New York Medicaid physical therapy coverage: telehealth, who can bill and referrals
The short answerNew York Medicaid covers medically necessary PT in private offices, hospital outpatient departments and free-standing clinics with a written order from a physician, PA or NP, and GP on the claim. Only private offices bill directly, and their fee schedule prices just 97530 and 97542 among the common PT codes.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · New York. Public policy, not the member's benefits.
New York Medicaid
eMedNY Rehabilitation Services Manual Policy Guidelines 2024-1 and Fee Schedule 2026-V1 · New York
| Where it applies | Visits in private practitioners' offices, certified hospital outpatient departments and free-standing diagnostic and treatment centers are covered when medically necessary. Therapy is medically necessary when there is a treatment plan with measurable goals, an identifiable diagnosis, a reasonable expectation of measurable functional outcomes and it is not duplicate therapy. [1][2] |
|---|---|
| Telehealth modifier | The GP modifier (services under an outpatient physical therapy plan of care) must be used with therapy procedure codes on Medicaid claims. NCCI associated modifiers are recognized for code pairs. [1] |
| Referral | PT must be ordered in writing by a physician, physician assistant or nurse practitioner authorized by law. An evaluation is required before any treatment plan is implemented. [2] |
| Who can bill | A qualified practitioner is a licensed therapist working within scope. PT assistants can provide services under the direction and supervision of the physical therapist. Aides, athletic trainers, exercise physiologists and rehabilitation technicians do not qualify regardless of supervision. [2] |
| Payment | January 2026 eMedNY non-facility fees (private office only): the PT/OT section lists 97530 $18.05 and 97542 $44.58; eVisits 98970 $9.42, 98971 $16.61, 98972 $26.74. Other common PT codes (97110, 97112, 97140, 97161 to 97164) are not on this schedule. In other settings (D&TC, hospital outpatient, nursing home) the therapist cannot bill Medicaid directly and the institution is paid. Fees are payment in full. [1] |
- NY Medicaid (eMedNY): Rehabilitation Services Procedure Codes & Fee Schedule, 2026-V1 (PDF), checked October 30, 2026
- NY Medicaid (eMedNY): Rehabilitation Services Manual Policy Guidelines, Version 2024-1 (PDF), checked October 30, 2026
What New York Medicaid's documents say
The table above has every field we found for New York Medicaid, with numbered sources. In short:
- Who can bill. A qualified practitioner is a licensed therapist working within scope. PT assistants can provide services under the direction and supervision of the physical therapist. Aides, athletic trainers, exercise physiologists and rehabilitation technicians do not qualify regardless of supervision.
- Where it applies. Visits in private practitioners' offices, certified hospital outpatient departments and free-standing diagnostic and treatment centers are covered when medically necessary. Therapy is medically necessary when there is a treatment plan with measurable goals, an identifiable diagnosis, a reasonable expectation of measurable functional outcomes and it is not duplicate therapy.
Check New York Medicaid's claim against the row
Before the claim goes out, compare it with the row above: the evaluation code matches the complexity you documented, the timed codes fit the minutes, any prior authorization covers the visit, and the plan of care is signed when the payer asks for it. The physical therapy table compares Medicaid with every other payer we checked.