Therapy Medicaid rates in North Dakota are consistently near the top of the country, and that consistency is the story. North Dakota Medicaid pays $129.16 an hour for code 97110, therapeutic exercise, which ranks 5th of 49 states and is 34.5% above the national median of $96.04. It also ranks 5th for occupational therapy, 5th for speech therapy and 3rd or 4th on all three evaluations.
Only Alaska joins North Dakota in the top five on all six therapy measures. Combine that with therapist wages well below the national median and North Dakota offers some of the widest Medicaid therapy margins in the country. Every rate here is compiled from official North Dakota Medicaid publications, with each rate linked to its source document. All of the therapy codes below carry a July 1, 2026 effective date.
Most states are strong on one discipline and weak on another. North Dakota pays well across the board.
| Service | Code | North Dakota rate | Rank | vs national median |
|---|---|---|---|---|
| Physical therapy | 97110 | $129.16 / hour | 5 of 49 | +34.5% |
| Occupational therapy | 97530 | $156.20 / hour | 5 of 48 | +41.2% |
| Speech-language therapy | 92507 | $85.24 | 5 of 39 | +38.3% |
| PT evaluation | 97161 | $109.64 | 4 of 46 | +34.2% |
| OT evaluation | 97165 | $112.65 | 4 of 46 | +36.7% |
| Speech-language evaluation | 92522 | $125.04 | 3 of 44 | +36.9% |
Every line is between 34.2% and 41.2% above its national median. For a practice planning a mixed PT, OT and speech caseload, that means North Dakota's Medicaid revenue does not depend on getting the discipline mix right.
North Dakota publishes code 97110 at $32.29 per 15-minute unit, with no modifier. Four units make $129.16 an hour. That puts it just behind Texas at $135.00 and Montana at $147.04, and well ahead of most of the country.
Because the rate is recent, effective July 1, 2026, it reflects the state's latest annual adjustment rather than a figure frozen years ago. A practice budgeting for the coming year can treat it as current and, given North Dakota's history, reasonably plan for the schedule to be reviewed again each July.
North Dakota prices therapy in the ND Medicaid Professional (General) Services Fee Schedule, the same document that carries physician and practitioner rates. Two kinds of codes behave differently.
Timed treatment codes
97110, 97112 and 97530 pay per 15-minute unit, so revenue tracks documented treatment time. Units per visit is the productivity measure that matters.
Per-visit codes and modifiers
Evaluations and 92507 pay once per service. North Dakota's January 2026 clarification on 92507 addressed the -52 and -22 modifiers, which in general billing practice signal a reduced or an unusually extended service. Speech practices should read that update carefully, because it is the state's guidance on how a session that departs from the standard should be billed.
The 97161 PT evaluation is unusually strong at $109.64, 4th of 46 states, and the 97165 OT evaluation pays $112.65. Many states with high treatment rates pay ordinary evaluation rates, so North Dakota's evaluation figures matter for clinics with frequent new admissions or short episodes.
The effect is to remove the usual penalty for intake-heavy case mixes. An orthopedic clinic that sees many short episodes, or a pediatric practice that screens and refers, earns close to the same per clinician hour on evaluation days as on treatment days. That makes North Dakota a good fit for models built around access and assessment as well as long-term treatment.
Occupational therapy on code 97530 pays $39.05 per unit, or $156.20 an hour, 41.2% above the national median of $110.60. North Dakota pays OT a clear premium over PT, which is unusual and makes OT the most valuable treatment hour on the schedule.
Speech is just as strong. North Dakota pays $85.24 for code 92507, 5th of 39 ranked states, and $125.04 for the speech-language evaluation on 92522, 3rd of 44. Only Alaska and New Mexico pay more for the speech evaluation. For a pediatric speech practice, North Dakota offers one of the best rate environments in the country.
North Dakota pairs high rates with wages well below national levels. Federal occupational data for May 2025 gives these median hourly wages, with US medians in parentheses:
- Physical therapist: $41.02 ($49.40)
- Occupational therapist: $40.00 ($48.24)
- Speech-language pathologist: $36.17 ($47.05)
- Physical therapist assistant: $30.54 ($32.88)
- Occupational therapy assistant: $29.31 ($34.76)
Every role earns less than the national median. Lower wages can also mean a smaller labor pool, so recruiting rather than reimbursement is often the binding constraint for a North Dakota therapy practice.
