Therapy Medicaid rates in Illinois are among the most uneven in the country. Illinois Medicaid pays $86.52 an hour for physical therapy under code 97112, which ranks 35th of 49 states and is 9.9% below the national median of $96.04. The rate is $21.63 per 15-minute unit, effective 2024-04-01.
Occupational therapy, by contrast, pays $156.36 an hour under 97533, 4th of 48 states and 41.4% above the national median. And the PT and OT evaluation codes on file rank last in the nation. An Illinois therapy practice can find itself with a top-five treatment rate and a bottom-ranked evaluation rate in the same episode of care. All rates are compiled from official Illinois Department of Healthcare and Family Services (HFS) publications, and the Illinois Medicaid rates hub links each to its source document.
Illinois Medicaid therapy reimbursement by service
| Service | Code | Illinois rate | Rank | vs national median |
|---|---|---|---|---|
| Occupational therapy | 97533 | $156.36/hour | 4 of 48 | +41.4% |
| Physical therapy | 97112 | $86.52/hour | 35 of 49 | -9.9% |
| Speech-language therapy | 92507 | $49.44 | 27 of 39 | -19.8% |
| Speech-language evaluation | 92522 | $72.44 | 37 of 44 | -20.7% |
| OT evaluation | 97166 GO | $19.63 | 46 of 46 | -76.2% |
| PT evaluation | 97163 GP | $10.27 | 46 of 46 | -87.4% |
The treatment rates and the speech-language evaluation carry the 2024-04-01 effective date. The PT and OT evaluation rates carry 2024-12-01.
Occupational therapy: a top-five Illinois rate
Illinois is one of five states on the national high list for occupational therapy, alongside Alaska ($338.72), New Mexico ($198.64), Montana ($197.20) and North Dakota ($156.20). Its $156.36 hourly rate for 97533 is nearly identical to North Dakota's.
For a pediatric or neurological practice with a large OT caseload, that rate changes the Illinois business case. Occupational therapy time in Illinois pays far more than physical therapy time, and the OT margin shown below is wide by any standard.
Evaluations rank last nationally
The other end of the schedule is just as striking. Illinois pays $10.27 for a PT evaluation under 97163 with the GP modifier, the national minimum and 87.4% below the $81.72 median. The OT evaluation under 97166 with the GO modifier pays $19.63, also last and 76.2% below the $82.41 median. Illinois appears on the national low list for both, alongside Pennsylvania and New Jersey.
For a practice, the implication is that intake is close to unpaid under the Illinois fee schedule. Revenue in an Illinois Medicaid therapy episode comes almost entirely from treatment visits, so episode length, not referral volume, drives the economics.
Labor costs and margins in Illinois
Illinois wages are near the national medians. In May 2025, physical therapists earned a median $50.60 an hour against $49.40 nationally, occupational therapists $47.93 against $48.24, and speech-language pathologists $45.71 against $47.05. Physical therapist assistants earned $31.37 against $32.88, and occupational therapy assistants $30.83 against $34.76.
The margins diverge sharply by discipline:
- Physical therapy (97112): wages take 83.1% of the $86.52 hourly rate, leaving $14.60 an hour after a loaded wage.
- Occupational therapy (97533): wages take 43.6% of the $156.36 hourly rate, leaving $88.24.
An OT hour in Illinois produces far more margin than a PT hour. Clinics that offer both should expect the OT side to carry the Medicaid book.
Unit limits and prior authorization
Illinois coverage rules lean on daily limits. Code 92507 carries three prior-authorization rules and a per-day limit, and the speech-language evaluations 92521, 92522, 92523 and 92524 each carry a per-day limit with no prior-authorization rule. Some therapy codes are also limited per state fiscal year. Billing staff should track both the daily cap on speech services and any annual limits when planning treatment frequency.
Illinois therapy rate history
Illinois has raised therapy rates twice in recent years:
- 2022-03-01: an HFS therapy fee schedule edition with a 58.27% change.
- 2024-01-01: Public Act 103-0102 (SB1298, the FY2024 Medicaid omnibus) enacted a rate increase for speech, physical and occupational therapy services, carried into the HFS therapy fee schedule effective 2024-01-01 with a 14.21% change. CMS approved IL SPA 23-0029 for the change.
The current rates on file reflect editions from April and December 2024.
Managed care in Illinois
Illinois Medicaid works with a large roster of managed-care plans; our data counts 71 plans and care-coordination entities, including Aetna Better Health of Illinois, Blue Cross Community Health Plans, CountyCare and Family Health Network. No separate therapy rule is on file; for physician and practitioner services, plans negotiate and the published rate applies out of network. Therapy practices should confirm their contract basis with each plan. The Illinois managed-care page lists the plans on file.
Illinois against the highest and lowest therapy states
On physical therapy, Illinois trails Alaska ($176.68), Texas ($135.00) and North Dakota ($129.16), while staying above New Jersey ($58.80) and Maine ($46.64). The national therapy rates hub compares every state, and our methodology explains how rates are converted and ranked.
Updated 2026-10-05