Medicaid Benefits: Occupational Therapy Services
This data is presented as an interactive tool that allows users to: filter by timeframe/year, select specific data columns (distributions), filter by state or geography, and view the data as a table, map, or trend chart.
2018
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limits on Services | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 39 No - 7 NR - 5 | 2018 data limited to CN | Yes - 13 | Yes - 23 | Included in "Limits on Services" for 2018 | Not included in 2018 survey |
| Alabama | No | - | - | |||
| Alaska | No | - | - | |||
| Arizona | Yes | CN | $3.00 per visit for beneficiaries with Transitional Medical Assistance | 15 visits hab 15 visits rehab | - | - |
| Arkansas | Yes | CN | NR | NR | - | - |
| California | Yes | CN | $1 per outpatient visit | Rehab potential required and related to activities of daily living. | - | - |
| Colorado | Yes | CN | No | No | - | - |
| Connecticut | No | - | - | |||
| Delaware | Yes | CN | No | in home or office and renewed by physician every 30 days services must be reasonable and necessary | - | - |
| District of Columbia | Yes | CN | No | Requires PA for service to be reimbursable | - | - |
| Florida | Yes | CN | No | $1500 max per year for outpatient services, as specified on the outpatient revenue code listing | - | - |
| Georgia | No | - | - | |||
| Hawaii | Yes | CN | No | No | - | - |
| Idaho | Yes | CN | No | No | - | - |
| Illinois | NR | NR | NR | NR | - | - |
| Indiana | Yes | CN | No | Prior authorization required unless ordered by physician prior to hospital discharge. 12 hours/30 days or 30 therapy sessions/month in combination with other therapy providers. | - | - |
| Iowa | NR | NR | NR | NR | - | - |
| Kansas | Yes | CN | $1.00 per service date | No | - | - |
| Kentucky | Yes | CN | $3 | Annual limit of 20 visits | - | - |
| Louisiana | Yes | CN | No | Services require prior authorization | - | - |
| Maine | Yes | CN | $.50 to $2/day depending on payment amount, up to $20/month | 1 evaluation and 5 treatment visits/year | - | - |
| Maryland | No | - | - | |||
| Massachusetts | Yes | CN | No | No | - | - |
| Michigan | Yes | CN | No | 144 units of service per 12 months without PA. | - | - |
| Minnesota | Yes | CN | NR | No | - | - |
| Mississippi | Yes | CN | No | NR | - | - |
| Missouri | No | - | - | |||
| Montana | Yes | CN | Income at or below 100% FPL - $4 per visit; above FPL - 10% of payment amount | No | - | - |
| Nebraska | Yes | CN | $1 per session for OT evaluation | a combined total of 60 therapy sessions per fiscal year (physical therapy, occupational therapy, speech therapy) | - | - |
| Nevada | NR | NR | NR | NR | - | - |
| New Hampshire | Yes | CN | No | NR | - | - |
| New Jersey | Yes | CN | No | No | - | - |
| New Mexico | Yes | CN | $7 for WDI recipients | No | - | - |
| New York | NR | NR | NR | NR | - | - |
| North Carolina | Yes | CN | No | Prior approval is required to verify medical necessity and treatment visits are limited per calendar year. | - | - |
| North Dakota | Yes | CN | $2 per visit | 1 evaluation per year 20 visits per year | - | - |
| Ohio | Yes | CN | No | 30 visits per benefit year without PA | - | - |
| Oklahoma | Yes | CN | $4 per visit | one evaluation/re-evaluation visit per calendar year; limited to 15 visits per calendar year in an outpatient hospital | - | - |
| Oregon | Yes | CN | No | Day limits. All coverage is based upon the prioritized list of health services. | - | - |
| Pennsylvania | No | - | - | |||
| Rhode Island | Yes | CN | No | No | - | - |
| South Carolina | NR | NR | NR | NR | - | - |
| South Dakota | Yes | CN | No | NR | - | - |
| Tennessee | Yes | CN | No | No | - | - |
| Texas | Yes | CN | No | Requires prior authorization. | - | - |
| Utah | Yes | CN | $4 per visit | Rehab potential required; 20 visits per year | - | - |
| Vermont | Yes | CN | No | 30 visits per year in combination with physical therapy and speech/language therapy; physician order required; additional services require prior authorization | - | - |
| Virginia | Yes | CN | $3 per visit | NR | - | - |
| Washington | Yes | CN | No | limit of 12 units per year, more with PA | - | - |
| West Virginia | Yes | CN | No | Service limits for occupational/physical therapy services are 20 visits in a calendar year | - | - |
| Wisconsin | Yes | CN | $0.50 - $3.00 per service; no copay after the first 30 hours of service or $1,500, whichever occurs first, per calendar year | Prior approval required after 35 visits - evaluations do not count towards the 35 visits; Services limited to 90 minutes per date of service | - | - |
| Wyoming | Yes | CN | No | Prior authorization is required after the first 20 visits to confirm ongoing medical necessity | - | - |
2012
