97542 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 34 state Medicaid programs publish a fee-for-service rate for 97542 at the therapy assistant level. Rates run from $6.22 in Kansas to $44.67 in New Mexico, with a median of $24.10.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 34
- Median rate
- $24.10units vary by state
- Highest
- $44.67New Mexico
- Medicare (non-facility)
- $28.93–$35.152026 physician fee schedule
97542 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 MexicoAny qualified provider (rate does not vary by provider) · New Mexico Medicaid (fee-for-service, HCA Medical Assistance Division) | $44.67since 2025-01-01 | 15 min | $178.68 | Plans must pay at least this | 149% | New Mexico Medicaid Fee for Service CPT |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $44.58since 2026-01-01 | 15 min | $178.32 | Plans negotiate; applies out of network | 127–147% | eMedNY Rehabilitation Services (PT/OT/SL |
| NebraskaAny qualified provider (rate does not vary by provider) · Nebraska Medicaid (fee-for-service) | $41.12since 2026-07-01 | 15 min | $164.48 | Plans negotiate; applies out of network | 138% | Nebraska Medicaid fee schedule 471-000-5 |
| New HampshireAny qualified provider (rate does not vary by provider) · New Hampshire Medicaid (fee-for-service, DHHS / NH MMIS) | $37.16since 2021-01-01 | 15 min | $148.64 | Plans negotiate; applies out of network | — | 2026 Fee Schedule - Covered Procedures R |
| FloridaAny qualified provider (rate does not vary by provider) · Florida Medicaid (fee-for-service) | $36.38since 2026-01-01 | 15 min | $145.52 | Plans negotiate; applies out of network | — | Occupational Therapy Services Fee Schedu |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $29.49since 2025-10-01 | 15 min | $117.96 | Plans negotiate; applies out of network | 96% | AHCCCS Arizona Health Care Cost Containm |
| IndianaAny qualified provider (rate does not vary by provider) · Indiana Medicaid (fee-for-service) | $29.40since 2026-01-01 | unit | — | Plans must pay at least this | — | IHCP Professional Fee Schedule (Last Upd |
| OklahomaAny qualified provider (rate does not vary by provider) · Oklahoma SoonerCare (fee-for-service, OHCA) | $27.54since 2026-07-01 | 15 min | $110.16 | Plans must pay at least this | 94% | SoonerCare Title XIX Fee Schedule |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $27.28since 2022-07-01 | 15 min | $109.12 | Paid by the state, outside plans | — | MO HealthNet fee schedule: First Steps |
| 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 |
| VermontAny qualified provider (rate does not vary by provider) · Vermont Medicaid (fee-for-service, DVHA) | $26.45since 2026-01-01 | 15 min | $105.80 | Not classified | 86% | Vermont Medicaid Fee Schedule - CPT Code |
| ColoradoAny qualified provider (rate does not vary by provider) · Child Health Plan Plus (CHP+, Colorado's CHIP) | $26.31since 2026-07-01 | 15 min | $105.24 | Plans negotiate; applies out of network | 82% | Child Health Plan Plus FY 2026-2027 Fee |
| NevadaAny qualified provider (rate does not vary by provider) · Nevada Medicaid (fee-for-service provider-type reimbursement schedules) | $26.28since 2020-03-01 | 15 min | $105.12 | Paid by the state, outside plans | — | Provider Type 60 School Based (rate data |
| MississippiAny qualified provider (rate does not vary by provider) · Mississippi Medicaid (fee-for-service) | $26.04since 2026-07-01 | 15 min | $104.16 | Plans must pay at least this | 90% | DOM Comprehensive Fee Schedule, Septembe |
| IdahoAny qualified provider (rate does not vary by provider) · Idaho Medicaid (fee-for-service, Division of Medicaid / Gainwell) | $25.67since 2026-07-01 | 15 min | $102.68 | Not classified | — | Idaho Medicaid Numerical Fee Schedule Ju |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $25.39since 2026-02-01 | 15 min | $101.56 | Plans negotiate; applies out of network | 77–82% | 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) | $24.27since 2026-10-01 | 15 min | $97.08 | Plans negotiate; applies out of network | 70–76% | Emergency Adoption (date filed: Septembe |
| MinnesotaAny qualified provider (rate does not vary by provider) · Minnesota Health Care Programs: Medical Assistance (fee-for-service) | $23.92since 2026-02-01 | 15 min | $95.68 | Plans negotiate; applies out of network | 77% | MHCP Fee Schedule - Current Fee Schedule |
| OhioAny qualified provider (rate does not vary by provider) · Ohio Medicaid (fee-for-service) | $23.79since 2017-01-01 | 15 min | $95.16 | Plans negotiate; applies out of network | 80% | Appendix DD to OAC 5160-1-60 (Non-Instit |
| UtahAny qualified provider (rate does not vary by provider) · Utah Medicaid (fee-for-service, Traditional plan) | $23.67since 2026-07-01 | 15 min | $94.68 | Plans negotiate; applies out of network | 79% | Utah Medicaid Coverage and Reimbursement |
