97165 Medicaid reimbursement rates by state
Occupational therapy evaluation, level 1 of 3. 33 state Medicaid programs publish a fee-for-service rate for 97165 at the therapist ot level. Rates run from $18.49 in Illinois to $143.05 in New Mexico, with a median of $76.54.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 33
- Median rate
- $76.54units vary by state
- Highest
- $143.05New Mexico
- Medicare (non-facility)
- $93.50–$114.122026 physician fee schedule
97165 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 |
|---|---|---|---|---|---|---|
| New MexicoOccupational therapist · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $143.05since 2025-01-01 | — | — | Plans must pay at least this | — | New Mexico Medicaid Fee for Service CPT |
| 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 |
| VirginiaOccupational therapist · Virginia Medicaid (fee-for-service, DMAS) | $108.73since 2026-07-01 | an evaluation | — | Plans negotiate; applies out of network | — | Outpatient Rehab Fee Schedule |
| ArizonaOccupational therapist · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $100.10since 2021-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| ArkansasOccupational therapist · Arkansas Medicaid (fee-for-service) | $98.88since 2024-12-04 | — | — | Not classified | — | Arkansas Medicaid Adult Developmental Da |
| IndianaOccupational therapist · Indiana Medicaid (fee-for-service) | $96.07since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| OklahomaOccupational therapist · Oklahoma SoonerCare (fee-for-service, OHCA) | $89.18since 2026-07-01 | — | — | Plans must pay at least this | — | SoonerCare Title XIX Fee Schedule |
| NebraskaOccupational therapist · Nebraska Medicaid (fee-for-service) | $87.74since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Nebraska Medicaid fee schedule 471-000-5 |
| MissouriOccupational therapist · Missouri MO HealthNet (fee-for-service) | $86.46since 2022-07-01 | — | — | Plans negotiate; applies out of network | — | MO HealthNet fee schedule: Rehabilitatio |
| ColoradoOccupational therapist · Child Health Plan Plus (CHP+, Colorado's CHIP) | $86.13since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | Child Health Plan Plus FY 2026-2027 Fee |
| MississippiOccupational therapist · Mississippi Medicaid (fee-for-service) | $84.30since 2026-07-01 | — | — | Plans must pay at least this | — | DOM Comprehensive Fee Schedule, Septembe |
| South CarolinaOccupational therapist · South Carolina Healthy Connections Medicaid (fee-for-service) | $83.99since 2024-07-01 | — | — | Not classified | — | SCDHHS Occupational Therapy Fee Schedule |
| KansasOccupational therapist · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $81.48since 2024-08-01 | — | — | Paid by the state, outside plans | — | KMAP Fee Schedule MKN Medicaid (FeeSched |
| OregonOccupational therapist · Oregon Health Plan (fee-for-service, OHA) | $81.47since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| MinnesotaOccupational therapist · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $78.21since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | MHCP Fee Schedule - Current Fee Schedule |
| LouisianaOccupational 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 |
| MassachusettsOccupational 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 |
| IowaPhysician or licensed psychologist (incl. BCBA-D) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $71.17since 2024-01-01 | — | — | Plans must pay at least this | — | Iowa Medicaid fee schedule #02 PHYSICIAN |
| MarylandOccupational therapist · Maryland Medicaid (fee-for-service, MDH) | $68.59since 2026-01-01 | — | — | Not classified | — | Maryland Medicaid Professional Services |
| NevadaOccupational therapist · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $68.10since 2025-01-01 | — | — | Plans must pay at least this | — | Provider Type 34, Therapy Reimbursement |
| GeorgiaOccupational therapist · Georgia Medicaid (fee-for-service) | $67.21since 2023-04-01 | — | — | Plans negotiate; applies out of network | — | Max Allow Payment_OutP Site of Service A |
| North CarolinaOccupational therapist · North Carolina Medicaid Direct (fee-for-service) | $64.14since 2025-10-01 | — | — | Plans must pay at least this | — | NC Medicaid fee schedule 'Nurse Midwives |
| MichiganOccupational therapist · Michigan Medicaid (fee-for-service) | $64.11since 2026-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Occupational Therapy Fee Schedule |
| ConnecticutOccupational therapist · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $63.88since 2026-01-01 | — | — | Not classified | — | CMAP fee schedule: Physician Office and |
| WisconsinOccupational 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- |
| PennsylvaniaOccupational therapist · Pennsylvania Medical Assistance (fee-for-service) | $61.73since 2021-09-01 | — | — | Plans negotiate; applies out of network | — | PA DHS PROMISe Outpatient Fee Schedule ( |
| OhioOccupational therapist · Ohio Medicaid School Program (school-based services) | $61.31since 2020-06-12 | — | — | Paid by the state, outside plans | — | Appendix DD to OAC 5160-1-60 (Non-Instit |
| WashingtonOccupational therapist · Washington Apple Health (Medicaid) fee-for-service | $61.15since 2026-07-01 | — | — | Plans negotiate; applies out of network | — | HCA Habilitative services fee schedule ( |
| FloridaOccupational 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 |
| AlabamaOccupational therapist · Alabama Medicaid (fee-for-service, Alabama Medicaid Agency fee schedules) | $52.76since 2026-08-25 | — | — | Not classified | — | Physician Fee Schedule (REF-0129-Q) |
| New JerseyOccupational therapist · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $43.24since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| KentuckyOccupational therapist · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $35.66since 2026-01-01 | visit | — | Plans negotiate; applies out of network | 37% | KY Medicaid OT fee schedule (2026Occupat |
| IllinoisOccupational therapist · Illinois Medicaid (HFS fee-for-service) | $18.49since 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 97165?
It depends on the state. Of the 33 states with a published fee-for-service rate, the median is $76.54. New Mexico pays the most ($143.05) and Illinois the least ($18.49).
Which state pays the highest Medicaid rate for 97165?
New Mexico, at $143.05, effective 2025-01-01.
How do Medicaid rates for 97165 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 97165?
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 97165 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.