The APTA State Medicaid Payment Rate Guide is a member-only benefit that offers information on the Medicaid fee-for-service payment rates for PT services provided by state Medicaid programs. The guide includes payment rates for selected CPT codes used by PTs under states' Medicaid programs as well as links to the Medicaid manuals for all 51 U.S. jurisdictions.
The information in the guide is designed to help APTA state chapters in their advocacy to increase Medicaid payment rates by providing comparison data for all 51 jurisdictions. This brief video provides guidance on how to use the guide and search for information.
Frequently Asked Questions
Some states do not have a Medicaid fee-for-service program; all payers are Managed Medicaid and fee schedules are not available. The map shows states that have a Medicaid FFS program. States that may not have published fee schedules include Colorado, Kansas, Nebraska, New Hampshire, and Tennessee.
The Multiple Procedure Payment Reduction is a Medicare rule. It shows the published rate for each Medicaid program that has published a fee schedule. Medicaid programs may adopt MPPR edits at their discretion, but that information is not designated in the fee schedule by CPT. Refer to each payer's provider manual for information.
Modifier definitions are available from the American Medical Association and the Centers for Medicare & Medicaid Services. Visit the Modifier Lookup Tool for guidelines on correctly submitting modifiers.
There are three reasons why there may be no payment information from a given payer:
- The payer did not include the code in their published fee schedule.
- A payer may have included the code in their fee schedule but left the information blank.
- A payer may have included the code in their fee schedule but entered $0, or NC (not covered).
Check the provider manual for more information about PT benefits in your state.
Each Medicaid program can publish fee schedules at their discretion and may not use the same format as Medicare. The fee schedule with CPT codes are included in the list on the first tab.
This report includes multiple files as defined below. Please review the training video for more information.
Payer-Code Lookup Dashboard: Key tab for report. Enable editing and use the CTRL key to multi-select state and codes of interest for summary information.
- Medicaid Manual Inventory: Contains links for provider manuals for each state.
- Fee Schedule Inventory: Links for payment information contained in the dashboard.
- Data dictionary and FAQs: Reference for an explanation of data elements and answers to common questions.
- NONFAC: Pivot view of raw data that shows each state's files and max rate as published for non-facility rate.
- FAC: Pivot view of raw data that shows each state's files and max rate as published for facility payment.
- RATE: Pivot view of raw data that shows each state's files and max rate as published (outside of the facility/non-facility system).
- Raw data: Export of Physician Fee Schedule tool with available payer/code/modifier combinations and published rates, unfiltered.
- Methods: Source of data and contact information.