Occupational therapy evaluation: Medicaid rates by state

States publish occupational therapy evaluation under their own codes, modifiers and units. To compare them, this page picks the rate in each state that matches the same service and provider level.

• Provider level. States are compared at the occupational therapist level. Rates for other levels on file (physician or licensed psychologist, any qualified provider, physical therapist and registered nurse) are kept separate, never mixed into this ranking.
• Unit. Of the 49 states, 2 publish their headline rate per visit and 1 per unit, and 46 schedules print no unit at all (a flat amount per service). The ranking uses the rate as published, so read the unit before comparing two states.
• Variants. 49 of the 49 states publish more than one rate for this service (by modifier, program, setting or provider type); the headline rate is the one that matches the comparison, and the workspace lists every variant.
• Depth. 2,974 rates for this service are on file across all states, versions and provider levels; this page shows one headline rate per state.

The highest-paying state, Alaska, pays $153.02; the lowest, Illinois, pays $19.63, a 7.8x gap. 49 of the 49 states pay above the median of —. Common reasons rates for therapy (PT/OT/speech) services spread this way:

• States pay therapy by CPT code, but many pay therapy assistants a reduced percentage and some pay differently in outpatient hospital, private practice and home settings.
• Children's therapy is driven by the EPSDT benefit, so some states maintain separate pediatric rates or programs.
• Visit limits, prior authorization and annual caps vary by state and change how much a single code is worth to a practice.

Billing notes

Many treatment codes are timed in 15-minute units, while evaluations and re-evaluations are billed once per session. Medicare applies a rule for counting timed minutes into units; Medicaid programs may follow it or set their own, so check the state's therapy manual.