97535 Medicaid reimbursement rates by state
Training in daily living skills at home. 28 state Medicaid programs publish a fee-for-service rate for 97535 at the therapy assistant level. Rates run from $5.31 in California to $30.75 in Arizona, with a median of $21.92.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 28
- Median rate
- $21.92per 15 min
- Highest
- $30.75Arizona
- Medicare (non-facility)
- $30.04–$41.432026 physician fee schedule
97535 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 |
|---|---|---|---|---|---|---|
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $30.75since 2025-10-01 | 15 min | $123.00 | Plans negotiate; applies out of network | 97% | AHCCCS Arizona Health Care Cost Containm |
| MarylandAny qualified provider (rate does not vary by provider) · Maryland Medicaid (fee-for-service, MDH) | $28.66since 2026-01-01 | 15 min | $114.64 | Not classified | 84–88% | Maryland Medicaid Professional Services |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $28.56since 2026-07-01 | 15 min | $114.24 | Plans must pay at least this | 94% | SoonerCare Title XIX Fee Schedule |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $27.48since 2026-07-01 | 15 min | $109.92 | Plans negotiate; applies out of network | 82% | Child Health Plan Plus FY 2026-2027 Fee |
| TexasPhysician or licensed psychologist (incl. BCBA-D) · Texas Medicaid (fee-for-service, TMHP) | $27.00since 2019-09-01 | 15 min | $108.00 | Plans negotiate; applies out of network | — | TMHP Texas Medicaid Fee Schedule - Physi |
| KansasAny qualified provider (rate does not vary by provider) · MediKan (Kansas state-funded medical program, KMAP fee schedule) | $26.40since 2024-08-01 | 15 min | $105.60 | Paid by the state, outside plans | 86% | KMAP Fee Schedule MKN Medicaid (FeeSched |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $26.21since 2026-02-01 | 15 min | $104.84 | Plans negotiate; applies out of network | 76–81% | OHP FFS medical-dental fee schedule (fee |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $25.15since 2026-10-01 | 15 min | $100.60 | Plans negotiate; applies out of network | 69–75% | Emergency Adoption (date filed: Septembe |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri DD Community Support Waiver (DMH Division of DD, 1915(c)) | $25.09since 2024-10-01 | 15 min | $100.36 | Paid by the state, outside plans | — | MO HealthNet fee schedule: Community Sup |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $24.95since 2026-02-01 | 15 min | $99.80 | Plans negotiate; applies out of network | 76% | MHCP Fee Schedule - Current Fee Schedule |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $24.62since 2025-10-01 | 15 min | $98.48 | Paid by the state, outside plans | 79% | NC Medicaid fee schedule 'Children Devel |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $24.24since 2026-01-01 | 15 min | $96.96 | Not classified | 71% | CMAP fee schedule: Independent Physical |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid School Program (school-based services) | $23.50since 2020-06-12 | 15 min | $94.00 | Paid by the state, outside plans | 76% | Appendix DD to OAC 5160-1-60 (Non-Instit |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $22.80since 2011-07-11 | 15 min | $91.20 | Not classified | 73% | SCDHHS Base Physician Fee Schedule (sche |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $21.03since 2022-01-01 | 15 min | $84.12 | Plans negotiate; applies out of network | 67% | ForwardHealth max fee schedule: Therapy- |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $20.92since 2024-04-01 | 15 min | $83.68 | Plans negotiate; applies out of network | 63–67% | HFS Practitioner Fee Schedule (effective |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $20.91since 2017-01-01 | 15 min | $83.64 | Plans negotiate; applies out of network | 64–68% | Physician Maximum Allowed Fee Schedule - |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $20.66since 2026-01-01 | 15 min | $82.64 | Plans negotiate; applies out of network | 65–67% | MDHHS Occupational Therapy Fee Schedule |
| IowaAny qualified provider (rate does not vary by provider) · Iowa Medicaid (fee-for-service schedules; the floor IA Health Link plans must pay) | $19.80since 2013-07-01 | 15 min | $79.20 | Plans must pay at least this | 64% | Iowa Medicaid fee schedule #50 NURSE PRA |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $19.68since 2026-07-01 | 15 min | $78.72 | Plans negotiate; applies out of network | 53–59% | HCA Habilitative services fee schedule ( |
| VirginiaAny qualified provider (rate does not vary by provider) · Virginia Medicaid (fee-for-service, DMAS) | $17.71since 2015-07-01 | 15 min | $70.84 | Paid by the state, outside plans | 55% | DMAS procedure fee file cptmedical4.csv |
| AlabamaOccupational therapist · Alabama Community Waiver Program (1115 demonstration with 1915(c)/1915(i) services; ADMH-DDD) | $14.30since 2020-12-17 | 15 min | — | Not classified | 47% | ADMH Community Waiver Program Rate Sheet |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $11.43since 2026-01-01 | 15 min | $45.72 | Plans negotiate; applies out of network | 38% | KY Medicaid OT fee schedule (2026Occupat |
| LouisianaAny qualified provider (rate does not vary by provider) · Louisiana Medicaid (fee-for-service) | $10.07since 2022-05-01 | 15 min | $40.28 | Plans must pay at least this | 32–33% | Louisiana Medicaid EPSDT Health Services |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Traumatic Brain Injury (TBI) Waiver | $9.45since 2023-07-01 | 15 min | $37.80 | Paid by the state, outside plans | — | IHCP Professional Fee Schedule (Last Upd |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $8.87since 2025-01-01 | 15 min | $35.48 | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
| FloridaAny qualified provider (rate does not vary by provider) · Florida iBudget waiver for people with developmental disabilities (APD) | $6.71since 2026-07-01 | 15 min | $26.84 | Paid by the state, outside plans | — | Florida Medicaid Developmental Disabilit |
| CaliforniaAny qualified provider (rate does not vary by provider) · California Medi-Cal school-based services (Local Educational Agency) | $5.31since 2026-10-01 | 15 min | $21.24 | Paid by the state, outside plans | 13–16% | Medi-Cal Rates (Rates files zip: rates_d |
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 97535?
It depends on the state. Of the 28 states with a published fee-for-service rate, the median is $21.92 per 15 min. Arizona pays the most ($30.75 per 15 min) and California the least ($5.31 per 15 min).
Which state pays the highest Medicaid rate for 97535?
Arizona, at $30.75 per 15 min ($123.00 per hour), effective 2025-10-01.
How do Medicaid rates for 97535 compare with Medicare?
Where the billing units match, Medicaid pays between 15% and 97% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97535?
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 97535 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.