It is incredibly important to note that none of this information has been generated from, though, because of, or in any way a part of any clinical data, claims data, or insurance processing that we have done within our mental health billing service at TheraThink. All information enclosed is based purely on contracted rates for in-network providers that have been shared with us. Again, no clinical, claims, or private information was used during the creation of this article. We take HIPAA extremely seriously.
Skip ahead to see mental health reimbursement rates by CPT code!
So you want to figure out what are insurance reimbursement rates for psychotherapy and mental health services. We can’t blame you.
Insurance companies are completely unwilling to release their contracted rate information for reason we’ll discuss shortly and as a result, you don’t know how much you’ll be reimbursed for providing psychotherapy and other mental health services.
The truth is there are no guarantees about your contracted rates and this article certainly is not one.Instead, we hope to help illustrate, on a relative basis, the differences between payments based on license, CPT code, insurance company, and location, so you can make the best decision about which insurance companies to work with.
Want to skip all this wall of text nonsense about the intricacies of mental health reimbursement rates and just focus on doing therapy? We offer an mental health billing service to end all your insurance and claims nightmares!
- Why Insurance Companies Don’t Release Reimbursement Data
- Your Location Impacts Your Mental Health Reimbursement Rate
- Insurance Reimbursement Rates for Psychotherapy by State
- Psychotherapy Reimbursement Rates for Private Insurance
- Your License Impacts Your Insurance Reimbursement Rate for Psychotherapy
- Medicaid Mental Health Reimbursement Rates 
- Medicaid License Practitioner Level Information
- Medicaid Mental Health Reimbursement Rates for Individual Therapy 
- Your Taxonomy Code Impacts Your Insurance Reimbursement
- Medicare Reimbursement Rates for Psychotherapy 
- Provider Demand Effecting Reimbursement
- How to Choose Insurance Companies for Mental Health Credentialing
Why Mental Health Insurance Companies Don’t Release Reimbursement Rate Information
There are a few reasons that insurance companies won’t let you know what you’ll be paid until you are accepted in their network.
The biggest reason they don’t release contracted rate information is they change their rates daily, depending on a few factors and mechanisms. This is the primary reason you cannot find insurance reimbursement rates for psychotherapy online — they are not “set”.
Your contracted rate will vary compared to colleagues in many cases because it is specific to you.
Factors that effect your insurance reimbursement rate for psychotherapy:
- Location, paying more for under-served locales and less for over-served locations.
- License, education, and specialization.
- Consumer demand at the time of signing your contract.
(Tip: Renegotiate Your Contracted Rate Annually)
Your contracted rate for a specific insurance plan or network is set when you sign your initial contract.
Insurance companies tend not to change, nor adjust, your rates for inflation if you do not personally request a raise or update of your fee schedule.
As a result, many providers get stuck with lower insurance reimbursement rates for psychotherapy without realizing they are being underpaid.
We strongly encourage all our providers we work with to request an annual fee schedule adjustment to match inflation. If you haven’t received a raise in pay in the last two years, we suggest you reach out to request a 5%-15% raise in pay.
How Your Location Impacts Your Mental Health Reimbursement Rate
Your location has an enormous impact on your contracted rate.
If you live in San Francisco, Los Angeles, Seattle, or many cities with high levels of education, there tend to be an abundance of mental health providers serving those locales.
On the other hand, if you are only one of a small handful of providers in a town, city, or state, you may see a significantly higher insurance reimbursement rate for psychotherapy.
Want to make the most money per session? You could move to Alaska.
Your location is one of the least flexible aspects that decides your contracted rate with insurance companies but it has a serious impact on your reimbursement rates for psychotherapy.
Consider this a business strategy question you’ll need to answer before settling on an office location.
The closer you are in proximity to under-served locales, the higher you can expect your rates to be priced.
If you are struggling to pick the right companies to increase your caseload, consider working with our mental health billing service to get these sorts of questions answered, along with all your billing, with way less headache along the way.
