97164 Medicaid reimbursement rates by state
Physical therapy follow-up assessment. 32 state Medicaid programs publish a fee-for-service rate for 97164 at the therapist pt level. Rates run from $23.83 in Kentucky to $104.57 in Texas, with a median of $53.81.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 32
- Median rate
- $53.81units vary by state
- Highest
- $104.57Texas
- Medicare (non-facility)
- $62.36–$86.342026 physician fee schedule
97164 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) | $104.57since 2017-09-01 | — | — | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| ArkansasPhysical therapist · Arkansas Medicaid (fee-for-service) | $98.88since 2024-12-04 | — | — | Not classified | — | Arkansas Medicaid Adult Developmental Da |
| New MexicoPhysical therapist · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $97.94since 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) | $94.14since 2026-10-01 | — | — | Paid by the state, outside plans | — | Medi-Cal Rates (Rates files zip: rates_d |
| ArizonaPhysical therapist · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $70.46since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| IndianaPhysical therapist · Indiana Medicaid (fee-for-service) | $64.47since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| 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- |
| OklahomaPhysical therapist · Oklahoma SoonerCare (fee-for-service, OHCA) | $59.59since 2026-07-01 | — | — | Plans must pay at least this | — | SoonerCare Title XIX Fee Schedule |
| MissouriPhysical therapist · Missouri MO HealthNet (fee-for-service) | $59.14since 2022-07-01 | — | — | Paid by the state, outside plans | — | MO HealthNet fee schedule: First Steps |
| ColoradoPhysical therapist · Child Health Plan Plus (CHP+, Colorado's CHIP) | $58.02since 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) | $57.74since 2024-07-01 | — | — | Not classified | — | SCDHHS Physical Therapy Fee Schedule (sc |
| MississippiPhysical therapist · Mississippi Medicaid (fee-for-service) | $56.26since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| LouisianaPhysical therapist · Louisiana Medicaid (fee-for-service) | $55.42since 2025-07-01 | — | — | Plans must pay at least this | — | Louisiana Medicaid Professional Services |
| NebraskaPhysical therapist · Nebraska Medicaid (fee-for-service) | $54.68since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| OregonPhysical therapist · Oregon Health Plan (fee-for-service, OHA) | $54.67since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| 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 |
| MassachusettsPhysical therapist · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $53.23since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| KansasPhysical therapist · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $52.70since 2024-08-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| MinnesotaPhysical therapist · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $52.48since 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) | $49.61since 2017-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| MarylandPhysical therapist · Maryland Medicaid (fee-for-service, MDH) | $48.70since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| GeorgiaPhysical therapist · Georgia Medicaid (fee-for-service) | $47.14since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | Max Allow Payment_OutP Site of Service A |
| ConnecticutPhysical therapist · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $45.54since 2026-01-01 | — | — | Not classified | — | CMAP fee schedule: Independent Physical |
| North CarolinaPhysical therapist · North Carolina Medicaid Direct (fee-for-service) | $44.80since 2025-10-01 | — | — | Plans negotiate; applies out of network | — | NC Medicaid fee schedule 'Physical Thera |
| NevadaPhysical therapist · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $43.50since 2017-01-01 | — | — | Plans must pay at least this | — | Provider Type 34, Therapy Reimbursement |
| PennsylvaniaPhysical therapist · Pennsylvania Medical Assistance (fee-for-service) | $43.12since 2017-08-07 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| MichiganPhysical therapist · Michigan Medicaid (fee-for-service) | $43.03since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Physical Therapy Fee Schedule data |
| OhioPhysical therapist · Ohio Medicaid School Program (school-based services) | $42.78since 2020-06-12 | — | — | Paid by the state, outside plans | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| WashingtonPhysical therapist · Washington Apple Health (Medicaid) fee-for-service | $41.09since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Habilitative services fee schedule ( |
| AlabamaPhysical therapist · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $36.74since 2026-08-25 | — | — | Not classified | — | Physician Fee Schedule (REF-0129-Q) |
| New JerseyPhysical therapist · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $29.07since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| KentuckyPhysical therapist · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $23.83since 2026-01-01 | visit | — | Plans negotiate; applies out of network | 37% | KY Medicaid PT fee schedule (2026Physica |
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 97164?
It depends on the state. Of the 32 states with a published fee-for-service rate, the median is $53.81. Texas pays the most ($104.57) and Kentucky the least ($23.83 per visit).
Which state pays the highest Medicaid rate for 97164?
Texas, at $104.57, effective 2017-09-01.
How do Medicaid rates for 97164 compare with Medicare?
Where the billing units match, Medicaid pays between 37% and 37% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97164?
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 97164 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.