New York Medicaid (fee schedule) pediatric speech and OT coverage: codes, telehealth and limits
The short answerSLP and OT. New York Medicaid pays $40.31 for 92507 (30 minute minimum session) and $18.05 for each 15 minutes of 97530 in a private office, with GN, GO or GP modifiers on therapy codes. Speech therapy can be based on an SLP referral. In other settings the institution is paid, not the therapist.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · New York. Public policy, not the member's benefits.
New York Medicaid (fee schedule)
Rehabilitation Services Procedure Codes & Fee Schedule, version 2026-V1 · New York
| 92507 | Listed ($40.31 non-facility, 30 minute minimum session) [1] |
|---|---|
| 92521 | Listed ($116.41 non-facility) [1] |
| 92522 | Listed ($97.85 non-facility) [1] |
| 92523 | Listed ($198.17 non-facility) [1] |
| 92524 | Listed ($96.32 non-facility) [1] |
| 97530 | Listed ($18.05 per 15 minutes non-facility) [1] |
| Telehealth modifier | Therapy codes must carry GP for physical therapy, GO for occupational therapy or GN for speech-language pathology plans of care. ST marks a patient with traumatic brain injury. [1] |
| Visit limits | 92507 has a 30 minute minimum session length. [1] |
| Referral | Services must be ordered in writing by a physician, physician assistant or nurse practitioner. Speech therapy may instead be based on a written referral from a speech-language pathologist authorized by law. [1] |
| Who can bill | Visits in private practitioners' offices, hospital outpatient departments and diagnostic and treatment centers are covered. In any setting other than a private office, the therapist cannot bill Medicaid directly and is paid by the medical institution. [1] |
| Payment | January 2026 non-facility fees: 92507 $40.31, 92521 $116.41, 92522 $97.85, 92523 $198.17, 92524 $96.32, 97530 $18.05 per 15 minutes. Fees apply in a private office. [1] |
What New York Medicaid (fee schedule)'s documents say
The table above has every field we found for New York Medicaid (fee schedule), with numbered sources. In short:
- Visit limits. 92507 has a 30 minute minimum session length.
- Who can bill. Visits in private practitioners' offices, hospital outpatient departments and diagnostic and treatment centers are covered. In any setting other than a private office, the therapist cannot bill Medicaid directly and is paid by the medical institution.
- Codes. 92507, 92521, 92522, 92523, 92524 and 97530 are listed.
Codes we checked at New York Medicaid (fee schedule)
What Medicaid's own text says about one code: 92507.
Other pediatric speech and OT rows for New York
Excellus BlueCross BlueShield (New York).
Check New York Medicaid (fee schedule)'s claim against the row
Before the claim goes out, compare it with the row above: the evaluation and treatment codes are ones the policy lists, the plan of care and any prior authorization cover the date, and the visit count fits the limit. The pediatric speech and OT table compares Medicaid with every other payer we checked.