Insurance Reimbursement Rates for Psychotherapy Compared by State
Below is an sample list of insurance reimbursement rates for one national insurance company, with roughly the same license, LICSW / Level 3 License, across multiple states, for a 60 minute individual therapy session:
|Alaska – AK||$100-$110|
|Maine – ME||$60-$85|
|Ohio – OH||$75-$90|
|Rhode Island – RI||$75-$90|
|Oregon – OR||$80-$105|
|California – CA||$80-$85|
|Georgia – GA||$80-$90|
|Maryland – MD||$80-$90|
|New York – NY||$80-$95|
|Colorado – CO||$85-$95|
|Washington – WA||$90-$100|
|Virginia – VA||$90-$105|
|Pennsylvania – PA||$90-$110|
|Texas – TX||$90-$110|
Again, these are estimated rates for a typical 60 minute session for an entry-level mental health license. The city you practice in will have a larger impact on your insurance reimbursement rates for psychotherapy than the state you pick.
This is not a representation of what rates will be today or in the future but a general range to expect, rather we are illustrating that each state varies.
Medicare Insurance Reimbursement Rates by State [2022 Rates]
|State||Fee Schedule Area||CPT Code 90791 Reimbursement Rate 2022||Reimbursement Compared to National Rate|
|CA - California||SANTA CLARA (SANTA CLARA COUNTY)||$224.26||114.73%|
|CA - California||SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO COUNTY)||$225.09||115.16%|
|CA - California||SAN FRANCISCO (SAN FRANCISCO COUNTY)||$219.23||112.16%|
|CA - California||SAN MATEO (SAN MATEO COUNTY)||$219.23||112.16%|
|CA - California||OAKLAND-BERKLEY (ALAMEDA AND CONTRA COSTA)||$219.23||112.16%|
|CA - California||SAN FRANCISCO-OAKLAND-HAYWARD (MARIN COUNTY)||$219.44||112.27%|
|CA - California||SALINAS (MONTEREY COUNTY)||$209.01||106.93%|
|CA - California||NAPA||$209.67||107.27%|
|CA - California||VALLEJO-FAIRFIELD (SOLANO COUNTY)||$209.67||107.27%|
|CA - California||SANTA CRUZ-WATSONVILLE||$209.55||107.21%|
|CA - California||SANTA ROSA (SONOMA COUNTY)||$208.27||106.55%|
|CA - California||RIVERSIDE-SAN BERNARDINO-ONTARIO (SAN BERNARDINO AND RIVERSIDE COUNTY)||$202.15||103.42%|
|CA - California||BAKERSFIELD (KERN COUNTY)||$202.42||103.56%|
|CA - California||SACRAMENTO-ROSEVILLE-ARDEN-ARCADE (SACRAMENTO, PLACER, YOLO, EL DORADO)||$202.86||103.79%|
|CA - California||CHICO (BUTTE COUNTY)||$200.53||102.59%|
|CA - California||FRESNO||$200.53||102.59%|
|CA - California||HANFORD-CORCORAN (KINGS COUNTY)||$200.53||102.59%|
|CA - California||MADERA||$200.53||102.59%|
|CA - California||MERCED||$200.53||102.59%|
|CA - California||MODESTO (STANISLAUS COUNTY)||$200.53||102.59%|
|CA - California||REDDING (SHASTA COUNTY)||$200.53||102.59%|
|CA - California||STOCKTON-LODI (SAN JOAQUIN COUNTY)||$200.53||102.59%|
|CA - California||VISALIA-PORTERVILLE (TULARE COUNTY)||$200.53||102.59%|
|CA - California||YUBA CITY (SUTTER, YUBA)||$200.53||102.59%|
|CA - California||CALIFORNIA (ALL OTHER COUNTIES)||$200.53||102.59%|
