Florida Medicaid Fee Schedule for Physical Therapy Services in 2026

The latest edition of the Florida Physical Therapy Fee Schedule 2026 determines Medicaid payments for physical therapy services. There are a few factors that will help you determine the amount reimbursed to the patient. These are:

• CPT code (procedure code) for the service provided.
• Modifiers added to the CPT code to describe additional aspects of your service.
• Type of provider: whether the provider was licensed and qualified to perform the service; i.e., Physical Therapist (PT) or Physical Therapist Assistant(PTA).

Mastering the rules of the 2026 fee schedule for Florida, from initial evaluation tiers to time-based codes like neuromuscular reeducation, allows you to move beyond guesswork.

When you understand exactly how these codes and modifiers interact, you stop wondering what your margins look like and start forecasting your practice’s revenue with total confidence.

In this blog post, we will examine Florida Medicaid’s physical therapy fee schedule for 2026.

What is the Physical Therapy Services Fee Schedule?

The 2026 Physical Therapy Fee Schedule is the rule book for reimbursement. It sets the ceiling for what Florida Medicaid will pay for every CPT code and limits how many units you can bill per week. Ignoring these limits affects your payment and triggers audits.

If the provider uses the precise CPT code along with the correct number of units and/or billed correctly, claims are usually processed quickly.

However, if either the CPT code or the number of units is billed incorrectly, then you can expect to spend the majority of your time trying to resolve denials. This really hurts your revenue.

2026 Florida Medicaid Fee Schedule for Physical Therapy Services

Service Category	Code	Modifier	Description of Service	Maximum Fee ($)	Allowed Units
Evaluation Services
Evaluation	97161	—	Physical Therapy Evaluation for  Low Complexity	$58.11	1 per year
Evaluation	97162	—	Physical Therapy Evaluation for Moderate Complexity	$58.11	1 per year
Evaluation	97163	—	Physical Therapy Evaluation for High Complexity	$58.11	1 per year
Evaluation	97164	—	Physical Therapy Re-Evaluation	$58.11	1 per 5 months
General Treatment Services
Treatment	97110	GP	Therapy Treatment Session by Physical Therapist	$20.33	4 per day, 14 per week
Treatment	97110	HM	Therapy Treatment Session by Physical Therapist Assistant	$16.28	4 per day, 14 per week
Specialized Therapy Services
Specialized Therapy	97112	—	Neuromuscular Reeducation Therapy	$20.33	4 per day, 14 per week
Specialized Therapy	97113	—	Aquatic Therapy	$20.33	4 per day, 14 per week
Specialized Therapy	97530	GP	Therapeutic Activities	$20.33	4 per day, 14 per week
Assistive Training Services
Assistive Training	97542	GP	Wheelchair Management and Training	$36.38	4 visits per year
Orthopedic Support Services
Orthopedic Support	29799	HA, GP	Casting or Strapping Application	$22.27	2 per day

Let’s now break down the specific categories of FL Medicaid’s physical therapy CPT codes and their corresponding fee schedules.

1). Evaluation Codes (97161-97164)

Evaluation Codes 97161, 97162, 97163 & 97164 are where every single episode of Physical Therapy (PT) care begins. In addition to being necessary for compliance purposes, these codes establish the clinical basis for your claim submission process.

The reason most therapists get into trouble when using these codes is that all three tiers have the same fee, i.e., $58.11. However, they all have different documentation requirements. Auditors expect a high-complexity justification for code 97163 for providing reimbursement.

Here are the 2026 Florida Medicaid reimbursement rates for all physical therapy evaluation codes:

Code	Description	Maximum Fee	Maximum Allowable Units
97161	Physical Therapy Evaluation with Low Complexity	$58.11	1 per year
97162	Physical Therapy Evaluation with Moderate Complexity	$58.11	1 per year
97163	Physical Therapy Evaluation with High Complexity	$58.11	1 per year
97164	Physical Therapy Services for Re-Evaluation	$58.11	1 per 5 months

CPT Code 97161 for a Low Complexity

Based on the 2026 fee schedule, the maximum fee for CPT Code 97161 is $58.11. As a provider, use this code for situations where the patient has one location of impairment and the documentation is minimal. You can use it for Ankle sprains as it doesn’t take much of a therapist’s time, and payment is the same as more complex codes.

