CurrentAlaska MedicaidPolicy N/A

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.

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CurrentAlaska MedicaidPolicy N/A

Outpatient Therapy Services Fee Schedule and Coverage Indicators (SFY 2026)

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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

Procedure Codes, HCPCS, and Fee Schedule

Sample listed outpatient therapy CPT/HCPCS with ratesCPTCovered

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

Common PT/OT therapy codes with fees/justificationCPTCovered

97110	THERAPEUTIC EXERCISES
97112	NEUROMUSCULAR REEDUCATION
97113	AQUATIC THERAPY/EXERCISES

DME/orthotic HCPCS/L-codes referencing DME fee scheduleHCPCSCovered

A4565	SLINGS (DME)
L0120	CERV FLEXIBLE NON-ADJUSTABLE

Assistive technology and orthotic/prosthetic managementCPTCovered

97755	ASSISTIVE TECHNOLOGY ASSESS
97760	ORTHOTIC MGMT & TRAINING 1ST ENC

Rate rounding rule

Rounding ruleRBRVS-based rates are rounded to the nearest cent following adjustments for multiple units and cutbacks.

Highest medical justification amount observed

Highest medical-justification amount observed$420.77 (97607 Requires Medical Justification = $420.77)

Common PT evaluation maximums/justification

Common PT evaluation maximums (97161/97162/97163)$149.95 (maximum allowable for 97161 / 97162 / 97163 as shown in the schedule)

97110 typical justification

Documentation, Medical Justification, and Billing Requirements

Documentation Required

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.

Denial Risk

Medical justification thresholds for selected procedure codes

Scope & Term Definitions

Outpatient Therapy Services — program types and service categories included

Included program typesPhysical Therapy (039); Occupational Therapy (041); Speech/Language Pathology (040); Outpatient Occ, Speech, and PT center (045)

Service categoriesOutpatient therapy services for PT, OT, SLP and related outpatient center services

Effective periodState Fiscal Year 2026 effective 7/1/2025 - 6/30/2026

Requires Medical Justification — definition of the dollar-amount threshold

DefinitionA dollar amount listed next to procedure codes indicating a medical-justification threshold or associated fee value for Alaska Medicaid reimbursement as presented in this schedule.

PurposeIndicates when providers must supply medical justification to support payment at or above the listed amount

Documentation Required

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.