Therapy Medicaid Rates in the District of Columbia: PT, OT and Speech Reimbursement (2026)

Therapy Medicaid rates in the District of Columbia sit in the upper-middle of the national table, and they move on a predictable cycle. DC Medicaid pays $103.52 an hour for physical therapy under code 97110, which ranks 16th of 49 states and is 7.8% above the national median of $96.04. The rate is $25.88 per 15-minute unit, effective 2026-01-01.

What sets DC apart is the regular rhythm of its rate updates. The Department of Health Care Finance (DHCF) has issued a dedicated reimbursement transmittal for physical, occupational and speech therapy at mid-year and at the start of the year since 2024. For a practice, that means DC's therapy rates are a schedule to re-check twice a year rather than once. All rates are compiled from official DHCF publications, and the DC Medicaid rates hub links each to its source document.

Every ranked DC therapy rate lands between 14th and 16th nationally, a consistent upper-middle position. Occupational therapy is the strongest relative to the median, at 14.2% above; the PT evaluation is the closest to typical, at 6.6% above.

For an outpatient clinic, the practical reading is that DC pays somewhat better than a typical state on every therapy service, without the peaks or troughs that make some schedules hard to model.

DC's therapy rates use two pricing shapes. PT and OT treatment codes such as 97110 and 97530 are priced per 15-minute unit, so revenue for a visit is the unit rate times documented billable units. Evaluations are paid once per service at their level of complexity.

Speech treatment under 92507 is priced differently from the other services: DHCF sets it as a percentage rather than a flat dollar amount, which is why DC has no ranked speech treatment rate in the national comparison. Speech practices should confirm how their 92507 claims are priced in the DHCF fee schedule report before budgeting.

DC's $25.88 unit rate for 97110 is 80% of the Medicare non-facility rate for the same code, and 97530 is also paid at 80% of Medicare. That fixed relationship is useful for planning. A mixed-payer clinic can treat a DC Medicaid treatment unit as worth four-fifths of a Medicare unit, and can expect the gap to hold steady as long as DHCF keeps setting rates on that basis.

It also gives contract negotiators a clean reference. A plan offering well below the DHCF rate is offering a much smaller share of Medicare than the District itself pays.

The DC change history is unusually regular:

• Transmittal 24-24: reimbursement rate changes for physical therapy, occupational therapy and speech and language therapy, effective July 1, 2024.
• Transmittal 24-42: PT, OT and ST rate changes effective January 1, 2025.
• Transmittal 25-17: PT, OT and ST rate changes effective 2025-07-01.
• Transmittal 26-18: PT-OT-ST rate changes effective 7-1-2026, published 2026-06-30.

Loading each transmittal on time

Each transmittal was published within days of its effective date, which leaves little lead time for billing systems. Practices should load the new DHCF rates as soon as each transmittal appears and check the first claims paid after each effective date. The current rates on this page carry a 2026-01-01 effective date, so Transmittal 26-18 is the one to compare against: any code it changed should be priced at the July 2026 figure for dates of service from July 1.

A simple routine works well: keep a calendar reminder for late June and late December, read the transmittal the day it appears, update the practice's expected-payment table, and review the first two weeks of remittances under the new rates.

DC wages split by role. In May 2025, occupational therapists earned a median $52.49 an hour against $48.24 nationally, and speech-language pathologists $52.59 against $47.05. Physical therapists earned $48.87, slightly below the $49.40 national median. Assistants earned less than the national figures: physical therapist assistants $30.48 against $32.88, and occupational therapy assistants $31.92 against $34.76.

At those wages, the margins on treatment time are healthy for a mid-ranked market:

• Physical therapy (97110): wages take 67.1% of the $103.52 hourly rate, leaving $34.06 an hour after a loaded wage.
• Occupational therapy (97530): wages take 59.1% of the $126.32 hourly rate, leaving $51.72.

Occupational therapy carries the better margin despite the higher OT wage, because DC's OT rate is further above the median than its PT rate. Lower assistant wages also give practices that use PTAs and OTAs some extra room, where DC billing rules allow supervised assistants to deliver treatment.

The speech-language pathologist wage, well above the national median, is the cost line to watch. With speech treatment priced on a percentage basis and the SLP wage high, speech margins depend more on how 92507 actually pays than on the evaluation rate.

The coverage rules on file are light. Code 92523, a speech-language evaluation, code 97161, the PT evaluation, and code 97165, the OT evaluation, each carry one prior-authorization rule. The remaining listed codes, including 92507, 92521, 92522, 92524, 97110, 97112, 97530 and the other evaluation and re-evaluation codes, carry none, and no listed code has a unit limit.

For DC practices, that puts the authorization step at intake for those evaluations rather than on ongoing treatment. Once a case is open, treatment can proceed on the plan of care without repeated approvals, which keeps the administrative cost of each episode low.

DC enrolls Medicaid members with managed-care plans including AmeriHealth Caritas District of Columbia, MedStar Family Choice DC and Health Services for Children with Special Needs (HSCSN), and our data counts 6 plans in total. Plan membership shifted in 2026: under Transmittal 26-19, Wellpoint DC exited and its enrollees were auto-assigned to AmeriHealth Caritas DC effective August 1, 2026.

The managed-care rules on file do not include a separate therapy line. For physician and practitioner services and for behavioral health, the rule is that services are paid directly by the District, outside managed care. Therapy practices should confirm with each plan whether a claim is paid under the plan contract or under the DHCF fee-for-service schedule. The DC managed-care page lists the plans on file.

After the Wellpoint DC exit

Practices that treated Wellpoint DC members should check that those patients' coverage was moved correctly, that any open authorizations carried over or were re-requested, and that claims for dates of service from August 1, 2026 go to AmeriHealth Caritas DC. Plan transitions are a common source of denials in the months after they take effect.

DC's $103.52 physical therapy hour is well short of Alaska at $176.68 and New Mexico at $165.64, and comfortably above the bottom group of New Jersey ($58.80), California ($48.88) and Maine ($46.64). On occupational therapy, the gap to Alaska's $338.72 is larger, while the bottom of the table falls to New Jersey's $31.56. Maryland and Virginia are the natural regional comparisons for practices serving the capital area.

For mid-Atlantic therapy groups, DC is a steady, above-median market whose main administrative demand is tracking the twice-yearly transmittals.

• The January 2027 transmittal. If DHCF keeps its pattern, a PT, OT and ST transmittal will appear in late December with a January 1 effective date. Plan to load it immediately.
• Plan consolidation effects. With Wellpoint DC's enrollees moved to AmeriHealth Caritas DC, one plan now carries a larger share of DC Medicaid members. Contract terms, authorization rules and payment speed at that plan matter more than before.
• Fee schedule reports. DHCF publishes its medical fee schedule report through the MMIS portal, with the latest edition as of late September 2026. Checking each therapy code against the newest report after every transmittal confirms the rates actually loaded.

Practices that track these three items rarely face surprises in DC's otherwise predictable therapy schedule.

Budget DC therapy in half-year blocks that match the transmittal cycle, with PT and OT on units at 80% of Medicare and evaluations by expected new-patient volume. Hold speech treatment as a separate line until the percentage-based 92507 payment is confirmed in remittances.

DC's therapy line carries 289 current rates, part of all 87,654 current DC Medicaid rates available through MedicaidRate plans.

Rates on this page are compiled from official DHCF publications, including the DC Medicaid MMIS Medical Fee Schedule Report and the therapy transmittals cited above, and each rate links to its source document. The national therapy rates hub compares every state, and our methodology explains how rates are converted and ranked.