|CA - California||LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES COUNTY)||$209.34||107.10%|
|CA - California||LONG BEACH-ANAHEIM (ORANGE COUNTY)||$209.34||107.10%|
|CA - California||OXNARD-THOUSAND OAKS-VENTURA||$206.33||105.56%|
|CA - California||SANTA MARIA-SANTA BARBARA||$207.59||106.21%|
|CA - California||SAN DIEGO-CARLSBAD||$206.43||105.61%|
|CA - California||SAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE||$201.63||103.16%|
|CA - California||EL CENTRO (IMPERIAL COUNTY)||$200.63||102.65%|
|HI - Hawaii||HAWAII, GUAM, AMERICAN SAMOA, MARSHALL ISLANDS, PALAU, NORTHERN MARIANA ISLANDS, FEDERATED STATES OF MICRONESIA||$201.98||103.34%|
|NV - Nevada||STATEWIDE||$197.78||101.19%|
|AK - Alaska||STATEWIDE||$271.70||139.01%|
|ID - Idaho||STATEWIDE||$187.19||95.77%|
|OR - Oregon||PORTLAND (CLACKAMAS, MULTNOMAH AND WASHINGTON)||$199.43||102.03%|
|OR - Oregon||REST OF STATE||$190.93||97.68%|
|WA - Washington||WASHINGTON SEATTLE (KING COUNTY)||$208.55||106.70%|
|WA - Washington||REST OF STATE||$194.94||99.73%|
|AZ - Arizona||STATEWIDE||$192.57||98.52%|
|MT - Montana||STATEWIDE||$195.36||99.95%|
|ND - North Dakota||STATEWIDE||$192.88||98.68%|
|SD - South Dakota||STATEWIDE||$192.50||98.49%|
|UT - Utah||STATEWIDE||$190.85||97.64%|
|WY - Wyoming||STATEWIDE||$194.74||99.63%|
|CO - Colorado||STATEWIDE||$196.70||100.63%|
|NM - New Mexico||STATEWIDE||$191.46||97.95%|
|OK - Oklahoma||STATEWIDE||$189.03||96.71%|
|TX - Texas||HOUSTON||$200.98||102.82%|
|TX - Texas||GALVESTON (TARRANT COUNTY)||$199.26||101.94%|
|TX - Texas||BRAZORIA||$199.12||101.87%|
|TX - Texas||DALLAS||$197.93||101.26%|
|TX - Texas||FORT WORTH (TARRANT COUNTY)||$195.47||100.01%|
|TX - Texas||AUSTIN (TRAVIS COUNTY)||$196.07||100.31%|
|TX - Texas||REST OF STATE||$191.52||97.98%|
|TX - Texas||BEAUMONT (JEFFERSON COUNTY)||$190.86||97.65%|
|IA - Iowa||STATEWIDE||$188.60||96.49%|
|KS - Kansas||STATEWIDE||$188.80||96.59%|
|MO - Missouri||METROPOLITAN ST. LOUIS (JEFFERSON, ST. CHARLES, ST. LOUIS AND ST. LOUIS CITY)||$193.86||99.18%|
|MO - Missouri||METROPOLITAN KANSAS CITY (CLAY, JACKSON AND PLATTE)||$192.91||98.70%|
|MO - Missouri||REST OF STATE||$187.91||96.14%|
|NE - Nebraska||STATEWIDE||$187.78||96.07%|
|IL - Illinois||CHICAGO (COOK COUNTY)||$203.03||103.87%|
|IL - Illinois||SUBURBAN CHICAGO (DUPAGE, KANE, LAKE AND WILL)||$201.46||103.07%|
|IL - Illinois||EAST ST. LOUIS (BOND, CALHOUN, CLINTON, JERSEY, MACOUPIN, MADISON, MONROE, MONTGOMERY, RANDOLPH, ST. CLAIR AND WASHINGTON)||$195.81||100.18%|
|IL - Illinois||REST OF STATE||$192.26||98.36%|
|MN - Minnesota||STATEWIDE||$193.12||98.80%|
|WI - Wisconsin||STATEWIDE||$189.62||97.01%|
|AR - Arkansas||STATEWIDE||$186.04||95.18%|
|LA - Louisiana||NEW ORLEANS (JEFFERSON, ORLEANS, PLAQUEMINES AND ST. BERNARD)||$194.52||99.52%|
|LA - Louisiana||REST OF STATE||$191.00||97.72%|
|MS - Mississippi||STATEWIDE||$186.74||95.54%|
|IN - Indiana||STATEWIDE||$188.46||96.42%|
|MI - Michigan||DETROIT (MACOMB, OAKLAND, WASHTENAW AND WAYNE)||$198.15||101.38%|