| North CarolinaAny qualified provider (rate does not vary by provider) · North Carolina Medicaid Direct (fee-for-service) | $22.15since 2025-10-01 | 15 min | $88.60 | Plans negotiate; applies out of network | 74% | NC Medicaid fee schedule 'Occupational T |
| ConnecticutAny qualified provider (rate does not vary by provider) · Connecticut Medicaid / HUSKY Health (fee-for-service, CMAP) | $21.84since 2026-01-01 | 15 min | $87.36 | Not classified | 67% | CMAP fee schedule: Independent Physical |
| MaineAny qualified provider (rate does not vary by provider) · MaineCare (fee-for-service) | $21.55since 2026-01-01 | 15 min | $86.20 | Not classified | 70–72% | MaineCare Fee Schedule (MaineCare UCR, H |
| South CarolinaAny qualified provider (rate does not vary by provider) · South Carolina Healthy Connections Medicaid (fee-for-service) | $20.95since 2011-07-11 | 15 min | $83.80 | Not classified | 70% | SCDHHS Base Physician Fee Schedule (sche |
| IllinoisAny qualified provider (rate does not vary by provider) · Illinois Medicaid (HFS fee-for-service) | $20.37since 2024-04-01 | 15 min | $81.48 | Plans negotiate; applies out of network | 64–68% | HFS Practitioner Fee Schedule (effective |
| MontanaAny qualified provider (rate does not vary by provider) · Montana Medicaid and HMK Plus (fee-for-service) | $19.98since 2026-07-01 | 15 min | $79.92 | Not classified | 64% | Montana Healthcare Programs fee schedule |
| MichiganAny qualified provider (rate does not vary by provider) · Michigan Medicaid (fee-for-service) | $19.81since 2026-01-01 | 15 min | $79.24 | Plans negotiate; applies out of network | 64–66% | MDHHS Occupational Therapy Fee Schedule |
| WashingtonAny qualified provider (rate does not vary by provider) · Washington Apple Health (Medicaid) fee-for-service | $18.92since 2026-07-01 | 15 min | $75.68 | Plans negotiate; applies out of network | 54–59% | HCA Habilitative services fee schedule ( |
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $17.85since 2008-07-01 | 15 min | $71.40 | Plans negotiate; applies out of network | 59% | ForwardHealth max fee schedule: Therapy- |
| GeorgiaAny qualified provider (rate does not vary by provider) · Georgia Medicaid (fee-for-service) | $13.94since 2017-01-01 | 15 min | $55.76 | Plans negotiate; applies out of network | 44–47% | Physician Maximum Allowed 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) | $13.38since 2020-05-01 | 15 min | $53.52 | Plans must pay at least this | 45% | Iowa Medicaid fee schedule #50 NURSE PRA |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $11.14since 2026-01-01 | 15 min | $44.56 | 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) | $9.76since 2022-05-01 | 15 min | $39.04 | Plans must pay at least this | 32–33% | Louisiana Medicaid EPSDT Health Services |
| KansasAny qualified provider (rate does not vary by provider) · Kansas Medicaid QMB (Qualified Medicare Beneficiary) KMAP fee schedule | $6.22since 2009-12-18 | 15 min | $24.88 | Not classified | 21% | KMAP Fee Schedule QMB Medicaid (FeeSched |
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 97542?
It depends on the state. Of the 34 states with a published fee-for-service rate, the median is $24.10. New Mexico pays the most ($44.67 per 15 min) and Kansas the least ($6.22 per 15 min).
Which state pays the highest Medicaid rate for 97542?
New Mexico, at $44.67 per 15 min ($178.68 per hour), effective 2025-01-01.
How do Medicaid rates for 97542 compare with Medicare?
Where the billing units match, Medicaid pays between 21% and 149% of the 2026 Medicare physician fee schedule amount for the state (non-facility).
Do managed-care plans pay the same rate for 97542?
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.
Related Physician & professional codes
10005Physician and practitioner services (fee schedule) · 42 states10006Physician and practitioner services (fee schedule) · 42 states10007Physician and practitioner services (fee schedule) · 42 states10008Physician and practitioner services (fee schedule) · 42 states10009Physician and practitioner services (fee schedule) · 42 states10010Physician and practitioner services (fee schedule) · 42 states10021Physician and practitioner services (fee schedule) · 42 states10030Physician and practitioner services (fee schedule) · 42 states10060Physician and practitioner services (fee schedule) · 42 states10061Physician and practitioner services (fee schedule) · 42 states10080Physician and practitioner services (fee schedule) · 42 states10081Physician and practitioner services (fee schedule) · 42 states
Track 97542 in your statesYour codes on one rate card: every payer's rule, Medicare comparison, rank and rate changes.