97130 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. A like-for-like rank only counts states that use the same unit: 37 of the 38 states publish 97130 per 15 min, enough to rank them against each other.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 28 of the 38 states list more than one rate for 97130, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 38 states, 37 publish 97130 per 15 min and 1 per unit.
• Per hour. Time-based units are converted to an hour of service (four 15-minute units make an hour). 36 of the 38 states bill 97130 by time, with a median of $74.06 per hour.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. Shown only where the Medicaid rate uses the code's own billing unit and a Medicare amount exists: 36 states for 97130, at between 33% and 149%.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 97130 run from $6.75 in Louisiana to $40.92 in Alaska, a 6.1x gap in the same unit. Half the states pay more than the median of $18.52 and half pay less. The usual reasons for a spread like this in therapy (PT/OT/speech) rates:

• Visit limits, prior authorization and annual caps vary by state and change how much a single code is worth to a practice.
• States pay therapy by CPT code, but many pay therapy assistants a reduced percentage and some pay differently in outpatient hospital, private practice and home settings.
• Children's therapy is driven by the EPSDT benefit, so some states maintain separate pediatric rates or programs.

Timing matters too. 26 states set the current rate for 97130 in 2026 or later, while 8 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

What a plan pays for 97130 is negotiated privately, but the state decides how much room there is to negotiate. Here is how the rules break down across the 38 states.

In 7 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 19 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 12 states is not classified yet.

• Plans negotiate; the published rate applies out of network (19 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (7 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example Alaska managed care.

97130 is a CPT medicine code in the therapy (PT/OT/speech) line, billed mostly by physical, occupational and speech therapists and therapy practices. The medicine section runs from vaccines and psychiatry to dialysis, cardiology and therapy. Some of its codes are timed in 15-minute units, others are billed once per session or per test, so the unit matters more here than in most sections.

Many treatment codes are timed in 15-minute units, while evaluations and re-evaluations are billed once per session. Medicare applies a rule for counting timed minutes into units; Medicaid programs may follow it or set their own, so check the state's therapy manual.

Medicare's 2026 physician fee schedule pays $20.35–$29.38 for 97130 (non-facility), depending on the Medicare locality. That is a useful reference point, but Medicare and Medicaid can define the unit differently, so compare only where the units match.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.