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 36 No - 20 | Yes - 15 No - 21 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | $2.30/visit | Outpatient coverage limited to ALTCS members | Yes | Fee for service |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Rehab potential required and related to activities of daily living, limited to 2 services per month in combination with services by selected other practitioners | Treatment plan | Fee for service |
| Colorado | Yes | CN | $2/visit | 48 units of therapy/year in combination with PT | Additional therapy | Fee for service |
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | Yes | CN & MN | Limited to services pertaining to wheelchair evaluations and fittings, $1,500/year limit in combination with PT and most non-emergency outpatient hosp services | Fee for service | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Yes | Fee for service | ||
| Idaho | Yes | CN | $3.65/visit up to 5% of income/year across all services | 25 home or ambulatory visits/year included in limits for other specified practitioners up to a maximum of $1,870 in payments/year | Fee for service | |
| Illinois | Yes | CN & MN | 20 visits/year | Yes | Fee for service or certified cost | |
| Indiana | Yes | CN | 12 hours/30 days or 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Yes, unless ordered by physician prior to hospital discharge | Fee for service | |
| Iowa | Yes | CN & MN | $1/day | Limitations mirror Medicare benefit | Fee for service | |
| Kansas | Yes | CN & MN | $1/visit | Limited to post-trauma/illness only, rehab potential required | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to acute conditions, rehab potential required | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 20 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | Fee for service | |||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $2/visit | 40 hours/year | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | 60 visits/year in combination with other therapies, rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with PT and SP providers | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | A - limited to short-term treatment up to 60 days per condition but may be extended with prior approval | Yes | Fee for service |
| New York | Yes | CN & MN | 20 visits/year - persons with developmental disabilities or acquired brain injuries exempt from limit | Fee for service | ||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $2/visit | 1 evaluation/year, 20 therapy visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | 30 dates of service/year in non-institutional setting, combined with limit for PT | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Services limited to funded conditions on the priority list | Yes | Fee for service, using Medicare Relative Value Units and a state conversion factor |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | $1/visit | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service | |||
| Tennessee | Yes | A, B & C - See state-specific FN | See state-specific FN | |||
| Texas | Yes | CN & MN | 180 days/episode of care, limited to recipients of home health care and to nursing facility residents | Yes | Fee for service | |
| Utah | Yes | A & B - See state-specific FN | B - $3/visit | B - rehab potential required and 16 visits/year included with limit for physical therapy | Yes | Fee for service |
| Vermont | Yes | A & B - See state-specific FN | 30 visits/year in combination with PT and services for speech, hearing and language disorders | For selected conditions following 30 visits | Fee for service, using Medicare Relative Value Units and a state conversion factor | |
| U.S. Virgin Islands | No | |||||
| Virginia | No | |||||
| Washington | Yes | CN | 6 visits/year | Fee for service | ||
| West Virginia | Yes | A, B & C | Yes | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year | Fee for service |
2010
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 35 No - 21 | Yes - 13 No - 22 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | $2.30/visit | Outpatient coverage limited to ALTCS members | Yes | Fee for service |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Rehab potential required and related to activities of daily living, 2 visits/month up to 6 months | Treatment plan | Fee for service |
| Colorado | Yes | CN | $2/visit | 24 15-minute units/year | Additional therapy | Fee for service |
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | Yes | CN & MN | Limited to services pertaining to wheelchair evaluations and fittings | Fee for service | ||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Yes | Fee for service | ||
| Idaho | Yes | CN | 25 home or ambulatory visits/year included in limits for other specified practitioners | Fee for service | ||
| Illinois | Yes | CN & MN | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | ||
