Virginia Medicaid physical therapy coverage: codes, limits and prior authorization
The short answerVirginia fee-for-service Medicaid pays the first 5 visits per discipline each July 1 to June 30, including the evaluation, without service authorization. Anything over five needs authorization from Acentra Health before payment; MCO members follow their plan.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Virginia. Public policy, not the member's benefits.
Virginia Medicaid
DMAS Rehabilitation Provider Manual, Appendix D Service Authorization (9/24/2026) · Virginia
| 97110 | Listed (1 unit = 15 minutes) [1] |
|---|---|
| 97161 | Listed (evaluation, 1 unit = an evaluation) [1] |
| Other codes | Private rehabilitation agencies, CORFs and physician providers request authorization with CPT codes: 97110 and 97112, 97140 and the 97161 to 97163 evaluations are among the listed codes (1 unit = 15 minutes for timed codes, 1 unit = an evaluation for evaluations). [1] |
| Visit limits | Fee-for-service members get 5 visits per rehabilitative discipline per state fiscal year (July 1 to June 30) without service authorization, counting the initial evaluation and all providers combined. The limit renews every July 1, and the provider must use those first five before the authorization number applies. Managed care members follow their MCO's rules. [1] |
| Prior authorization | Service authorization requests go to Acentra Health through its Atrezzo Next Generation portal. Authorization is required before payment for any units over five a year, so a provider who knows treatment will go beyond 5 visits must request it. [1] |
- Virginia DMAS: Rehabilitation Provider Manual, Appendix D Service Authorization (revised 9/24/2026, PDF), checked October 30, 2026
What Virginia Medicaid's documents say
The table above has every field we found for Virginia Medicaid, with numbered sources. In short:
- Prior authorization. Service authorization requests go to Acentra Health through its Atrezzo Next Generation portal. Authorization is required before payment for any units over five a year, so a provider who knows treatment will go beyond 5 visits must request it.
- Visit limits. Fee-for-service members get 5 visits per rehabilitative discipline per state fiscal year (July 1 to June 30) without service authorization, counting the initial evaluation and all providers combined. The limit renews every July 1, and the provider must use those first five before the authorization number applies. Managed care members follow their MCO's rules.
- Codes. 97110 and 97161 are listed.
Check Virginia 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.