97163 Medicaid reimbursement rates by state
Physical therapy evaluation, level 3 of 3. 47 state Medicaid programs publish a fee-for-service rate for 97163 at the therapist pt level. Rates run from $10.27 in Illinois to $197.76 in Arkansas, with a median of $79.56.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 47
- Median rate
- $79.56units vary by state
- Highest
- $197.76Arkansas
- Medicare (non-facility)
- $91.20–$126.432026 physician fee schedule
97163 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 |
|---|---|---|---|---|---|---|
| ArkansasPhysical therapist · Arkansas Medicaid (fee-for-service) | $197.76since 2024-12-04 | — | — | Not classified | — | Arkansas Medicaid Adult Developmental Da |
| AlaskaRegistered nurse (RN) · Alaska Medicaid (fee-for-service, Department of Health) | $149.65since 2026-07-01 | — | — | Not classified | — | Alaska Medicaid APRN Fee Schedule SFY202 |
| New MexicoPhysical therapist · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $141.72since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| CaliforniaPhysical therapist · California Medi-Cal school-based services (Local Educational Agency) | $135.56since 2026-10-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Rates (Rates files zip: rates_d |
| 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 |
| Rhode IslandPhysical therapist · Rhode Island Medicaid (fee-for-service) | $105.04since 2024-10-01 | — | — | Plans negotiate; applies out of network | — | RI Medicaid Interactive Fee For Service |
| HawaiiPhysical therapist · Hawaii Medicaid (Med-QUEST) fee-for-service | $104.43since 2026-06-01 | — | — | Plans negotiate; applies out of network | — | Medicaid Fee-For-Service (FFS) Fee Sched |
| 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 |
| DelawarePhysical therapist · Delaware Medicaid (fee-for-service, DMMA / DMAP) | $95.90since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | DMAP 2026 Physician Fee Schedule |
| South DakotaPhysical therapist · South Dakota Medicaid (fee-for-service, DSS Division of Medical Services) | $94.23since 2026-07-01 | — | — | Not classified | — | South Dakota Medicaid Physician fee sche |
| 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 |
| UtahPhysical therapist · Utah Medicaid (fee-for-service, Traditional plan) | $90.07since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Utah Medicaid Coverage and Reimbursement |
| WyomingPhysical therapist · Wyoming Medicaid (fee-for-service, Department of Health) | $87.91since 2026-07-01 | — | — | Not classified | — | Wyoming Medicaid Downloadable Fee Schedu |
| 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 |
| OklahomaPhysical therapist · Oklahoma SoonerCare (fee-for-service, OHCA) | $86.94since 2026-07-01 | — | — | Plans must pay at least this | — | SoonerCare Title XIX Fee Schedule |
| MissouriPhysical therapist · Missouri MO HealthNet (fee-for-service) | $85.88since 2022-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Rehabilitatio |
| MontanaPhysical therapist · Montana Medicaid and HMK Plus (fee-for-service) | $84.24since 2026-07-01 | — | — | Not classified | — | Montana Healthcare Programs fee schedule |
| 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 |
| VermontPhysical therapist · Vermont Medicaid (fee-for-service, DVHA) | $83.02since 2026-01-01 | — | — | Not classified | — | Vermont Medicaid Fee Schedule - CPT Code |
| MississippiPhysical therapist · Mississippi Medicaid (fee-for-service) | $82.23since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| IdahoPhysical therapist · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $81.22since 2026-07-01 | — | — | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| OregonPhysical therapist · Oregon Health Plan (fee-for-service, OHA) | $79.56since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| LouisianaPhysical therapist · Louisiana Community Choices Waiver (OAAS 1915(c) waiver for older adults and adults with disabilities) | $77.50since 2024-01-01 | per service | — | Paid by the state, outside plans | — | Community Choices Waiver services proced |
| KansasPhysical therapist · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $76.93since 2024-08-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| 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 |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $73.33since 2017-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| MarylandPhysical therapist · Maryland Medicaid (fee-for-service, MDH) | $70.69since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| GeorgiaPhysical therapist · Georgia Medicaid (fee-for-service) | $69.34since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | Max Allow Payment_OutP Site of Service A |
| MainePhysical therapist · MaineCare (fee-for-service) | $68.09since 2026-01-01 | — | — | Not classified | — | MaineCare Fee Schedule (MaineCare UCR, H |
| West VirginiaPhysical therapist · West Virginia Medicaid School-Based Health Services (SBHS) | $66.37since 2026-04-01 | — | — | Paid by the state, outside plans | — | School Based Health Services (SBHS) - Di |
| 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 |
| NevadaPhysical therapist · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $63.91since 2017-01-01 | — | — | Plans must pay at least this | — | Provider Type 34, Therapy Reimbursement |
| 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 |
| WisconsinPhysical therapist · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $62.66since 2017-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Therapy- |
| MichiganPhysical therapist · Michigan Medicaid (fee-for-service) | $62.41since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Physical Therapy Fee Schedule data |
| ConnecticutPhysical therapist · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $62.18since 2026-01-01 | — | — | Not classified | — | CMAP fee schedule: Physician Office and |
| 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 ( |
| 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 |
| AlabamaPhysical therapist · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $54.35since 2026-08-25 | — | — | Not classified | — | Physician Fee Schedule (REF-0129-Q) |
| New HampshirePhysical therapist · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $52.12since 2023-07-01 | — | — | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| New JerseyPhysical therapist · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $42.07since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| KentuckyPhysical therapist · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $34.88since 2026-01-01 | visit | — | Plans negotiate; applies out of network | 38% | KY Medicaid PT fee schedule (2026Physica |
| 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 97163?
It depends on the state. Of the 47 states with a published fee-for-service rate, the median is $79.56. Arkansas pays the most ($197.76) and Illinois the least ($10.27).
Which state pays the highest Medicaid rate for 97163?
Arkansas, at $197.76, effective 2024-12-04.
How do Medicaid rates for 97163 compare with Medicare?
Where the billing units match, Medicaid pays between 38% and 38% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97163?
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 97163 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.