|MI - Michigan||REST OF STATE||$191.30||97.87%|
|FL - Florida||MIAMI (DADE AND MONROE COUNTY)||$203.91||104.32%|
|FL - Florida||FORT LAUDERDALE (BROWARD, COLLIER, INDIAN RIVER, LEE, MARTIN, PALM BEACH, AND ST. LUCIE)||$199.41||102.02%|
|FL - Florida||REST OF STATE||$194.65||99.59%|
|PR - Puerto Rico||PUERTO RICO||$195.77||100.16%|
|VI - Virgin Islands||VIRGIN ISLANDS||$195.77||100.16%|
|AL - Alabama||STATEWIDE||$189.98||97.20%|
|GA - Georgia||ATLANTA (BUTTS, CHEROKEE, CLAYTON, COBB, DEKALB, DOUGLAS, FAYETTE, FORSYTH, FULTON, GWINNETT, NEWTON, ROCKDALE AND WALTON)||$194.94||99.73%|
|GA - Georgia||REST OF STATE||$189.45||96.93%|
|TN - Tennessee||STATEWIDE||$188.22||96.30%|
|SC - South Carolina||STATEWIDE||$189.64||97.02%|
|VA - Virginia||STATEWIDE||$194.77||99.65%|
|WV - West Virginia||STATEWIDE||$189.87||97.14%|
|NC - North Carolina||STATEWIDE||$191.35||97.90%|
|DE - Delaware||STATEWIDE||$196.87||100.72%|
|DC - Washington, DC||DC + MD/VA SUBURBS (DISTRICT OF COLUMBIA; ALEXANDRIA CITY, ARLINGTON, FAIRFAX, FAIRFAX CITY, FALLS CHURCH CITY IN VIRGINIA; MONTGOMERY AND PRINCE GEORGE'S IN MARYLAND)||$215.43||110.22%|
|MD - Maryland||BALTIMORE/SURROUNDING COUNTIES||$205.34||105.05%|
|MD - Maryland||REST OF STATE||$199.07||101.85%|
|NJ - New Jersey||NORTHERN NEW JERSEY (BERGEN, ESSEX, HUDSON, HUNTERDON, MIDDLESEX, MORRIS, PASSAIC, SOMERSET, SUSSEX, UNION AND WARREN)||$211.50||108.21%|
|NJ - New Jersey||REST OF STATE||$207.10||105.96%|
|PA - Pennsylvania||METROPOLITAN PHILADELPHIA (BUCKS, CHESTER, DELAWARE, MONTGOMERY AND PHILADELPHIA)||$203.36||104.04%|
|PA - Pennsylvania||REST OF STATE||$192.17||98.32%|
|CT - Connecticut||STATEWIDE||$205.75||105.26%|
|NY - New York||NYC SUBURBS/LONG ISLAND (BRONX, KINGS, NASSAU, RICHMOND, ROCKLAND, SUFFOLK AND WESTCHESTER)||$220.07||112.59%|
|NY - New York||MANHATTAN||$217.56||111.31%|
|NY - New York||POUGHKPSIE/N NYC SUBURBS (COLUMBIA, DELAWARE, DUTCHESS, GREENE, ORANGE, PUTNAM, SULLIVAN AND ULSTER)||$207.12||105.97%|
|NY - New York||REST OF STATE||$192.28||98.37%|
|NY - New York||QUEENS||$221.56||113.35%|
|ME - Maine||SOUTHERN MAINE (CUMBERLAND AND YORK COUNTY)||$193.75||99.13%|
|ME - Maine||REST OF STATE||$189.22||96.81%|
|MA - Massachusetts||METROPOLITAN BOSTON (MIDDLESEX, NORFOLK AND SUFFOLK)||$211.15||108.03%|
|MA - Massachusetts||REST OF STATE||$201.31||102.99%|
|NH - New Hampshire||STATEWIDE||$196.83||100.70%|
|RI - Rhode Island||STATEWIDE||$200.62||102.64%|
|VT - Vermont||STATEWIDE||$193.55||99.02%|
|KY - Kentucky||STATEWIDE||$188.69||96.54%|
|OH - Ohio||STATEWIDE||$191.91||98.18%|
Psychotherapy Reimbursement Rates for Private Insurance 
It cannot be stated enough: the following information is not direct information from each of these insurance companies but rather is an average of fee schedules based exclusively on contracts with these companies. These insurance reimbursement rates for psychotherapy vary by state, by license, taxonomy, and other factors.
