| Is the Benefit Covered? |
Copayment Requirement |
Prior Approval Requirement |
Coverage Limitations |
Reimbursement Methodology |
Populations Covered |
|
|
Alabama
|
|
No
|
|
|
|
|
|
|
Alaska
|
|
Yes
|
|
|
|
Fee for service at 85% of physician fee
|
CN
|
|
Arizona
|
|
Yes
|
|
Yes
|
Rehab potential required
|
Fee for service
|
CN & MN
|
|
Arkansas
|
|
No
|
|
|
|
|
|
|
California
|
|
Yes
|
$1/visit
|
Treatment plan
|
Rehab potential required and to prevent hospitalization
|
Fee for service
|
CN & MN
|
|
Colorado
|
|
Yes
|
|
Additional therapy
|
24 15-minute units/year
|
Fee for service
|
CN
|
|
Connecticut
|
|
No
|
|
|
|
|
|
|
Delaware
|
|
Yes
|
|
|
|
Fee for service
|
CN
|
|
District of Columbia
|
|
Yes
|
|
Treatment plan
|
|
Fee for service
|
CN & MN
|
|
Florida
|
|
No
|
|
|
|
|
|
|
Georgia
|
|
No
|
|
|
|
|
|
|
Hawaii
|
|
Yes
|
|
Yes
|
Two weeks of treatment
|
Fee for service
|
CN & MN
|
|
Idaho
|
|
Yes
|
|
Treatment plan
|
25 home or ambulatory visits/year included in limits for other specified practitioners
|
Fee for service
|
CN
|
|
Illinois
|
|
Yes
|
|
Services other than to continue therapy provided in previous 30 days on inpatient basis
|
|
Fee for service or certified cost
|
CN & MN
|
|
Indiana
|
|
Yes
|
|
Therapy not following hospital discharge
|
12 hours/30 days or 30 therapy sessions/month in combination with other therapy providers if ordered by physician prior to hospital discharge
|
Fee for service
|
CN
|
|
Iowa
|
|
Yes
|
$1/day
|
|
Limited to services meeting Medicare standards
|
Fee for service
|
CN & MN
|
|
Kansas
|
|
Yes
|
$1/visit
|
|
Limited to post-trauma/illness only, rehab potential required
|
Fee for service
|
CN & MN
|
|
Kentucky
|
|
Yes
|
A - $2/visit
|
Specified services
|
A - 15 visits/year, C & D - 30 visits/year
|
Fee for service
|
A, B, C & D - See state-specific FN
|
|
Louisiana
|
|
No
|
|
|
|
|
|
|
Maine
|
|
Yes
|
$.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
|
CN & MN
|
|
Maryland
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
Massachusetts
|
|
Yes
|
|
|
20 visits/year
|
Fee for service
|
CN & MN
|
|
Michigan
|
|
No
|
|
|
|
|
|
|
Minnesota
|
|
Yes
|
null
|
After initial 30 sessions
|
|
Fee for service
|
A & B - See state-specific FN
|
|
Mississippi
|
|
No
|
|
|
|
|
|
|
Missouri
|
|
Yes
|
|
|
Adult coverage limited to those who are pregnant, blind or residing in nursing facilities
|
Fee for service
|
CN & MN
|
|
Montana
|
|
Yes
|
$2/visit
|
|
40 hours/year
|
Fee for service
|
A & B - See state-specific FN
|
|
Nebraska
|
|
Yes
|
$1 or $3/specified services - see state-specific FN
|
|
60 visits/year in combination with other therapies, rehab potential required
|
Fee for service
|
CN & MN
|
|
Nevada
|
|
Yes
|
|
Yes
|
Rehab potential required
|
Fee for service
|
CN
|
|
New Hampshire
|
|
Yes
|
|
|
Eighty 15-minute time units/year included in limits with other therapy providers
|
Fee for service
|
CN & MN
|
|
New Jersey
|
|
No
|
|
|
|
|
|
|
New Mexico
|
|
Yes
|
A - $5/visit, B - $7/visit - see state-specific FN
|
Yes
|
|
Fee for service
|
CN
|
|
New York
|
|
Yes
|
|
|
|
Fee for service
|
CN & MN
|
|
North Carolina
|
|
No
|
|
|
|
|
|
|
North Dakota
|
|
Yes
|
$2/visit
|
|
15 visits/year
|
Fee for service
|
CN & MN
|
|
Ohio
|
|
Yes
|
|
|
30 dates of service/year in non-institutional setting, combined with limit for occupational therapy
|
Fee for service
|
CN
|
|
Oklahoma
|
|
No
|
|
|
|
|
|
|
Oregon
|
|
Yes
|
A - $3/visit
|
Yes
|
|
Fee for service
|
A - See state-specific FN
|
|
Pennsylvania
|
|
No
|
|
|
|
|
|
|
Rhode Island
|
|
No
|
|
|
|
|
|
|
South Carolina
|
|
No
|
|
|
|
|
|
|
South Dakota
|
|
Yes
|
|
|
|
Fee for service for frequently performed services, 40% of charge up to Medicare limits for low volume procedures, supplies paid 90% of charge
|
CN
|
|
Tennessee
|
|
Yes
|
|
|
|
|
A & B - See state-specific FN
|
|
Texas
|
|
Yes
|
|
Yes
|
180 days of treatment/year for acute or exaxcerbation of chronic condition
|
Fee for service
|
CN & MN
|
|
Utah
|
|
Yes
|
B - $3/visit
|
Yes
|
B & C - rehab potential required and16 visits/year included with limits for other specified practitioners
|
Fee for service
|
A & B - See state-specific FN
|
|
Vermont
|
|
No
|
|
|
|
|
|
|
Virginia
|
|
No
|
|
|
|
|
|
|
Washington
|
|
Yes
|
|
Yes
|
48 units of service/year
|
Fee for service
|
CN
|
|
West Virginia
|
|
Yes
|
|
|
A - 20 visits/year in combination with other therapies
|
Fee for service
|
A & B
|
|
Wisconsin
|
|
Yes
|
$.50-$3/service, depending on payment, up to 30 hours or $1,500/year
|
Yes
|
|
Fee for service
|
CN & MN
|
|
Wyoming
|
|
Yes
|
|
|
Post-trauma/illness only, therapy services must be restorative and are limited to 20 visits/year across all therapy providers
|
Fee for service
|
CN
|
|
American Samoa
|
|
Yes
|
|
|
|
|
See territory-specific FN
|
|
Guam
|
|
No
|
|
|
|
|
|
|
Northern Mariana Islands
|
|
Yes
|
|
Yes
|
|
|
CN & MN - See territory-specific FN
|
|
Puerto Rico
|
|
Yes
|
|
|
Physician order required and limited to 15 treatments/condition/year
|
Fee for service
|
CN & MN
|
|
Virgin Islands
|
|
No
|
|
|
|
|
|