The resulting margins are wide. The median PT wage is 45.1% of the $129.16 hourly rate, leaving $70.86 an hour after a loaded wage. For OT, the wage is 36.4% of the $156.20 rate, leaving $99.35 an hour.
Those margins give a practice choices. It can pay above the local median to attract therapists from neighboring states, fund travel to rural patients, or absorb the cost of a smaller, more spread-out caseload. In a state where distance and staffing are the hard problems, the rate is what makes solving them affordable. Because the margin is so wide, assistant staffing is less essential here than in low-rate states, and therapist-delivered care is viable on its own.
The North Dakota schedule attaches no prior authorization rule to 92507, 97110, 97112, the 97161 evaluation, or the speech evaluation codes 92521, 92522, 92523 and 92524. None of these codes has a published unit limit either. The 97164 and 97168 re-evaluation codes each carry one prior authorization rule.
That does not mean therapy is unmanaged. A provider update posted December 31, 2025 announced that ND Medicaid is updating its physical therapy, occupational therapy and speech-language therapy policies, effective February 1, 2026, and a follow-up on January 28, 2026 added clarifications for 92507. Practices should read the current policy alongside the fee schedule, because the policy, not the schedule, is where visit limits and documentation rules sit.
North Dakota's therapy rates come from the North Dakota Medicaid (fee-for-service) schedule. The state's coverage data names 5 plans and program arrangements, including Blue Cross Blue Shield of North Dakota, Primary Care Case Management (PCCM) and Northland PACE. North Dakota relies far less on risk-based managed care than most states, so for most therapy practices the published schedule is the rate that matters. The North Dakota managed care page explains how each arrangement is organized and which service lines it covers.
North Dakota's state plan notices show steady annual increases. The Public Notice - Medicaid State Plan Changes for July 1, 2026 proposed a 2.0% change, and a provider update of July 18, 2026 confirmed the new fee schedules were posted. That matches the 2.0% in the July 1, 2025 notice, while the 2024 and 2023 notices each carried 3.0%. A separate notice for January 1, 2026 carried a 3.2% change.
Annual increases of that size, compounded on an already high base, explain much of how North Dakota climbed into the top five. They also make North Dakota one of the more predictable states for multi-year planning.
North Dakota trails only a handful of states. Alaska pays $176.68 an hour for 97110 and New Mexico $165.64. At the other end, New Jersey pays $58.80, California $48.88 and Maine $46.64, less than half of North Dakota's PT hour.
On speech, Washington leads at $144.10 on 92507, while Pennsylvania, Nebraska and New Hampshire pay near $20. Neighbor South Dakota is the closest comparison for practices serving both Dakotas.
What distinguishes North Dakota from the other top states is breadth. Some high-ranking states earn their place on one strong code; North Dakota sits in the top five on treatment and evaluation alike, across all three disciplines. For a group choosing where to add capacity, that breadth lowers the risk that a single code change undoes the case for expansion.
- Budgeting. Use the July 2026 rates at face value for all disciplines, including evaluations, and plan for an annual July review.
- Recruiting. Treat part of the margin as a recruiting budget; staffing, not rate, is the usual constraint.
- Compliance. Read the February 2026 therapy policy and the 92507 clarification before changing session lengths or modifier use.
- Re-evaluations. Track authorizations for the 97164 and 97168 re-evaluation codes, the only therapy lines with a prior authorization rule, so a re-evaluation is not the visit that goes unpaid.
- Benchmarking. Compare your blended Medicaid revenue per therapist hour with the $129.16 PT and $156.20 OT figures. In a state that pays evaluations this well, a large gap usually points to low units per visit or to denials, not to case mix.
The full dataset covers all 19,715 current North Dakota Medicaid rates, with history back to 2023. See pricing for access.
Rates on this page are compiled from official North Dakota Medicaid publications, chiefly the ND Medicaid Professional (General) Services Fee Schedule (Data Updated as of 2026-07-01), and each rate links to its source document. See therapy Medicaid rates by state for the national overview and the North Dakota Medicaid rates hub for every other code. Our methodology explains how 15-minute units are converted to hourly rates.