97113 Medicaid reimbursement rates by state
Other therapy services. 23 state Medicaid programs publish a fee-for-service rate for 97113 at the physician psychologist level. Rates run from $9.60 in Pennsylvania to $38.60 in Arizona, with a median of $25.49.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 23
- Median rate
- $25.49units vary by state
- Highest
- $38.60Arizona
- Medicare (non-facility)
- $34.21–$47.842026 physician fee schedule
97113 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) | $38.60since 2026-10-01 | 15 min | $154.40 | Plans negotiate; applies out of network | 106% | AHCCCS Arizona Health Care Cost Containm |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $35.12since 2026-01-01 | 15 min | $140.48 | Not classified | 90–94% | Maryland Medicaid Professional Services |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $34.77since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $32.12since 2026-07-01 | 15 min | $128.48 | 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) | $31.42since 2026-07-01 | 15 min | $125.68 | Plans negotiate; applies out of network | 82% | Child Health Plan Plus FY 2026-2027 Fee |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $31.00since 2019-09-01 | 15 min | $124.00 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $30.39since 2024-07-01 | 15 min | $121.56 | Not classified | — | SCDHHS Occupational Therapy Fee Schedule |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $28.81since 2026-02-01 | 15 min | $115.24 | Plans negotiate; applies out of network | 77% | MHCP Fee Schedule - Current Fee Schedule |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $28.29since 2026-10-01 | 15 min | $113.16 | Plans negotiate; applies out of network | 68–74% | Emergency Adoption (date filed: Septembe |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $27.86since 2022-07-01 | 15 min | $111.44 | Plans must pay at least this | 77–81% | MO HealthNet fee schedule: Practitioner |
| North CarolinaPhysician or licensed psychologist (incl. BCBA-D) · North Carolina Medicaid Direct (fee-for-service) | $27.49since 2025-10-01 | 15 min | $109.96 | Plans must pay at least this | 77% | NC Medicaid fee schedule 'Physician Serv |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $25.49since 2022-01-01 | 15 min | $101.96 | Plans negotiate; applies out of network | 71% | ForwardHealth max fee schedule: Therapy- |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $24.67since 2026-07-01 | 15 min | $98.68 | Plans negotiate; applies out of network | 70% | Nebraska Medicaid fee schedule 471-000-5 |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $23.42since 2024-04-01 | 15 min | $93.68 | Plans negotiate; applies out of network | 62–66% | HFS Practitioner Fee Schedule (effective |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $22.55since 2026-07-01 | 15 min | $90.20 | Plans negotiate; applies out of network | 53–59% | HCA Habilitative services fee schedule ( |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $22.32since 2023-07-01 | 15 min | $89.28 | Plans negotiate; applies out of network | 59–64% | Max Allow Payment_OutP Site of Service J |
| LouisianaPhysical therapist · Louisiana Children's Choice Waiver (OCDD/OIDD 1915(c) waiver for children with developmental disabilities) | $21.25since 2025-11-18 | 15 min | $85.00 | Paid by the state, outside plans | 59–61% | Children's Choice Waiver rate and proced |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $20.60since 2025-01-01 | 15 min | $82.40 | Not classified | 50–52% | NJMMIS Procedure Master Listing CPTHCPCS |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $20.33since 2026-01-01 | 15 min | $81.32 | Plans negotiate; applies out of network | 53–56% | Physical Therapy Fee Schedule (Physical |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $18.76since 2020-01-01 | 15 min | $75.04 | Plans negotiate; applies out of network | 54% | KY Medicaid Physician fee schedule (2020 |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid School Program (school-based services) | $18.11since 2020-06-12 | 15 min | $72.44 | Paid by the state, outside plans | 51% | Appendix DD to OAC 5160-1-60 (Non-Instit |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $13.93since 2026-10-01 | 15 min | $55.72 | Plans negotiate; applies out of network | 29–36% | Medi-Cal Rates (Rates files zip: rates_d |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $9.60since 1995-01-03 | 15 min | $38.40 | Plans negotiate; applies out of network | 25–27% | PA DHS PROMISe Outpatient Fee Schedule ( |
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 97113?
It depends on the state. Of the 23 states with a published fee-for-service rate, the median is $25.49. Arizona pays the most ($38.60 per 15 min) and Pennsylvania the least ($9.60 per 15 min).
Which state pays the highest Medicaid rate for 97113?
Arizona, at $38.60 per 15 min ($154.40 per hour), effective 2026-10-01.
How do Medicaid rates for 97113 compare with Medicare?
Where the billing units match, Medicaid pays between 26% and 106% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97113?
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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