98972 Medicaid reimbursement rates by state
Physician and practitioner services (fee schedule). 9 state Medicaid programs publish a fee-for-service rate for 98972 at the independent level. Rates run from $14.68 in New Jersey to $33.82 in Wisconsin, with a median of $26.01.
Data as of 2026-10-05. Every rate links to the official document it came from.
- States publishing
- 9
- Median rate
- $26.01units vary by state
- Highest
- $33.82Wisconsin
- Medicare (non-facility)
- $32.95–$38.692026 physician fee schedule
98972 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 |
|---|---|---|---|---|---|---|
| WisconsinAny qualified provider (rate does not vary by provider) · Wisconsin Medicaid and BadgerCare Plus (fee-for-service, ForwardHealth maximum allowable fees) | $33.82since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | ForwardHealth max fee schedule: Therapy- |
| ArizonaAny qualified provider (rate does not vary by provider) · Arizona AHCCCS fee-for-service (AIHP, Tribal ALTCS, TRBHA and other FFS members) | $32.51since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | AHCCCS Arizona Health Care Cost Containm |
| OregonAny qualified provider (rate does not vary by provider) · Oregon Health Plan (fee-for-service, OHA) | $27.60since 2026-02-01 | — | — | Plans negotiate; applies out of network | — | OHP FFS medical-dental fee schedule (fee |
| New YorkAny qualified provider (rate does not vary by provider) · New York Medicaid (fee-for-service) | $26.74since 2025-07-01 | unit | — | Plans negotiate; applies out of network | — | eMedNY Rehabilitation Services (PT/OT/SL |
| KentuckyAny qualified provider (rate does not vary by provider) · Kentucky Medicaid (fee-for-service, DMS fee schedules) | $26.01since 2021-01-01 | — | — | Plans negotiate; applies out of network | — | KY Medicaid Physician fee schedule (2021 |
| MassachusettsAny qualified provider (rate does not vary by provider) · MassHealth (fee-for-service, EOHHS 101 CMR rate regulations) | $22.65since 2026-10-01 | — | — | Plans negotiate; applies out of network | — | Emergency Adoption (date filed: Septembe |
| MissouriAny qualified provider (rate does not vary by provider) · Missouri MO HealthNet (fee-for-service) | $22.34since 2024-07-01 | — | — | Plans must pay at least this | — | MO HealthNet fee schedule: Practitioner |
| MichiganIndependent (non-agency) provider · Michigan Medicaid (fee-for-service) | $19.27since 2023-01-01 | — | — | Plans negotiate; applies out of network | — | MDHHS Independent Diagnostic Testing Fac |
| New JerseyAny qualified provider (rate does not vary by provider) · New Jersey Medicaid / NJ FamilyCare (fee-for-service) | $14.68since 2026-07-01 | — | — | Not classified | — | NJMMIS Procedure Master Listing CPTHCPCS |
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 98972?
It depends on the state. Of the 9 states with a published fee-for-service rate, the median is $26.01. Wisconsin pays the most ($33.82) and New Jersey the least ($14.68).
Which state pays the highest Medicaid rate for 98972?
Wisconsin, at $33.82, effective 2023-01-01.
Do managed-care plans pay the same rate for 98972?
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.