| Indiana | Yes | CN | 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Fee for service | ||
| Iowa | No | |||||
| Kansas | Yes | CN & MN | $1/visit | Limited to post-trauma/illness only, rehab potential required | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to acute conditions, rehab potential required | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 20 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 120 units of service | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $2/visit | 40 hours/year | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | 60 visits/year in combination with other therapies, rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with other therapy providers | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $0-$7/visit depending on income, B - $7/visit - see state-specific FN | A - limited to short-term treatment up to 60 days per condition but may be extended with prior approval | Yes | Fee for service |
| New York | Yes | CN & MN | Quantity and frequency limitations vary by procedure | Fee for service | ||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $2/visit | 1 evaluation/year, 20 therapy visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | 30 dates of service/year in non-institutional setting, combined with limit for PT | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Services limited to funded conditions on the priority list | Yes | Fee for service, using Medicare Relative Value Units and a state conversion factor |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | $1/visit | Service is included in the capitated rate paid to managed care plans | ||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service | |||
| Tennessee | Yes | A & B - See state-specific FN | See state-specific FN | |||
| Texas | Yes | CN & MN | 180 days/episode of care | Yes | Fee for service | |
| Utah | Yes | A & B - See state-specific FN | B - $3/visit | B - rehab potential required and 10 visits/year included with limits for other specified practitioners | Yes | Fee for service |
| Vermont | Yes | A & B - See state-specific FN | 30 visits/year in combination with PT and services for speech, hearing and language disorders | For selected conditions following 30 visits | Fee for service, using Medicare Relative Value Units and a state conversion factor | |
| U.S. Virgin Islands | No | |||||
| Virginia | No | |||||
| Washington | Yes | CN | 12 visits/year | Fee for service | ||
| West Virginia | Yes | A, B & C | Yes | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year | Fee for service |
2008
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 32 No - 24 | Yes - 10 No - 22 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Outpatient coverage limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Rehab potential required | Treatment plan | Fee for service |
| Colorado | Yes | CN | 24 15-minute units/year | Additional therapy | Fee for service | |
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | No | |||||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Two weeks of treatment | Yes | Fee for service | |
| Idaho | Yes | CN | 25 home or ambulatory visits/year included in limits for other specified practitioners | Fee for service | ||
| Illinois | Yes | CN & MN | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | ||
| Indiana | Yes | CN | 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Fee for service | ||
| Iowa | No | |||||
| Kansas | Yes | CN & MN | $1/visit | Limited to post-trauma/illness only, rehab potential required | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to acute conditions or where assistance with ADLs is demonstrated, rehabilitation potential required | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 20 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 200 units of service | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $2/visit | 40 hours/year | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | 60 visits/year in combination with other therapies, rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with other therapy providers | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Yes | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $2/visit | 1 evaluation/year, 20 therapy visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | 30 dates of service/year in non-institutional setting, combined with limit for physical therapy | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service for contracted staff, cost based payment for public health staff | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | Yes | CN | Fee for service | |||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | No | |||||
| Utah | Yes | A & B - See state-specific FN | B - $3/visit | B - rehab potential required and 10 visits/year included with limits for other specified practitioners | Yes | Fee for service |
