97116 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 26 state Medicaid programs publish a fee-for-service rate for 97116 at the therapy assistant level. Rates run from $8.38 in Pennsylvania to $27.54 in Indiana, with a median of $19.31.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 26
- Median rate
- $19.31units vary by state
- Highest
- $27.54Indiana
- Medicare (non-facility)
- $27.16–$36.612026 physician fee schedule
97116 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 |
|---|---|---|---|---|---|---|
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $27.54since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $27.41since 2026-10-01 | 15 min | $109.64 | Plans negotiate; applies out of network | 96% | AHCCCS Arizona Health Care Cost Containm |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $25.17since 2026-07-01 | 15 min | $100.68 | Plans negotiate; applies out of network | 88% | DMAS procedure fee file cptmedical4.csv |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $24.98since 2019-09-01 | 15 min | $99.92 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $24.65since 2026-07-01 | 15 min | $98.60 | Plans negotiate; applies out of network | 82% | Child Health Plan Plus FY 2026-2027 Fee |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $24.65since 2022-07-01 | 15 min | $98.60 | Plans must pay at least this | 87–91% | MO HealthNet fee schedule: Podiatry |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $23.49since 2026-02-01 | 15 min | $93.96 | Plans negotiate; applies out of network | 76–81% | OHP FFS medical-dental fee schedule (fee |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $23.48since 2025-07-01 | 15 min | $93.92 | Plans must pay at least this | 83–85% | Louisiana Medicaid Professional Services |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $23.45since 2026-01-01 | 15 min | $93.80 | Not classified | 77–80% | Maryland Medicaid Professional Services |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $22.47since 2026-10-01 | 15 min | $89.88 | Plans negotiate; applies out of network | 70–75% | Emergency Adoption (date filed: Septembe |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $22.38since 2026-02-01 | 15 min | $89.52 | Plans negotiate; applies out of network | 77% | MHCP Fee Schedule - Current Fee Schedule |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $20.05since 2025-10-01 | 15 min | $80.20 | Plans negotiate; applies out of network | 72% | NC Medicaid fee schedule 'Occupational T |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $19.66since 2026-01-01 | 15 min | $78.64 | Not classified | 65% | CMAP fee schedule: Independent Physical |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $18.96since 2011-07-11 | 15 min | $75.84 | Not classified | 68% | SCDHHS Base Physician Fee Schedule (sche |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $18.89since 2024-04-01 | 15 min | $75.56 | Plans negotiate; applies out of network | 63–67% | HFS Practitioner Fee Schedule (effective |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $18.85since 2023-07-01 | 15 min | $75.40 | Plans negotiate; applies out of network | 64–68% | Max Allow Payment_OutP Site of Service J |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $18.53since 2026-01-01 | 15 min | $74.12 | Plans negotiate; applies out of network | 64–66% | MDHHS Occupational Therapy Fee Schedule |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $18.28since 2026-07-01 | 15 min | $73.12 | Plans negotiate; applies out of network | 66% | Nebraska Medicaid fee schedule 471-000-5 |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $17.58since 2026-07-01 | 15 min | $70.32 | Plans negotiate; applies out of network | 53–59% | HCA Habilitative services fee schedule ( |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $17.29since 2022-01-01 | 15 min | $69.16 | Plans negotiate; applies out of network | 61% | ForwardHealth max fee schedule: Therapy- |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $17.29since 2020-05-01 | 15 min | $69.16 | Plans must pay at least this | 62% | Iowa Medicaid fee schedule #50 NURSE PRA |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid School Program (school-based services) | $16.43since 2020-06-12 | 15 min | $65.72 | Paid by the state, outside plans | 59% | Appendix DD to OAC 5160-1-60 (Non-Instit |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $14.70since 2026-07-01 | 15 min | $58.80 | Not classified | 46–47% | NJMMIS Procedure Master Listing CPTHCPCS |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal (fee-for-service) | $11.28since 2026-10-01 | 15 min | $45.12 | Plans negotiate; applies out of network | 31–37% | Medi-Cal Rates (Rates files zip: rates_d |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $10.32since 2026-01-01 | 15 min | $41.28 | Plans negotiate; applies out of network | 38% | KY Medicaid OT fee schedule (2026Occupat |
| PennsylvaniaAny qualified provider (rate does not vary by provider) · Pennsylvania Medical Assistance (fee-for-service) | $8.38since 2021-09-01 | 15 min | $33.52 | Plans negotiate; applies out of network | 28–30% | 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 97116?
It depends on the state. Of the 26 states with a published fee-for-service rate, the median is $19.31. Indiana pays the most ($27.54 per unit) and Pennsylvania the least ($8.38 per 15 min).
Which state pays the highest Medicaid rate for 97116?
Indiana, at $27.54 per unit, effective 2026-01-01.
How do Medicaid rates for 97116 compare with Medicare?
Where the billing units match, Medicaid pays between 29% and 96% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97116?
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 97116 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.