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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Wisconsin Medicaid Physical and Occupational Therapy Rates

Wisconsin Medicaid rates for physical and occupational therapy services.  These are the fee-for-service rates so they may be different from Medicaid managed care rates and rates may change based on the setting or patient category.  Members can ask questions or request information on any Medicaid issue at any time.  Please contact us to request additional codes or updates.  

Updated November 8, 2024

Code

Description

Fee

97161

Evaluation of physical therapy, low complexity, typically 20 minutes

$66.41

97162

Evaluation of physical therapy, moderate complexity, typically 30 minutes

$66.41

97163

Evaluation of physical therapy, high complexity, typically 45 minutes

$66.41

97164

Re-evaluation of physical therapy, typically 20 minutes

$66.41

97165

Evaluation of occupational therapy, low complexity, typically 30 minutes

$62.66

97166

Evaluation of occupational therapy, moderate complexity, typically 45 minutes

$62.66

97167

Evaluation of occupational therapy established plan of care, high complexity, typically 60 minutes

$62.66

97168

Re-evaluation of occupational therapy established plan of care, typically 30 minutes

$62.66

97010

Application of a modality to one or more areas; hot or cold packs

N/A

97012

Traction, mechanical

$12.35

97014

Electrical stimulation, unattended

N/A

97016

Vasopneumatic device

$12.97

97018

Paraffin bath

$12.97

97022

Whirlpool

$12.97

97024

Diathermy

$12.97

97026

Infrared

$13.11

97028

Ultraviolet

$12.97

97032

Application of a modality to one or more areas; electrical stimulation (manual), each 15 minutes

$16.38

97034

Contrast baths, each 15 minutes

$11.10

97035

Ultrasound, each 15 minutes

$13.52

97036

Hubbard tank, each 15 minutes

$24.97

97110

Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, ROM and flexibility

$15.57

97112

Neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and proprioception

$15.57

97113

Aquatic therapy with therapeutic exercises

$27.02

97116

Gait training (includes stair climbing)

$15.57

97124

Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)

$15.57

97140

Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions, each 15 minutes

$27.06

97150

Therapeutic procedure(s), group (2 or more individuals)

$16.80

97530

Therapeutic activities, direct (one on one) patient contact by the provider, (use of dynamic activities to improve functional performance), each 15 minutes 

$17.05

97533

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one on one) patient contact by the provider, each 15 minutes

$22.94

97535

Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of adaptive equipment), direct one on one contact by provider each 15 minutes

$19.84

97542

Wheelchair management/propulsion training, each 15 minutes

$17.85

97597

Removal of devitalized tissue from wounds

$42.35

97598

Removal of devitalized tissue from wounds

$37.24

97750

Physical performance test or measurement, (e.g., musculoskeletal, functional capacity) with written report, each 15 minutes

N/A

97760

Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 15 minutes

$25.85

97761

Prosthetic training, upper and/or lower extremity(s), each 15 minutes

$24.97

97763

Checkout for orthotic/prosthetic, use, established patient, each 15 minutes

$29.84

About Us

Zachary Edgar JD, LLM is the managing partner for Therapy Comply.  Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.  

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