin, Molina and Network Health Plan. The state's coverage data names 35 plans and program arrangements, including Family Care organizations.
With PT and OT rates set in 2022, an HMO contract tied to the fee schedule inherits that age. A practice with strong access or specialty capacity has grounds to ask for more, especially for OT, where the schedule ranks near the bottom. See the Wisconsin managed care page for each plan.
The Wisconsin schedule attaches no prior authorization rule to 92507, 92508, 97110, 97112 or the speech evaluation codes 92521 through 92524, and no therapy code has a published unit limit. HMO members are subject to their plan's authorization process, so a practice contracted with several HMOs should keep a plan-by-plan record of requirements.
Wisconsin delivers long-term care through Family Care, a managed long-term care program, and Family Care Partnership, which integrates acute and long-term care. Children with long-term support needs may be served through the Children's Long-Term Support (CLTS) Waiver, which uses a statewide uniform rate schedule. Therapists serving these populations should confirm whether a service is billed to the waiver or program, or to the therapy schedule on this page, since the rules and rates differ. Family Care members, for example, may have therapy coordinated through their managed care organization, which can bring its own authorization process and payment terms.
No recent ForwardHealth update has changed outpatient therapy rates. The 2025-27 state budget (2025 Wisconsin Act 15) raised home health and private duty nursing rates from January 1, 2026, and ForwardHealth Update 2025-28 announced reimbursement rate increases on the same date. Therapists who also deliver home health therapy should check whether those increases reach their codes. For clinic-based therapy, the 2022 and 2017 dates suggest the next change will need a budget item of its own.
On PT and OT, Wisconsin sits in the lower part of the national ranking. Alaska pays $176.68 an hour for 97110 and Montana $147.04, while New Jersey pays $58.80 and Maine $46.64. On speech, Washington leads at $144.10 for 92507, and Wisconsin's $59.16 sits in the middle. Neighbor Ohio is the nearest comparison in the region.
- Billing. Build TF and TL modifiers into charge templates, and set charges at or above the maximum fees.
- Contracting. Negotiate HMO contracts with the age of the 2022 and 2017 rates in mind, especially for OT.
- Benchmarking. Compare your blended Medicaid revenue per therapist hour with the $81.16 PT and $80.00 OT figures; a gap usually points to missing modifiers, charges set below the maximum fee or low units per visit.
- Service mix. Expect speech, and assistant-delivered OT, to carry more of the Medicaid margin than therapist-delivered PT.
The full dataset covers all 83,088 current Wisconsin Medicaid rates. See pricing for access.
Rates on this page are compiled from official Wisconsin Medicaid publications, chiefly the ForwardHealth maximum fee schedules, 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 and how states are ranked.