If you run a physical therapy clinic in Florida and bill through Medicaid, there’s one document that quietly controls a huge portion of your revenue, and that’s the Florida Medicaid fee Schedule for physical therapy.
While most doctors and therapists know that a list exists, few understand how to use it properly to increase their revenue.
Therefore, in this guide, we’ll explain all the essential CPT codes, fee rates, modifiers, and unit limits of the 2026 Florida Medicaid fee schedule for physical therapy.
Why the Florida Medicaid Fee Schedule Matters
The physical therapy fee schedule is not just a general list of prices. In fact, it sets out the following:
- The maximum amount Florida Medicaid will pay for any procedure code.
- How many units can you bill daily, weekly, or annually?
- What modifiers are required and in what order to apply them?
- Who is providing the service, a physical therapist (PT) or assistant (PTA), and how the difference will affect your payment.
If even one of these things goes wrong, your claim will be rejected, or you will get less money. On the other hand, if you write it down exactly every time, your income will be secure. This is the real benefit of understanding the Florida Medicaid Fee Schedule 2026.
2026 Florida Medicaid Physical Therapy Rate Table
To give you a clear overview, the following table outlines the complete Florida Medicaid fee schedule for physical therapy reimbursement rates for 2026:
| Category | CPT Code | Modifier | Description | Max Fee | Unit Limit |
| Evaluation | 97161 | – | PT Evaluation, Low Complexity | $58.11 | 1/ year |
| Evaluation | 97162 | – | PT Evaluation, Moderate Complexity | $58.11 | 1/ year |
| Evaluation | 97163 | – | PT Evaluation, High Complexity | $58.11 | 1/ year |
| Re-Evaluation | 97164 | – | PT Re-Evaluation | $58.11 | 1 per 5 months |
| Treatment | 97110 | GP | Therapeutic Exercise, by PT | $20.33 | 4/ day, 14/week |
| Treatment | 97110 | HM | Therapeutic Exercise, by PT | $16.28 | 4/ day, 14/week |
| Specialized | 97112 | – | Neuromuscular Reeducation | $20.33 | 4/ day, 14/week |
| Specialized | 97113 | – | Aquatic Therapy | $20.33 | 4/ day, 14/week |
| Specialized | 97530 | GP | Therapeutic Activities | $20.33 | 4/ day, 14/week |
| Assistive | 97542 | GP | Wheelchair Management & Training | $36.38 | 4 visits/year |
| Orthopedic | 29799 | HA, GP | Casting or Strapping | $22.27 | 2/day |
Physical Therapy Evaluation Codes (97161–97164)
According to the Florida Medicaid fee schedule for physical therapy 2026, the same amount of $58.11 is charged for all three levels of evaluation (low, medium, or high complexity cases). However, the documentation and reporting requirements for each of these three are completely different.
CPT 97161, Low Complexity
This code is used when the patient’s problem is simple, such as an ankle sprain, a mild muscle strain, or a single joint stiffness. Because the case is simple, the report or documentation is also short, which typically results in faster payment processing.
CPT 97162, Moderate Complexity
It is for patients with a slightly more complex problem or who have two or three conditions at the same time, such as post-surgical rehab. Although it costs the same as 97161, you will need to create a detailed patient report and file it. Use it only when the patient’s condition truly requires it.
CPT 97163, High Complexity
This code is reserved for the most difficult and complex cases, such as those with multiple serious illnesses or very serious physical conditions. Even though the amount will still be $58.11, the auditors who check the bill will look at the file very carefully. Specifically, if your report does not prove that the case was truly very complex, your clinic may be subject to an audit (inquiry).
CPT 97164, Re-Evaluation
You cannot bill this code daily as part of your normal routine. According to Florida Medicaid, this bill can only be used if there is a major change in the patient’s condition, such as a sudden worsening, or if their benefit has stopped altogether, and you need to create a new treatment plan. Therefore, use it only when needed, not as a pre-determined plan.
General Treatment Code, CPT 97110
It is one of the most commonly used codes in any physical therapy clinic, given that most patients are treated with exercises. Under the Florida Medicaid fee schedule for physical therapy 2026, the amount paid for this code depends on who is performing the treatment:
- If a physical therapist (PT) performs the treatment themselves (with a GP modifier), they receive $20.33 per unit. (Limit: 4 units per day, 14 units per week).
- If an assistant (PTA) performs the treatment (with an HM modifier), they receive $16.28 per unit. Unit limits are the same for both.
How Does This Affect Your Earnings?
That $4.05 difference may seem small at first glance. However, when you bill dozens of patients and hundreds of units a week, that small difference adds up to a huge amount.
Clinics that let their PTAs handle everything without understanding this difference often worry about why their clinic’s profits are low despite the number of patients they’re seeing. For this reason, it is important to keep this rate difference in mind when billing.