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | No | |||||
| Washington | Yes | CN | 12 visits/year | Fee for service | ||
| West Virginia | Yes | A, B & C | A - 20 visits/year in combination with other therapies | Yes | Fee for service | |
| Wisconsin | Yes | CN & MN | $.50-$3/service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year across all therapy providers | Fee for service |
2006
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 30 No - 26 | Yes - 10 No - 20 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Outpatient coverage limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Rehab potential required | Treatment plan | Fee for service |
| Colorado | Yes | CN | 24 15-minute units/year | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | No | |||||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Rehab potential required | Yes | Fee for service | |
| Idaho | No | |||||
| Illinois | Yes | CN & MN | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | ||
| Indiana | Yes | CN | 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Therapy not following hospital discharge | Fee for service | |
| Iowa | No | |||||
| Kansas | Yes | CN & MN | $1/visit | Limited to post-trauma/illness only, rehab potential required | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Limited to acute conditions or where assistance with ADLs is demonstrated, rehabilitation potential required | Fee for service | |
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 20 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 200 units of service | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Adult coverage limited to those who are pregnant, blind or residing in nursing facilities | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $2/visit | 40 hours/year | Fee for service | |
| Nebraska | Yes | CN & MN | $2 or $3/specified services - see state-specific FN | Rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with other specified practitioners | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | A - $5/visit, B - $7/visit - see state-specific FN | Yes | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $2/visit | 1 evaluation/year, 20 therapy visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | Services direct billed for nursing facility residents only | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service for contracted staff, cost based payment for public health staff | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | No | |||||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | No | |||||
| Utah | Yes | A & B - See state-specific FN | B - $3/visit | B - rehab potential required and 10 visits/year included with limits for other specified practitioners | Yes | Fee for service |
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | No | |||||
| Washington | Yes | CN | 12 visits/year | Fee for service | ||
| West Virginia | Yes | CN & MN | 20 visits/year in combination with other therapies | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year across all therapy providers | Fee for service |
2004
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 30 No - 26 | Yes - 10 No - 20 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Coverage limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Rehab potential required | Treatment plan | Fee for service |
| Colorado | Yes | CN | 24 15-minute units/year | Fee for service | ||
| Connecticut | No | |||||
| Delaware | Yes | CN | Fee for service | |||
| District of Columbia | No | |||||
| Florida | No | |||||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Rehab potential required | Yes | Fee for service | |
| Idaho | No | |||||
| Illinois | Yes | CN & MN | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | ||
| Indiana | Yes | CN | 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Therapy not following hospital discharge | Fee for service | |
| Iowa | No | |||||
| Kansas | Yes | CN & MN | $1/visit | Limited to post-trauma/illness only, rehab potential required | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Fee for service | ||
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 20 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 200 units of service | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Services covered in rehab centers only and only to adjust to prosthetics and orthotics after loss of limb or function | Fee for service | ||
| Montana | Yes | A & B - See state-specific FN | $2/visit | 40 hours/year | Fee for service | |
| Nebraska | Yes | CN & MN | $1 or $3/specified services - see state-specific FN | Rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with other specified practitioners | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | B - $7/visit - see state-specific FN | Yes | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | $2/visit | 1 evaluation/year, 20 therapy visits/year | Fee for service | |
