97036 Medicaid reimbursement rates by state
Other therapy services. 21 state Medicaid programs publish a fee-for-service rate for 97036 at the physician psychologist level. Rates run from $11.14 in California to $36.12 in Arizona, with a median of $23.56.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 21
- Median rate
- $23.56units vary by state
- Highest
- $36.12Arizona
- Medicare (non-facility)
- $31.27–$46.682026 physician fee schedule
97036 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 |
|---|---|---|---|---|---|---|
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $36.12since 2026-10-01 | 15 min | $144.48 | Plans negotiate; applies out of network | 107% | AHCCCS Arizona Health Care Cost Containm |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $32.18since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $30.15since 2026-07-01 | 15 min | $120.60 | Plans negotiate; applies out of network | 92% | Nebraska Medicaid fee schedule 471-000-5 |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $30.09since 2026-07-01 | 15 min | $120.36 | Plans negotiate; applies out of network | 88% | DMAS procedure fee file cptmedical4.csv |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $29.67since 2026-07-01 | 15 min | $118.68 | Plans negotiate; applies out of network | 82% | Child Health Plan Plus FY 2026-2027 Fee |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $27.41since 2026-01-01 | 15 min | $109.64 | Not classified | 75–78% | Maryland Medicaid Professional Services |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $27.14since 2026-10-01 | 15 min | $108.56 | Plans negotiate; applies out of network | 68–75% | Emergency Adoption (date filed: Septembe |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $27.01since 2026-02-01 | 15 min | $108.04 | Plans negotiate; applies out of network | 77% | MHCP Fee Schedule - Current Fee Schedule |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $27.00since 2019-09-01 | 15 min | $108.00 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $25.74since 2022-07-01 | 15 min | $102.96 | Plans must pay at least this | 77–82% | MO HealthNet fee schedule: Podiatry |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $23.56since 2022-01-01 | 15 min | $94.24 | Plans negotiate; applies out of network | 70% | ForwardHealth max fee schedule: Therapy- |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $22.15since 2026-01-01 | 15 min | $88.60 | Plans negotiate; applies out of network | 65–68% | MDHHS Occupational Therapy Fee Schedule |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $22.01since 2024-04-01 | 15 min | $88.04 | Plans negotiate; applies out of network | 62–67% | HFS Practitioner Fee Schedule (effective |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $21.40since 2026-07-01 | 15 min | $85.60 | Plans negotiate; applies out of network | 52–59% | HCA Habilitative services fee schedule ( |
| North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service) | $20.14since 2025-10-01 | 15 min | $80.56 | Plans must pay at least this | 61% | NC Medicaid fee schedule 'Physician Serv |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $19.41since 2025-01-01 | 15 min | $77.64 | Not classified | 49–52% | NJMMIS Procedure Master Listing CPTHCPCS |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $19.29since 1995-01-02 | 15 min | $77.16 | Plans negotiate; applies out of network | 54–59% | PA DHS PROMISe Outpatient Fee Schedule ( |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $17.27since 2020-01-01 | 15 min | $69.08 | Plans negotiate; applies out of network | 54% | KY Medicaid Physician fee schedule (2020 |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $16.12since 2024-01-01 | 15 min | $64.48 | Plans negotiate; applies out of network | 50% | Appendix DD to OAC 5160-1-60 (Non-Instit |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $13.50since 2017-01-01 | 15 min | $54.00 | Plans negotiate; applies out of network | 38–42% | OutPatient Max Allowed Site of Service F |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $11.14since 2026-10-01 | 15 min | $44.56 | Plans negotiate; applies out of network | 24–30% | 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 97036?
It depends on the state. Of the 21 states with a published fee-for-service rate, the median is $23.56. Arizona pays the most ($36.12 per 15 min) and California the least ($11.14 per 15 min).
Which state pays the highest Medicaid rate for 97036?
Arizona, at $36.12 per 15 min ($144.48 per hour), effective 2026-10-01.
How do Medicaid rates for 97036 compare with Medicare?
Where the billing units match, Medicaid pays between 27% and 107% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97036?
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 97036 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.