Washington Apple Health physical therapy coverage: codes, telehealth, limits and prior authorization
The short answerApple Health pays 24 PT units (about 6 hours) per calendar year for adults 21 and older, with one evaluation and one discharge re-evaluation. Expedited prior authorization adds 24 units for listed diagnoses. Audio-only PT is not allowed.
By Javier Alvarez · Updated · 1 min read
1 row: Medicaid (by state) · Washington. Public policy, not the member's benefits.
Washington Apple Health
Washington Apple Health Outpatient Rehabilitation Billing Guide (Jan 1, 2026) · Washington
| 97110 | Listed (counts toward the 24-unit adult limit; on the audio-visual telemedicine list) [1] |
|---|---|
| 97140 | Listed (timed 15-minute units, GP or GO; counts toward the 24-unit adult limit) [1] |
| 97161 | Listed (evaluation; on the audio-visual telemedicine list) [1] |
| 97530 | Listed (timed 15-minute units, GP or GO; on the audio-visual telemedicine list) [1] |
| Telehealth rules | HCA pays for PT evaluation, re-evaluation and treatment by audio-visual telemedicine with specific codes (97161 to 97164, 97110, 97112, 97116, 97150, 97530, 97535, 97750) when clinically appropriate. Audio-only is not allowed for outpatient physical or occupational therapy. [1] |
| Visit limits | Clients age 21 and older (and MCS clients 19 to 20) get 24 PT units, about 6 hours, per calendar year in any setting, plus one evaluation and one re-evaluation at discharge a year. Clients 20 and younger have unlimited outpatient rehabilitation (except MCS ages 19 to 20). Check available units with HCA before treating. [1] |
| Prior authorization | Expedited prior authorization (EPA) adds up to 24 more units for listed diagnoses, such as non-healing wounds, burns, brain injury and stroke with residual deficits, and one extra evaluation for a new injury. Units beyond that need a limitation extension. [1] |
| Who can bill | Licensed physical therapists enroll with HCA. PTA services need CQ on the claim line along with GP, or the claim is rejected as unprocessed. [1] |
| Also | A new therapy prescription in the same calendar year requires an authorization for a new evaluation before more care, even if units remain. Extra units are tied to the condition they were authorized for and do not roll over. [1] |
What Washington Apple Health's documents say
The table above has every field we found for Washington Apple Health, with numbered sources. In short:
- Prior authorization. Expedited prior authorization (EPA) adds up to 24 more units for listed diagnoses, such as non-healing wounds, burns, brain injury and stroke with residual deficits, and one extra evaluation for a new injury. Units beyond that need a limitation extension.
- Visit limits. Clients age 21 and older (and MCS clients 19 to 20) get 24 PT units, about 6 hours, per calendar year in any setting, plus one evaluation and one re-evaluation at discharge a year. Clients 20 and younger have unlimited outpatient rehabilitation (except MCS ages 19 to 20). Check available units with HCA before treating.
- Who can bill. Licensed physical therapists enroll with HCA. PTA services need CQ on the claim line along with GP, or the claim is rejected as unprocessed.
- Codes. 97110, 97140, 97161 and 97530 are listed.
Check Washington Apple Health'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.