97162 Medicaid reimbursement rates by state
Physical therapy evaluation, level 2 of 3. 23 state Medicaid programs publish a fee-for-service rate for 97162 at the therapist pt level. Rates run from $10.27 in Illinois to $116.19 in Texas, with a median of $74.27.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 23
- Median rate
- $74.27units vary by state
- Highest
- $116.19Texas
- Medicare (non-facility)
- $91.50–$110.842026 physician fee schedule
97162 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) | $116.19since 2017-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| VirginiaPhysical therapist · Virginia Medicaid (fee-for-service, DMAS) | $105.84since 2026-07-01 | an evaluation | — | Plans negotiate; applies out of network | — | Outpatient Rehab Fee Schedule |
| ArizonaPhysical therapist · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $102.33since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| IndianaPhysical therapist · Indiana Medicaid (fee-for-service) | $93.69since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| NebraskaPhysical therapist · Nebraska Medicaid (fee-for-service) | $87.74since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MissouriPhysical therapist · Missouri MO HealthNet (fee-for-service) | $85.88since 2022-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Rehabilitatio |
| ColoradoPhysical therapist · Child Health Plan Plus (CHP+, Colorado's CHIP) | $83.86since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| South CarolinaPhysical therapist · South Carolina Healthy Connections Medicaid (fee-for-service) | $83.17since 2024-07-01 | — | — | Not classified | — | SCDHHS Physical Therapy Fee Schedule (sc |
| LouisianaPhysical therapist · Louisiana Medicaid (fee-for-service) | $80.33since 2025-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Professional Services |
| MassachusettsPhysical therapist · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $76.54since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| MinnesotaPhysical therapist · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $76.16since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| GeorgiaPhysical therapist · Georgia New Options Waiver (NOW) for people with IDD | $74.27since 2024-04-01 | — | — | Paid by the state, outside plans | — | New Options Waiver Program 4.1.24 (archi |
| MarylandPhysical therapist · Maryland Medicaid (fee-for-service, MDH) | $70.69since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| North CarolinaPhysical therapist · North Carolina Medicaid Direct (fee-for-service) | $66.11since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Nurse Midwives |
| WisconsinPhysical therapist · Wisconsin Children's Long-Term Support (CLTS) Waiver (fee-for-service, statewide uniform rate schedule) | $65.79since 2025-01-01 | Session | — | Paid by the state, outside plans | — | CLTS Waiver Statewide Uniform Rate Sched |
| PennsylvaniaPhysical therapist · Pennsylvania Medical Assistance (fee-for-service) | $63.61since 2021-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| OhioPhysical therapist · Ohio Medicaid School Program (school-based services) | $63.15since 2020-06-12 | — | — | Paid by the state, outside plans | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| MichiganPhysical therapist · Michigan Medicaid (fee-for-service) | $62.41since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Physical Therapy Fee Schedule data |
| WashingtonPhysical therapist · Washington Apple Health (Medicaid) fee-for-service | $59.43since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Habilitative services fee schedule ( |
| KentuckyPhysical therapist · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $59.30since 2026-01-01 | visit | — | Plans negotiate; applies out of network | 64% | KY Medicaid PT fee schedule (2026Physica |
| FloridaPhysical therapist · Florida iBudget waiver for people with developmental disabilities (APD) | $54.38since 2026-07-01 | visit | — | Paid by the state, outside plans | — | Florida Medicaid Developmental Disabilit |
| New JerseyPhysical therapist · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $42.07since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| IllinoisPhysical therapist · Illinois Medicaid (HFS fee-for-service) | $10.27since 2024-12-01 | — | — | Plans negotiate; applies out of network | — | HFS Therapy Fee Schedule (effective 2024 |
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 97162?
It depends on the state. Of the 23 states with a published fee-for-service rate, the median is $74.27. Texas pays the most ($116.19) and Illinois the least ($10.27).
Which state pays the highest Medicaid rate for 97162?
Texas, at $116.19, effective 2017-09-01.
How do Medicaid rates for 97162 compare with Medicare?
Where the billing units match, Medicaid pays between 64% and 64% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97162?
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 97162 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.