Yes. The Oregon Health Plan covers physical therapy when it is medically necessary and the condition being treated sits on the funded portion of Oregon’s Prioritized List of Health Services. For most members using an in-network provider, there is no copay, no coinsurance, and no deductible.1Oregon Health Authority. Summary of Benefits and Coverage2Oregon Health Authority. Oregon Health Plan Benefits Overview Coverage comes with annual visit caps, and the steps for getting care differ depending on whether you are in a Coordinated Care Organization (CCO) or on fee-for-service OHP.
What’s Covered and What Isn’t
Physical therapy is listed as a covered rehabilitation service under OHP. Out-of-network physical therapy is not covered.1Oregon Health Authority. Summary of Benefits and Coverage
The benefit package you have matters. OHP Plus, the more comprehensive package, includes physical therapy. OHP Standard, the more limited package, does not list physical therapy as a covered service.3Moda Health. Quick Reference Guide to OHP Plus and Standard Covered Services You can confirm which package you have in your OHP coverage letter, available through the dashboard at ONE.Oregon.gov.4Oregon Health Authority. OHP Benefits
For adults 21 and older, coverage of any particular course of physical therapy depends on the Prioritized List. The list pairs diagnoses with treatments and ranks them; as of February 2026, OHP covers lines 1 through 470.5Oregon Health Authority. Prioritized List of Health Services If your diagnosis and the physical therapy code fall together on a funded line, the service is covered. Diagnostic services needed to establish the diagnosis in the first place are covered regardless of where that diagnosis ultimately lands.6Oregon Health Authority. Prioritized List Overview
Children under 21 are not subject to the Prioritized List. Federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) rules require OHP to cover all medically necessary services for children, including physical therapy that might be limited or excluded for adults.7Oregon Health Authority. OHP Limitations
Annual Visit Limits
OHP sets two separate caps, one for each type of therapy:
- Rehabilitative therapy, which helps you restore skills lost to illness, injury, or disability: 30 visits per year.
- Habilitative therapy, which helps you develop skills you have not yet acquired at an age-appropriate level, such as a child learning to walk: a separate 30 visits per year.
These caps are set in Guideline Note 6 of the Prioritized List and apply to physical therapy and occupational therapy combined.8Oregon Public Law. OAR 410-131-0040
An additional 30 visits per year in each category can be authorized when a member has a new acute injury, a surgery, or a significant change in functional status. Children under 21 can receive visits beyond even those extended limits when medically appropriate.9Oregon Health Authority. Guideline Note 6, Prioritized List of Health Services
Members with spinal cord injuries, traumatic brain injuries, or strokes are exempt from the visit caps entirely during the first year after the injury. Visit limits also do not apply while a patient is in a skilled nursing facility for rehabilitation, an inpatient hospital, or an inpatient rehabilitation unit.9Oregon Health Authority. Guideline Note 6, Prioritized List of Health Services
Referrals and Prior Authorization
The approvals you need depend on how you get your OHP coverage.
On fee-for-service OHP (not enrolled in a CCO), the Oregon Health Authority has stated that physical therapy no longer requires prior authorization from OHA itself. Claims are reviewed after the fact against payment criteria. Initial evaluations and re-evaluations are not subject to prepayment review and need no prior authorization.10Oregon Health Authority. OHA PT/OT Bulletin Once you exceed 30 rehabilitative or 30 habilitative visits in a calendar year, your provider has five working days to request prior authorization. If filed on time, the authorization can be applied retroactively to services provided within the preceding five days.11Oregon Public Law. OAR 410-131-0160
In a CCO, the CCO sets its own authorization rules. Many require prior authorization for continued physical therapy after the initial visit. Trillium Community Health Plan, for example, does not require prior authorization for the first visit but does require it for continued care.12Trillium Community Health Plan. Prior Authorization and Referrals Check with your CCO directly for its policy.
You may also need a referral from your primary care provider. OHA notes that members may need a PCP referral to see certain providers, including physical therapists, and without one you could be billed.13Oregon Health Authority. Find Providers
What the Therapy Itself Has to Meet
For a course of physical therapy to be covered, it has to meet the criteria in Guideline Note 6. The therapy must be delivered by a licensed physical therapist, physician, or other licensed practitioner. There must be objective, measurable documentation that the patient is making clinically significant progress toward their goals. And the plan of care must genuinely require the skills of a medical provider; if the patient or a caregiver can simply be taught to do the exercises at home, the ongoing therapy is not covered.9Oregon Health Authority. Guideline Note 6, Prioritized List of Health Services
Back and Neck Pain
Physical therapy for back and neck pain gained a specific place in OHP coverage in 2016, when the Health Evidence Review Commission expanded coverage for these conditions to include non-pharmacological treatments. Along with physical therapy, the expansion added occupational therapy, chiropractic care, cognitive behavioral therapy, acupuncture, and yoga.14Oregon Health Authority. HERC Removes OHP Opioid Tapering Requirement for Neck and Back Pain If you are seeking PT for back or neck pain, it falls within covered services.
A proposal to extend physical therapy coverage to five specific chronic pain conditions, including fibromyalgia and chronic pain syndrome, was rejected by HERC. Those conditions remain in the unfunded portion of the Prioritized List.15Medicaid.gov. Oregon Health Plan Approved Health Services List
Telehealth
OHP covers telehealth visits, including video, phone, and online appointments, for what the Oregon Health Authority describes as most regular care. Physical therapy is not explicitly named in OHA’s telehealth materials; the general policy is that telehealth-eligible services are reimbursed the same as in-person visits, and whether a specific physical therapy service qualifies depends on the procedure code and Oregon’s Ancillary Guideline A5.16Oregon Health Authority. OHP Telehealth Ask your provider whether your treatment plan can be delivered remotely.
Finding an In-Network Physical Therapist
If you are in a CCO, use the CCO’s provider directory or call the CCO. Health Share of Oregon offers a searchable directory where you can filter by “Physical Therapist” across its network partners, including CareOregon, Kaiser Permanente, OHSU Health, and Providence.17Health Share of Oregon. Find a Provider If you are on fee-for-service OHP, use the state’s Online Provider Locator or call OHP Care Coordination at 800-562-4620.13Oregon Health Authority. Find Providers Call the clinic before scheduling to confirm the therapist takes OHP and your specific CCO.