CPT Code 97162 for Moderate Complexity

CPT codes 97161 and 97162 share the same reimbursement rate of $58.11. Although this code requires more clinical judgment, the documentation requirement is also demanding. You can use CPT code 97162 in situations like post-surgical rehab, where the patient has multiple functional limitations.

However, because the documentation takes longer to complete and the fee remains exactly the same, you should only use this code when the patient’s complexity strictly requires it.

CPT Code 97163 for High Complexity

Again, similar to the codes above, CPT code 97163 also reimburses $58.11. This is reserved for those patients who have multiple diagnoses and/or severe physical limitations. It requires an extensive amount of documentation.

Auditors thoroughly examine the documentation to verify that it justifies the high level of care. You must spend more time documenting to support the claim. However, the payment stays at $58.11. You cannot use this CPT code 97163 unless you have clear evidence that this level of complexity actually exists.

CPT Code 97164 for Re-evaluation

The code also reimburses at $58.11. However, this code cannot be submitted without evidence of a change in the patient’s condition. This includes, but is not limited to, documentation showing the patient has reached a plateau in their treatment progress; new complications have developed; or the patient’s functional level has changed significantly, requiring a new Plan of Care.

Although reimbursement for a reevaluation would be the same as an initial evaluation, the use of CPT Code 97164 has strict guidelines compared to an initial evaluation. In Florida, you typically cannot bill this more than once every few months per patient without proving a major clinical need. Billing this code multiple times without a clear “trigger” is a common red flag for auditors.

2). Treatment Visit Code (General Physical Therapy)

These codes provide the primary income for your practice. So, make sure you know these codes well. General treatment services generate the majority of revenue for a clinic and are utilized by physical therapists during almost every session.

As these codes are considered essential for cash flow, you must understand how different types of providers (PT’s and Assistants) affect the overall profit margin.

Code	Modifier	Description	Maximum Fee	Maximum Allowable Units
97110	GP	Therapy Treatment Session Provided by a Physical Therapist	$20.33	4 per day, 14 per week
97110	HM	Therapy Treatment Session Provided by a Therapy Assistant	$16.28	Same as above

CPT Code 97110 for a Therapeutic Exercise

Under the 2026 Fee Schedule for physical therapy in Florida, 97110 for Therapeutic Exercise pays $20.33 when delivered by a Physical Therapist (PT). And $16.28 when delivered by a physical therapist assistant. While a difference of $4.05 per unit might seem small, it adds up fast over dozens of sessions and hundreds of units. Also, as this is your most frequently used code, understanding the price gap between a PT and a PTA is the only way to manage your profit margins effectively.

3). Specialized Therapy Treatments Code

These codes are used to target specific clinical goals such as neurological recovery or functional improvement. Therefore, proper documentation is necessary to demonstrate medical necessity, ensure coverage, and reimbursement.

Code	Description	Maximum Fee	Maximum Allowable Units
97112	Neuromuscular Reeducation Therapy Session	$20.33	4 per day, 14 per week
97113	Aquatic Therapy Session	$20.33	4 per day, 14 per week
97530	Therapeutic Activities Session	$20.33	4 per day, 14 per week

CPT Code 97112 for a Neuromuscular Re‑education

Similar to CPT code 97110, Neuromuscular Re-education also pays a maximum of $20.33. This code covers skilled training for balance, coordination, and proprioception. It is typically required for patients recovering from neurological injury, including but not limited to stroke and vestibular disorders.

As with all of the other codes, the payment is reliable; however, precise documentation is the main requirement to support the claim. For instance, the therapist must show that they are retraining the nervous system and aren’t just performing strength exercises.

CPT Code 97113 for Aquatic Therapy

Aquatic Therapy also pays a maximum of $20.33. It is used for patients who cannot fully weight-bear on land due to arthritis, joint pain, or post-surgical edema. The fee for aquatic therapy is the same as land-based exercise; the location and the patient population provide an additional option for patients who need the buoyancy of water to start recovery.