Specialized Treatment Codes for Physical Therapy
These codes are used for specific medical purposes for a patient, which are different from general exercises. Florida Medicaid pays $20.33 per unit for all three codes (limit: maximum 4 units per day and 14 units per week).
The amounts are the same, but their use varies greatly depending on the patient’s condition and documentation.
CPT 97112, Neuromuscular Reeducation
This code is used to rehabilitate a patient’s balance, coordination, and range of motion. Typically, this is for patients recovering from a stroke, brain injury, or neurological disease.
CPT 97113, Aquatic Therapy
This therapy is for patients who are unable to bear weight on their feet on land, such as those with severe arthritis, severe post-surgical swelling, or severe joint weakness.
Exercising in water is the only way for patients to get the buoyancy of the water to take the weight off their joints and move more easily than they would on land.
CPT 97530, Therapeutic Activities
Whereas the generic code (97110) is simply about strengthening muscles, the goal of 97530 is to enable the patient to perform real-life tasks. For example: lifting hands above the head, lifting weights, or climbing stairs.
This code is used when your goal is not just to increase strength but also to help the patient become functionally independent.
Assistive Training and Orthopedic Support
CPT 97542, Wheelchair Management & Training
This code pays the highest rate on the Florida Medicaid fee schedule for physical therapy, $36.38. However, since it can only be billed 4 times per year, you cannot make it a regular or daily source of income for the clinic.
In addition, you must document with each visit a solid medical reason why the patient needed a wheelchair examination or training.
CPT 29799, Casting or Strapping
It is an unlisted code, which means that $22.27 is just a base rate; the actual payment is based on your report. Furthermore, the most common error with this code is incorrect modifiers. It requires two modifiers, HA and GP, to be applied, and their order is very important:
- HA will be applied first, then GP.
- If you reverse the order (i.e., put GP first) or forget one of the modifiers, Medicaid will immediately deny your claim.
How Modifiers Shape Your Florida Medicaid PT Claims?
Modifiers do not change your service, but they tell the biller exactly how and by whom the treatment was provided. Under the Florida Medicaid fee schedule for physical therapy, three modifiers are most important:
| Modifier | Description |
| GP | Service provided under the physical therapy plan of care |
| HM | Service delivered by a PTA |
| HA | Child/adolescent program identifier |
- If you forget to include the GP modifier, Medicaid will put your claim under another department or doctor’s account, causing the bill to be denied.
- The HM modifier is often misplaced in clinics where physical therapists (PTs) and assistants (PTAs) are treating the same patient, and their paperwork is not kept separate.
- For code 29799, modifier order is a hard rule (e.g., first HA and then GP). If the order is reversed, the bill will be rejected outright.
Unit Limits
Florida uses a system of CMS Medically Unlikely Edits (MUEs) to control Medicaid billing limits. As a rule, if you bill even one unit more than the set limit, the excess will be automatically denied, regardless of the reason for treating the patient.
Daily Caps
- Treatment Codes (97110, 97112, 97113, 97530): Maximum of 4 units per day. (The daily maximum at PT rates is $81.32).
- Casting/Stripping (29799): Maximum of 2 units per day. (Maximum of $44.54).
Weekly Caps
- All treatment codes combined: Maximum of 14 units per week.
- If a therapist (PT) treats: Maximum weekly earnings of $284.62.
- If a physical therapist (PTA) treats: Maximum weekly earnings of $227.92.
Per-Period Caps
- Re-examination (97164): Only once every 5 months.
- Initial examination (97161–97163): Only once per year.
- Wheelchair training (97542): Only once per year. (Annual maximum of $145.52).
Frequently Asked Questions (FAQs)
Q1: Does Medicaid pay for physical therapy in Florida?
Ans. Yes, Florida Medicaid pays for physical therapy, but there are some requirements:
- The treatment must be medically necessary.
- The therapist or clinic providing the treatment must be registered with Medicaid.
- The treatment must be in accordance with an approved Plan of Care.
Q2: What is the 8-minute rule in physical therapy?
Ans. This is a very important billing rule. It means that if you want to bill for 1 unit of a time-based service, such as exercise (CPT 97110), you must provide the patient with at least 8 minutes of that service. If the time is less than 8 minutes, you cannot bill for that unit.
Q3: Is Florida a direct access state for physical therapy?
Ans. Yes, Florida is a direct access state. The big advantage of this is that a patient can come directly to your clinic without a referral from a doctor or physician.
Conclusion
Ultimately, the Florida Medicaid fee schedule for physical therapy demands precision and accuracy. If you exceed the daily cap, apply the wrong modifier, or your report doesn’t match the complexity of the case, your claim will be denied automatically.
On the other hand, the clinics that learn to work within these rules, this fee schedule becomes a steady and reliable source of revenue. Clinics that understand the 2026 rates are better prepared to plan their future finances