Ohio Medicaid physical therapy coverage: limits, who can bill and referrals
The short answerOhio Medicaid pays 30 PT visits per benefit year in a non-institutional setting without prior authorization; more need prior authorization. A prescription is required, evaluations once per condition, and additional units in a day pay 80%.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Ohio. Public policy, not the member's benefits.
Ohio Medicaid
Ohio Administrative Code 5160-8-35, Skilled therapy services (effective January 1, 2024) · Ohio
| Visit limits | Physical therapy in a non-institutional setting is paid without prior authorization for not more than thirty visits per benefit year. More visits can be requested through prior authorization under rule 5160-1-31. Evaluations are paid not more than once per injury or condition. [1] |
|---|---|
| Referral | PT must be rendered in response to a prescription from a licensed practitioner of the healing arts, and the evaluation and treatment plan must be kept on file. [1] |
| Who can bill | Physical therapists (and mechanotherapists) can bill for their own services. A licensed physical therapist assistant can render a service under supervision to one individual at a time. Hospitals, physician practices, professional medical groups, ambulatory health care clinics, FQHCs and RHCs can bill for a rendering therapist. [1] |
| Payment | When more than one therapy service of the same discipline is rendered the same day, the highest-paying one is primary and pays 100% for its first unit. Each additional unit or procedure in the same discipline pays 80%. Payment is the lesser of the charge or a percentage of the appendix DD fee amount. [1] |
| Also | Unattended electrical stimulation and iontophoresis are part of the associated therapy procedure and are not paid separately. Evaluation prognosis must show expected improvement within sixty days for rehabilitative therapy, or a safe maintenance program. Payment is made only for services listed in the treatment or maintenance plan. [1] |
- Ohio Administrative Code Rule 5160-8-35, Skilled therapy services (effective January 1, 2024), checked October 30, 2026
What Ohio Medicaid's documents say
The table above has every field we found for Ohio Medicaid, with numbered sources. In short:
- Visit limits. Physical therapy in a non-institutional setting is paid without prior authorization for not more than thirty visits per benefit year. More visits can be requested through prior authorization under rule 5160-1-31. Evaluations are paid not more than once per injury or condition.
- Who can bill. Physical therapists (and mechanotherapists) can bill for their own services. A licensed physical therapist assistant can render a service under supervision to one individual at a time. Hospitals, physician practices, professional medical groups, ambulatory health care clinics, FQHCs and RHCs can bill for a rendering therapist.
Other physical therapy rows for Ohio
Check Ohio 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.