97035 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 33 state Medicaid programs publish a fee-for-service rate for 97035 at the therapy assistant level. Rates run from $7.43 in California to $27.82 in Texas, with a median of $10.80.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 33
- Median rate
- $10.80units vary by state
- Highest
- $27.82Texas
- Medicare (non-facility)
- $13.21–$18.082026 physician fee schedule
97035 rate in every state
One like-for-like fee-for-service rate per state, highest first. Units can differ between states; the per-hour column converts time-based units.
| State | Medicaid rate | Unit | Per hour | Managed-care plans | % of Medicare | Source |
|---|---|---|---|---|---|---|
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $27.82since 2019-09-01 | 15 min | $111.28 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| LouisianaOccupational therapist · Louisiana Residential Options Waiver (ROW, OCDD/OIDD 1915(c) waiver) | $23.00since 2025-11-18 | 15 min | $92.00 | Paid by the state, outside plans | — | Residential Options Waiver rate and proc |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $21.93since 2026-07-01 | 15 min | $87.72 | Plans negotiate; applies out of network | 161% | Nebraska Medicaid fee schedule 471-000-5 |
| New MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $19.81since 2025-01-01 | 15 min | $79.24 | Plans must pay at least this | 143% | New Mexico Medicaid Fee for Service CPT |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $18.17since 2026-07-01 | 15 min | $72.68 | Not classified | 127% | Montana Healthcare Programs fee schedule |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $13.38since 2026-10-01 | 15 min | $53.52 | Plans negotiate; applies out of network | 95% | AHCCCS Arizona Health Care Cost Containm |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $13.21since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $12.76since 2022-01-01 | 15 min | $51.04 | Plans negotiate; applies out of network | 92% | ForwardHealth max fee schedule: Therapy- |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $12.44since 2026-07-01 | 15 min | $49.76 | Plans negotiate; applies out of network | 88% | DMAS procedure fee file cptmedical4.csv |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $11.97since 2026-07-01 | 15 min | $47.88 | Plans must pay at least this | 90% | DOM Comprehensive Fee Schedule, Septembe |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $11.89since 2026-07-01 | 15 min | $47.56 | Plans negotiate; applies out of network | 80% | Child Health Plan Plus FY 2026-2027 Fee |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $11.78since 2026-07-01 | 15 min | $47.12 | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $11.38since 2026-01-01 | 15 min | $45.52 | Not classified | 76–79% | Maryland Medicaid Professional Services |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $11.23since 2020-03-01 | 15 min | $44.92 | Paid by the state, outside plans | — | Provider Type 60 School Based (rate data |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $10.97since 2026-10-01 | 15 min | $43.88 | Plans negotiate; applies out of network | 69–74% | Emergency Adoption (date filed: Septembe |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $10.86since 2024-07-01 | 15 min | $43.44 | Plans must pay at least this | 80% | Iowa Medicaid fee schedule #38 CERTIFIED |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $10.80since 2026-02-01 | 15 min | $43.20 | Plans negotiate; applies out of network | 75% | MHCP Fee Schedule - Current Fee Schedule |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $10.75since 2022-07-01 | 15 min | $43.00 | Plans must pay at least this | 77–80% | MO HealthNet fee schedule: Podiatry |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $10.45since 1995-01-02 | 15 min | $41.80 | Plans negotiate; applies out of network | 70–76% | PA DHS PROMISe Outpatient Fee Schedule ( |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $10.42since 2024-01-01 | 15 min | $41.68 | Plans negotiate; applies out of network | 76% | Appendix DD to OAC 5160-1-60 (Non-Instit |
| ArkansasAny qualified provider (rate does not vary by provider) · Arkansas Medicaid (fee-for-service) | $10.33since 2025-05-15 | 15 min | $41.32 | Not classified | 78% | Arkansas Medicaid Dental Fee Schedule (R |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $9.90since 2026-01-01 | 15 min | $39.60 | Not classified | 70–72% | MaineCare Fee Schedule (MaineCare UCR, H |
| West VirginiaAny qualified provider (rate does not vary by provider) · West Virginia Medicaid (fee-for-service, Bureau for Medical Services) | $9.76since 2026-04-01 | 15 min | $39.04 | Plans negotiate; applies out of network | 72% | BMS RBRVS 2026 Effective 4/1/26 - 3/31/2 |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $9.45since 2024-08-01 | 15 min | $37.80 | Paid by the state, outside plans | 70% | KMAP Fee Schedule MKN Medicaid (FeeSched |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $9.41since 2024-04-01 | 15 min | $37.64 | Plans negotiate; applies out of network | 65–69% | Max Allow Payment_OutP Site of Service A |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $9.34since 2025-10-01 | 15 min | $37.36 | Plans must pay at least this | 68% | NC Medicaid fee schedule 'Nurse Practiti |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $9.16since 2025-01-01 | 15 min | $36.64 | Plans negotiate; applies out of network | 64–66% | MDHHS Occupational Therapy Fee Schedule |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $9.09since 2026-01-01 | 15 min | $36.36 | Not classified | 60% | CMAP fee schedule: Independent Physical |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $9.06since 2024-04-01 | 15 min | $36.24 | Plans negotiate; applies out of network | 61–65% | HFS Practitioner Fee Schedule (effective |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $8.64since 2026-01-01 | 15 min | $34.56 | Plans negotiate; applies out of network | 64% | KY Medicaid OT fee schedule (2026Occupat |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $8.60since 2026-07-01 | 15 min | $34.40 | Plans negotiate; applies out of network | 53–58% | HCA Habilitative services fee schedule ( |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $7.89since 2025-01-01 | 15 min | $31.56 | Not classified | 49–52% | NJMMIS Procedure Master Listing CPTHCPCS |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $7.43since 2026-10-01 | 15 min | $29.72 | Plans negotiate; applies out of network | 41–50% | Medi-Cal Rates (Rates files zip: rates_d |
Rates are per the unit shown for each state; units can differ between states. Medicare amounts are computed from the CMS relative value file and locality cost indices with the CMS formula; states with several Medicare localities show a range. Confirm rates with the payer before billing.
Frequently asked questions
What does Medicaid pay for 97035?
It depends on the state. Of the 33 states with a published fee-for-service rate, the median is $10.80. Texas pays the most ($27.82 per 15 min) and California the least ($7.43 per 15 min).
Which state pays the highest Medicaid rate for 97035?
Texas, at $27.82 per 15 min ($111.28 per hour), effective 2019-09-01.
How do Medicaid rates for 97035 compare with Medicare?
Where the billing units match, Medicaid pays between 46% and 161% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97035?
Not necessarily. Each state's plan contracts decide whether plans must pay at least the fee-for-service rate, pay a state-set rate, or negotiate their own. The table shows the rule for each state, cited to the contract or statute.
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Track 97035 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.