CPT Code 97530 for Therapeutic Activities

Therapeutic Activities pay $20.33 and focus on functional activities, i.e., lifting, carrying, and reaching. While exercise codes (97110) focus on individual muscle strength, 97530 addresses the patient’s ability to perform real-world tasks. Since the reimbursement is the same, your choice between these codes should be based strictly on the patient’s functional goals and what you have documented in the medical record.

4). Assistive & Functional Training Code

In Florida’s 2026 Medicaid fee schedule, the Assistive & Functional Training Code is specifically for services that provide patients with the opportunity to regain their independence. It includes training on assistive devices, improving home mobility, and learning safety procedures for daily tasks.

While these services have the potential for greater reimbursement, they are typically subject to limitations and therefore must be carefully documented.

Code	Modifier	Description	Maximum Fee	Maximum Allowable Units
97542	GP	Wheelchair Management and Training by a Therapist	$36.38	4 visits per year

97542 for a Wheelchair Management

Wheelchair management gets paid a fee of $36.38 per 15-minute unit. It is limited to four visits per calendar year. Therefore, each visit must be thoroughly documented to justify why a wheelchair assessment was medically necessary.

Although the fee is higher than standard treatment codes, clinics must use 97543 carefully. If a practice consistently documents wheelchair usage, it will exceed the limit of four visits. For this reason, it should not be relied upon as a source of steady, recurring income.

5). Orthopedic Support Services Code

This code includes physical therapy techniques used to manage injuries. It is critical to use accurate modifiers, as incorrect or missing modifiers may prevent claims from being paid.

Code	Modifier	Description	Maximum Fee	Maximum Allowable Units
29799	HA, GP	Casting or Strapping Application	$22.27	2 per day

CPT Code 29799 for a Casting/Strapping

CPT code 29799 is used for unlisted casting or strapping procedures. Because this is an unlisted code, the $22.27 figure is a baseline, but the actual payment depends on your documentation.

This code is unique because it often requires two modifiers to be processed correctly in Florida:

• HA (to identify the service as part of a child/adolescent program)
• GP (to identify it as a physical therapy service)

If either modifier is missing or in the wrong order, the claim will be denied automatically.

Important note: CPT 29799 is a unique treatment code that frequently requires two modifiers for successful processing. It is crucial to enter HA as Modifier 1 and GP as Modifier 2 in your billing software. Validating that both modifiers are present and in this specific order is essential to prevent an automatic claim denial.

Modifiers in Physical Therapy Billing and Fee Adjustments

Modifiers are not an alteration of the service being performed. But rather, it’s additional information that gives the payer a better understanding of the services provided by physical therapists.

If Modifiers are incorrectly entered, they essentially nullify the claim process. In the table below, you can go through the modifiers that add specificity to physical therapy CPT codes in Florida.

Modifier	Purpose	Used With Code(s)	Key Details / Impact on Payment & Claims
GP	Indicates services are provided under a Physical Therapist’s Plan of Care	Most PT Codes	Required for most physical therapy billing. Missing GP may result in claim denial or incorrect processing.
HM	Indicates services are performed by a Physical Therapy Assistant (PTA)	97110	Results in reduced payment. Payment decreases from $20.33 (GP) to $16.28 when HM is applied.
HA	Used for casting or strapping procedures	29799	Must be used together with GP. HA must be entered first, followed by GP, otherwise the claim will be denied.

GP Modifier

Most PT Codes (97110, 97530, 97542, 29799) require a GP modifier. The GP modifier indicates that the physical therapy services are being provided under a Physical Therapist’s Plan of Care. Without a GP modifier, the insurance company may deny your claim or send it to an inappropriate medical specialty.

HM Modifier

The HM Modifier is used in conjunction with Code 97110 (Therapeutic Exercise) to indicate that a Physical Therapy Assistant (PTA) is delivering the service. When using this Modifier, you can expect a reduced payment for the CPT Code.

For example, if the normal payment for Code 97110, along with modifier GP, would be approximately $20.33, with the HM Modifier, you would receive a payment of approximately $16.28.