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | Services direct billed for nursing facility residents only | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | A - See state-specific FN | A - $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | No | |||||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | No | |||||
| Utah | Yes | A & B - See state-specific FN | B - $3/visit | B & C - rehab potential required and 16 visits/year included with limits for other specified practitioners | Yes | Fee for service |
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | No | |||||
| Washington | Yes | CN | 12 visits/year | Fee for service | ||
| West Virginia | Yes | CN & MN | 20 visits/year | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/service, depending on payment, up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Post-trauma/illness only, rehab potential required, 20 visits/year | Fee for service |
2003
| Location | Benefit Covered | Coverage Code | Copayment Required? | Limit on services days | Prior Approval Required | Reimbursement Methodology |
|---|---|---|---|---|---|---|
| United States | Yes - 29 No - 27 | Yes - 9 No - 20 | ||||
| Alabama | No | |||||
| Alaska | Yes | CN | Fee for service at 85% of physician fee | |||
| American Samoa | No | |||||
| Arizona | Yes | CN & MN | Coverage limited to ALTCS members - see state-specific FN | Yes | Fee for service | |
| Arkansas | No | |||||
| California | Yes | CN & MN | $1/visit | Rehab potential required | Treatment plan | Fee for service |
| Colorado | Yes | CN | 24 15-minute units/year | Fee for service | ||
| Connecticut | No | |||||
| Delaware | No | |||||
| District of Columbia | No | |||||
| Florida | No | |||||
| Georgia | No | |||||
| Guam | No | |||||
| Hawaii | Yes | CN & MN | Rehab potential required | Yes | Fee for service | |
| Idaho | No | |||||
| Illinois | Yes | CN & MN | Services other than to continue therapy provided in previous 30 days on inpatient basis | Fee for service or certified cost | ||
| Indiana | Yes | CN | 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge | Therapy not following hospital discharge | Fee for service | |
| Iowa | No | |||||
| Kansas | Yes | CN & MN | $1/visit | Limited to post-trauma/illness only, rehab potential required | Fee for service | |
| Kentucky | No | |||||
| Louisiana | No | |||||
| Maine | Yes | CN & MN | $.50-$2/day, depending on payment, up to $20/month | Fee for service | ||
| Maryland | No | |||||
| Massachusetts | Yes | CN & MN | For more than 20 visits/year | Fee for service | ||
| Michigan | No | |||||
| Minnesota | Yes | A & B - See state-specific FN | After initial 200 units of service | Fee for service | ||
| Mississippi | No | |||||
| Missouri | Yes | CN | Services covered in rehab centers only and only to adjust to prosthetics and orthotics after loss of limb or function | Fee for service | ||
| Montana | Yes | CN & MN | $2/visit | 70 visits/year, 30 additional possible with prior approval | Fee for service | |
| Nebraska | Yes | CN & MN | $1 or $3/specified services - see state-specific FN | Rehab potential required | Fee for service | |
| Nevada | Yes | CN | Rehab potential required | Yes | Fee for service | |
| New Hampshire | Yes | CN & MN | Eighty 15-minute time units/year included in limits with other specified practitioners | Fee for service | ||
| New Jersey | No | |||||
| New Mexico | Yes | CN | B - $5/visit - see state-specific FN | Yes | Fee for service | |
| New York | Yes | CN & MN | Fee for service | |||
| North Carolina | No | |||||
| North Dakota | Yes | CN & MN | Fee for service | |||
| Northern Mariana Islands | Yes | CN & MN - See territory-specific FN | Yes | |||
| Ohio | Yes | CN | Services for nursing facility residents only | Fee for service | ||
| Oklahoma | No | |||||
| Oregon | Yes | CN & MN | $3/visit | Yes | Fee for service | |
| Pennsylvania | No | |||||
| Puerto Rico | Yes | CN & MN | Fee for service | |||
| Rhode Island | No | |||||
| South Carolina | No | |||||
| South Dakota | No | |||||
| Tennessee | Yes | A & B - See state-specific FN | ||||
| Texas | No | |||||
| Utah | Yes | A & B - See state specific FN | B - $3/visit | B & C - rehab potential required and 16 visits/year included with limits for other specified practitioners | Yes | Fee for service |
| Vermont | No | |||||
| U.S. Virgin Islands | No | |||||
| Virginia | No | |||||
| Washington | Yes | CN | 12 visits/year | Fee for service | ||
| West Virginia | Yes | CN & MN | 10 visits/year | Fee for service | ||
| Wisconsin | Yes | CN & MN | $.50-$3/ service, depending on payment up to 30 hours or $1,500/year | Yes | Fee for service | |
| Wyoming | Yes | CN | Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year across all therapy providers | Fee for service |