Yes, the Oregon Health Plan does cover 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 charge for covered visits, and OHP benefit packages carry no deductible, copayment, or coinsurance.1Oregon Health Authority. Summary of Benefits and Coverage2Oregon Health Authority. Oregon Health Plan Benefits Overview Out-of-network physical therapy is not covered.
When Physical Therapy Is Covered
For adults 21 and older, coverage turns on Oregon’s Prioritized List. The list ranks condition-and-treatment pairs, and as of February 2026, OHP covers lines 1 through 470.3Oregon Health Authority. Prioritized List of Health Services If your diagnosis and the physical therapy procedure code pair together on a covered line, the service is paid for. Diagnostic services needed to establish a diagnosis are covered regardless of where that diagnosis ultimately lands on the list.4Oregon Health Authority. Prioritized List Overview
Children under 21 are not subject to the Prioritized List. Federal Early and Periodic Screening, Diagnostic, and Treatment rules require OHP to cover all medically necessary services for children, including physical therapy that might be limited or unavailable for adults.5Oregon Health Authority. OHP Limitations
Which benefit package you have also matters. Under OHP Plus, the more comprehensive package, physical therapy is a covered service. Under OHP Standard, it is not listed as covered.6Moda Health. Quick Reference Guide to OHP Plus and Standard Covered Services You can check which package you have by reviewing your OHP coverage letter through the dashboard at ONE.Oregon.gov.7Oregon Health Authority. OHP Benefits
A course of therapy also has to meet clinical criteria set in Guideline Note 6. It must be delivered by a licensed physical therapist, physician, or other licensed practitioner. There must be objective, measurable documentation of clinically significant progress toward the goals in the plan of care. And the treatment must genuinely require a medical provider’s skills; if you or a caregiver can be taught to do the work at home, the ongoing visits are not covered.8Oregon Health Authority. Guideline Note 6, Prioritized List of Health Services
How Many Visits OHP Pays For
OHP separates therapy into two categories and sets a cap on each.
- Rehabilitative therapy, which helps you restore or regain 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 apply to physical therapy and occupational therapy combined, and they are set in Guideline Note 6.9Oregon Public Law. OAR 410-131-0040
Additional visits are available in real-world situations. An extra 30 visits per year in each category can be authorized after a new acute injury, a surgery, or a significant change in functional status. Children under 21 may receive visits beyond even those extended limits when medically appropriate. Patients with spinal cord injuries, traumatic brain injuries, or strokes are exempt from visit limits entirely during the first year after injury.8Oregon Health Authority. Guideline Note 6, Prioritized List of Health Services
Visit limits also do not apply while you are in a skilled nursing facility for rehabilitation, an inpatient hospital, or an inpatient rehabilitation unit.8Oregon Health Authority. Guideline Note 6, Prioritized List of Health Services
Referrals and Prior Authorization
What you need to have in hand before a visit depends on how you receive OHP.
If you are a fee-for-service member (not enrolled in a Coordinated Care Organization), the Oregon Health Authority no longer requires prior authorization from OHA itself for physical therapy. Claims are reviewed after submission to confirm they meet payment criteria.10Oregon Health Authority. OHA PT/OT Bulletin Initial evaluations and re-evaluations do not require prior authorization. Once you exceed 30 rehabilitative or 30 habilitative visits in a calendar year, the provider has to request prior authorization within five working days; a timely request can be approved retroactively to cover services provided within the preceding five days.11Oregon Public Law. OAR 410-131-0160
If you are enrolled in a CCO, the CCO sets its own rules. Some require prior authorization for continued visits after the initial evaluation. Trillium Community Health Plan, for example, does not require prior authorization for the first physical therapy visit but does require it for continued visits.12Trillium Community Health Plan. Prior Authorization and Referrals Check directly with your CCO before scheduling.
You may also need a referral from your primary care provider. OHA warns that without a required PCP referral, you could be responsible for the bill.13Oregon Health Authority. Find Providers
Back and Neck Pain
Physical therapy for back and neck pain is specifically covered under a policy the Health Evidence Review Commission adopted in 2016. The commission broadened coverage for these conditions to include non-pharmacological treatments: physical therapy, occupational therapy, chiropractic care, cognitive behavioral therapy, acupuncture, and yoga.14Oregon Health Authority. HERC Removes OHP Opioid Tapering Requirement for Neck and Back Pain The policy was designed to shift treatment away from opioid prescriptions toward evidence-based alternatives.
Not every chronic pain diagnosis gained the same access. A proposal to extend physical therapy coverage to five chronic pain conditions, including fibromyalgia and chronic pain syndrome, was rejected by HERC, and those conditions remain in the unfunded portion of the Prioritized List.15Medicaid.gov. Oregon Health Plan Approved Health Services List
Telehealth Visits
OHP covers telehealth appointments, including video, phone, and online visits, for what the Oregon Health Authority describes as “most of your regular care.” The state does not explicitly name physical therapy in its telehealth materials, and whether a specific service can be delivered remotely depends on the procedure code and Oregon’s Ancillary Guideline A5.16Oregon Health Authority. OHP Telehealth Ask your provider whether your treatment plan qualifies.
Finding an In-Network Physical Therapist
If you are enrolled in a CCO, use your CCO’s provider directory or call the CCO directly. Health Share of Oregon, for example, 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 not in a CCO, use the state’s Online Provider Locator or call OHP Care Coordination at 800-562-4620.13Oregon Health Authority. Find Providers Whichever route you use, call the therapist’s office before scheduling to confirm they accept OHP and your specific CCO.