HA Modifier

When billing for casting/strapping (code 29799), you need to use both HA and GP modifiers. When coding for Casting/Strapping, you have to enter HA before GP. If you reverse the order or leave out either modifier, your claim will be rejected. The maximum allowable fee associated with this modifier is $22.27.

Tip: Manual checks may be a good idea, but they can also fail under high-pressure situations. Therefore, validate the correct usage of modifiers through EHR.

Understanding CPT Unit Limits and Revenue Caps

When you provide an evaluation or treatment using CPT codes, Florida Medicaid applies strict limits on how often each CPT code may be billed in a Day, Week, month, etc.

These limitations are referred to as Maximum Allowable Units. They represent the maximum amount that may be billed for a particular CPT code during the specified time period.

For example, if you exceed these limits by one visit, regardless of how many hours of treatment were performed, your claim will be automatically denied.

➜ Maximum Allowable Units per Day

For 2026, the following CPT codes are limited to a total of 4 units per day: 97110, 97112, 97113, and 97530. Casting services (29799) are limited to 2 units per day.

Regardless of the total services rendered, a therapist cannot exceed these daily limits. It is possible to perform a full hour of therapy, but only receive reimbursement for the units allowed by the cap.

Example of Daily Billing Limitation (97110):

• Max Units/Day: 4
• Pay/Unit: $20.33
• Total Max Per Day: $81.32
• Note: You cannot bill a 5th unit, even if the patient requires more time.

Example of Daily Billing Limitation (29799):

• Max Units/Day: 2
• Pay/Unit: $22.27
• Total Max Per Day: $44.54
• Note: You cannot bill for 3 units, even if you cast multiple areas.

➜ Maximum Allowable Units per Week

In Florida, the common therapeutic codes (97110, 97112, 97113, 97530) are capped at 14 units per week. Therapists must carefully schedule sessions to stay within this limit; otherwise, units billed at the end of the week will be automatically denied.

Example of Weekly Billing Limitation (CPT 97110)

Provider Level	Max Units/Week	Pay/Unit	Total Max/Week
PT (GP Modifier)	14	$20.33	$284.62
PTA (HM Modifier)	14	$16.28	$227.92

The difference in revenue is $56.70 less per week when using an assistant (PTA).

➜ Maximum Allowable Units per 5 Months

CPT 97164 (Re-evaluation) is payable only once every five months. Therapists must track this date specifically; a re-evaluation cannot be billed as a standard treatment appointment.

Example of 5-Month Limitation:

• Max Units: 1 per 5 months
• Pay/Unit: $58.11
• Total Max/Period: $58.11

➜ Maximum Allowable Units per Year

Initial evaluations and specialized assessments have strict annual caps. These limits typically reset at the beginning of the patient’s plan year.

• Initial Evaluations (97161–97163): 1 unit per year ($58.11)
• Wheelchair Management (97542): 4 units per year ($145.52 total)

Example of Annual Limitation:

If you bill for a high-complexity evaluation (97163) today, you cannot bill for a second evaluation of any complexity level for that patient until the limit resets next year.

FAQs

What’s the main difference between using Modifier GP on CPT 97110 and HM on CPT 97110?

The use of Modifier GP means that the service was performed by a Licensed Physical Therapist, who is reimbursed at a maximum of $20.33. The use of Modifier HM means that the service was performed by a Physical Therapist Assistant and will be reimbursed at a maximum of $16.28. A PTA works under the direction of a Physical Therapist and is generally paid at a lower rate than a Licensed Physical Therapist (LPT).

In 2026, how many PT Treatment Visits are permitted weekly?

According to the new 2026 Florida Medicaid Fee Schedule, these codes 97110, 97112, 97113, and 97530 are limited to four units per day and 14 units per week. There is no overall limit to treatment visit codes as long as they are used appropriately per individual code.

What does CPT Code 29799 cover in physical therapy?

CPT Code 29799 covers the application of a cast or strap by a Physical Therapist as part of their plan of care. CPT Code 29799 requires both the HA and GP Modifiers and is payable at a maximum of $22.27 per unit with a maximum of 2 units allowable per day.