97530 Medicaid reimbursement rates by state
Functional activity training. 22 state Medicaid programs publish a fee-for-service rate for 97530 at the therapist ot level. Rates run from $11.14 in California to $3,510.00 in New Jersey, with a median of $27.35.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 22
- Median rate
- $27.35units vary by state
- Highest
- $3,510.00New Jersey
- Medicare (non-facility)
- $32.30–$45.392026 physician fee schedule
97530 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 JerseyOccupational therapist · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $3,510.00⚠ over 3× mediansince 2025-12-01 | 15 min | $14,040.00 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| VirginiaOccupational therapist · Virginia Medicaid (fee-for-service, DMAS) | $37.93since 2026-07-01 | 15 min | $151.72 | Plans negotiate; applies out of network | 110% | Outpatient Rehab Fee Schedule |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $33.75since 2017-09-01 | 15 min | $135.00 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| IndianaOccupational therapist · Indiana Medicaid (fee-for-service) | $32.88since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $32.82since 2026-10-01 | 15 min | $131.28 | Plans negotiate; applies out of network | 95% | AHCCCS Arizona Health Care Cost Containm |
| MarylandOccupational therapist · Maryland Medicaid (fee-for-service, MDH) | $31.76since 2026-01-01 | 15 min | $127.04 | Not classified | 86–90% | Maryland Medicaid Professional Services |
| MissouriOccupational therapist · Missouri MO HealthNet (fee-for-service) | $31.09since 2022-07-01 | 15 min | $124.36 | Plans must pay at least this | 91–96% | MO HealthNet fee schedule: Podiatry |
| GeorgiaOccupational therapist · Georgia New Options Waiver (NOW) for people with IDD | $30.23since 2024-04-01 | 15 min | $120.92 | Paid by the state, outside plans | — | New Options Waiver Program 4.1.24 (archi |
| ColoradoOccupational therapist · Child Health Plan Plus (CHP+, Colorado's CHIP) | $29.76since 2026-07-01 | 15 min | $119.04 | Plans negotiate; applies out of network | 82% | Child Health Plan Plus FY 2026-2027 Fee |
| MassachusettsOccupational therapist · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $28.65since 2026-10-01 | 15 min | $114.60 | Plans negotiate; applies out of network | 72–79% | Emergency Adoption (date filed: Septembe |
| NebraskaOccupational therapist · Nebraska Medicaid (fee-for-service) | $27.42since 2026-07-01 | 15 min | $109.68 | Plans negotiate; applies out of network | 82% | Nebraska Medicaid fee schedule 471-000-5 |
| MinnesotaOccupational therapist · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $27.27since 2026-02-01 | 15 min | $109.08 | Plans negotiate; applies out of network | 77% | MHCP Fee Schedule - Current Fee Schedule |
| North CarolinaOccupational therapist · North Carolina Medicaid Direct (fee-for-service) | $24.10since 2025-10-01 | 15 min | $96.40 | Plans negotiate; applies out of network | 72% | NC Medicaid fee schedule 'Occupational T |
| IllinoisOccupational therapist · Illinois Medicaid (HFS fee-for-service) | $23.34since 2024-04-01 | 15 min | $93.36 | Plans negotiate; applies out of network | 65–70% | HFS Practitioner Fee Schedule (effective |
| MichiganOccupational therapist · Michigan Medicaid (fee-for-service) | $22.37since 2026-01-01 | 15 min | $89.48 | Plans negotiate; applies out of network | 65–67% | MDHHS Occupational Therapy Fee Schedule |
| WisconsinOccupational therapist · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $21.64since 2022-01-01 | 15 min | $86.56 | Plans negotiate; applies out of network | 64% | ForwardHealth max fee schedule: Therapy- |
| WashingtonOccupational therapist · Washington Apple Health (Medicaid) fee-for-service | $21.40since 2026-07-01 | 15 min | $85.60 | Plans negotiate; applies out of network | 53–59% | HCA Habilitative services fee schedule ( |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $18.05since 2023-10-01 | 15 min | $72.20 | Plans negotiate; applies out of network | 45–53% | eMedNY Rehabilitation Services (PT/OT/SL |
| FloridaOccupational therapist · Florida iBudget waiver for people with developmental disabilities (APD) | $17.96since 2026-07-01 | 15 min | $71.84 | Paid by the state, outside plans | — | Florida Medicaid Developmental Disabilit |
| OhioOccupational therapist · Ohio Medicaid School Program (school-based services) | $17.75since 2020-06-12 | 15 min | $71.00 | Paid by the state, outside plans | 53% | Appendix DD to OAC 5160-1-60 (Non-Instit |
| PennsylvaniaOccupational therapist · Pennsylvania Medical Assistance (fee-for-service) | $13.00since 2021-09-01 | 15 min | $52.00 | Plans negotiate; applies out of network | 36–39% | PA DHS PROMISe Outpatient Fee Schedule ( |
| CaliforniaOccupational therapist · California Medi-Cal (fee-for-service) | $11.14since 2026-10-01 | 15 min | $44.56 | Plans negotiate; applies out of network | 25–30% | Medi-Cal Rates (Rates files zip: rates_d |
Rates marked ⚠ are more than three times the median for the same unit; they are published as shown but often reflect an office (non-facility) fee or a different scope of service. 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 97530?
It depends on the state. Of the 22 states with a published fee-for-service rate, the median is $27.35. New Jersey pays the most ($3,510.00 per 15 min) and California the least ($11.14 per 15 min).
Which state pays the highest Medicaid rate for 97530?
New Jersey, at $3,510.00 per 15 min ($14,040.00 per hour), effective 2025-12-01.
How do Medicaid rates for 97530 compare with Medicare?
Where the billing units match, Medicaid pays between 28% and 110% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97530?
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.