Outpatient Therapy Services Fee Schedule and Coverage Indicators (SFY 2026)
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This document provides Alaska Medicaid's outpatient therapy fee schedule and coverage indicators (physical therapy, occupational therapy, speech/language pathology, outpatient therapy) and maximum allowable rates for CPT/HCPCS codes for State Fiscal Year 2026 (7/1/2025–6/30/2026). It affects providers billing Alaska Medicaid for outpatient PT/OT/SLP services and related procedures.
No material clinical or coverage changes in this revision.
Per-code Coverage & Payment Guidance
Per-code coverage and payment nodes
Per-code indicators in the fee schedule show which therapy discipline may bill the code (X marks applicable discipline), whether medical justification is required, and the maximum allowable payment.
ALL of the following
- Physical Therapy: X
- Occupational Therapy: (none)
- Speech/Language Pathology: (none)
- Outpatient Therapy: X
- Requires Medical Justification: No
- Maximum Allowable: $78.48
ALL of the following
- Physical Therapy: X
- Occupational Therapy: X
- Speech/Language Pathology: (none)
- Outpatient Therapy: X
- Requires Medical Justification: No
- Maximum Allowable: $116.67
ALL of the following
- Physical Therapy: X
- Occupational Therapy: X
- Speech/Language Pathology: (none)
- Outpatient Therapy: X
- Requires Medical Justification: No
- Maximum Allowable: $92.98
ALL of the following
- Physical Therapy: X
- Occupational Therapy: X
- Speech/Language Pathology: (none)
- Outpatient Therapy: X
- Requires Medical Justification: No
- Maximum Allowable: $110.88
ALL of the following
- Physical Therapy: X
- Occupational Therapy: X
- Speech/Language Pathology: (none)
- Outpatient Therapy: X
- Requires Medical Justification: No
- Maximum Allowable: $60.57
ALL of the following
- Physical Therapy: X
- Requires Medical Justification: No
- Maximum Allowable: $347.17
ALL of the following
- Physical Therapy: X
- Occupational Therapy: X
- Speech/Language Pathology: X
- Outpatient Therapy: X
- Requires Medical Justification: $201.52
ALL of the following
- Physical Therapy: X
- Occupational Therapy: X
- Speech/Language Pathology: (none)
- Outpatient Therapy: X
- Requires Medical Justification: $9.09
ALL of the following
- Physical Therapy: X
- Occupational Therapy: X
- Speech/Language Pathology: (none)
- Outpatient Therapy: X
- Requires Medical Justification: $18.50
Per-code coverage and payment guidance
Per-code coverage indicators and payment guidance:
ALL of the following
- Covers disciplines: Physical Therapy, Occupational Therapy, Speech/Language Pathology
- Outpatient: Yes
- Medical Justification threshold: $201.52
ALL of the following
- Covers disciplines: Physical Therapy, Occupational Therapy
- Outpatient: Yes
- Medical Justification threshold: $44.04
ALL of the following
- Covers disciplines: Physical Therapy
- Outpatient: Yes
- Maximum Allowable: See DME Fee Schedule
Procedure Codes, HCPCS, and Fee Schedule
| 92507 | TX SP LANG VOICE COMM INDIV - Maximum Allowable $116.77 |
| 92508 | TX SP LANG VOICE COMM GROUP - Maximum Allowable $35.46 |
| 92521 | EVALUATION OF SPEECH FLUENCY - Maximum Allowable $203.01 |
| 92626 | EVAL AUD FUNCJ 1ST HOUR - Requires medical justification; Maximum Allowable $129.00 |
| 97010 | HOT OR COLD PACKS THERAPY - Maximum Allowable $9.09 |
| 97014 | ELECTRIC STIMULATION THERAPY - Maximum Allowable $18.50 |
Documentation, Medical Justification, and Billing Requirements
Medical justification requirement example
Certain procedure codes require medical justification before payment. Document clinical reason(s) for the service, functional limitations, objective findings, treatment goals, and progress toward goals. Attach supporting evaluation notes, standardized test scores, or other objective measures when applicable.
- Example: CPT 92626 (Evaluation of auditory rehabilitation status) requires medical justification when billed — include indication, prior treatment history, and findings that support need for the evaluation.
- Include date(s) of prior conservative treatment, response to prior therapies, and rationale for continued or additional therapy.
- For eval codes, document complexity level, time spent, and components performed to support the selected CPT evaluation code.
Medical justification thresholds for selected procedure codes
Providers must ensure medical justification thresholds are met for the listed procedure codes; claims may be denied or returned for insufficient documentation when billed amounts or frequencies exceed the listed thresholds without supporting clinical justification.
- 96112 – Requires medical justification at $201.52
- 96113 – Requires medical justification at $86.49
- 97010 – Requires medical justification at $9.09
- 97012 – Requires medical justification at $22.12
- 97014 – Requires medical justification at $18.50
- 97110 – Requires medical justification at $44.04
- 97112 – Requires medical justification at $49.00
- 97113 – Requires medical justification at $54.50
- 97116 – Requires medical justification at $44.04
- 97124 – Requires medical justification at $43.68
- 97129 – Requires medical justification at $35.70
- 97130 – Requires medical justification at $34.14
- 97140 – Requires medical justification at $41.64
- 97150 – Requires medical justification at $26.92
- 97161 – Requires medical justification at $149.95
- 97162 – Requires medical justification at $149.95
- 92626 – Requires medical justification (maximum allowable $129.00)
Therapy service documentation/justification
Therapy service documentation must include: the evaluation and/or treatment provided, objective measurements, discipline-specific findings, time spent (timed codes), modality parameters when applicable, frequency and duration plan, measurable goals, and evidence of progress or rationale for continued services. For outpatient therapy, clearly indicate the therapy discipline (PT/OT/SLP) and link each billed CPT to documentation supporting medical necessity and the billed units.
- For CPT 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97140, 97150: document treatment detail, time in minutes for timed codes, skilled service rationale, and objective change/progress.
- For CPT evaluation codes (97161–97163): document complexity, history, examination findings, clinical decision making, and time to justify the selected evaluation level and billed amount.
- For development/assessment codes (96112, 96113): include test name, administration time, results, interpretation, and how results affect the plan of care.
- When billing group therapy (97150), list group composition, member counts, and skilled activities performed for each member.
- When billing modalities (97010, 97012, 97014, etc.), document modality parameters (e.g., temperature, duration, settings), treatment purpose, and response.
- Retain all supporting documentation in the medical record and make available upon request for prior authorization or post-payment review.
Scope & Term Definitions
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