No one ever has access to contracted rate informationuntilan EOB is issued for out of network providers OR you’ve been accepted as in-network and they’ve given you your fee schedule.
Here is a sample of psychotherapy reimbursement rates for private insurance by major mental health insurance brand:
|Anthem Blue Cross||$68||$91|
|United Health Care / United Behavioral Health / Optum||$67||$79|
|Beacon Health Options / Value Option||$62||$81|
|Beacon Health Strategies||$64||$74|
(Again, these are not exact rates but estimated ranges).
Here is a view of the same psychotherapy reimbursement rate for private insurance information after averaging the low and high prices individually and then showing the delta of price differential between these private insurance polices as a relative percentage out of 100%.
|Avg High||Avg High|
|Anthem Blue Cross||$67||$88||102%||114%|
|United Health Care / United Behavioral Health / Optum||$66||$78||100%||101%|
|Beacon Health Options / Value Option||$62||$74||94%||96%|
|Beacon Health Strategies||$60||$72||91%||94%|
Here’s an image version that might be easier to read!
In summary, some private insurance companies reimburse mental health therapists for far more than others. A great way to quickly learn which companies pay the most is to simply ask your colleagues about their experiences with different reimbursement rates for private insurance companies.
If you’re wondering about which private insurance companies are reimbursing the most in your state with your license, we’re happy to help you fill in the gaps.
How Your License Impacts Your Insurance Reimbursement Rate for Psychotherapy
In most states, mental health therapists are initially licensed as an LPC or LMHC or LPCMH or LCPC or LPCC (and on and on), depending on your state. While it’s safe to assume you already know your license for your state, you can also check this PDF document here to confirm your license and what’s required.
With this license comes, normally, the lowest or entry level rates for working with insurance companies providing mental health services.
You’ve just been licensed and you’re ready to begin working on your own in private practice. Expect rates insurance reimbursement rates for psychotherapy to be in the lowest tier of payment.
|45 Minute Individual Therapy||60 Minute Individual Therapy|
|LPC, Licensed Professional Counselor||$68||$77|
|LMFT, Licensed Marriage and Family Therapist||$74||$89|
|LICSW, Licensed Independent Social Workers||$68||$77|
|MD / PhD, American Board of Psychiatry and Neurology Certified||$88||$105|
Medicaid Mental Health Reimbursement Rates 
Medicaid requirements for licensing vary state by state. Likewise, Medicaid pays out differing rates based on very specific criteria and coding.
Here’s a link for Medicaid’s PDF on Mental Health Payment Rates.
Make sure you have one of the following licenses to get credentialed with the medicaid provider(s) in your state:
- Physician’s Assistant (PA)
- Advanced PracticeRegistered Nurse (APRN)
- Clinical Nurse
- Specialist/Psychiatric Mental Health (CNSPMH) and NursePractitioner (NP)
- Licensed Pharmacist
- Registered Nurse (RN)
- Licensed PracticalNurse (LPN)
- Licensed Dietician (LD)
- Qualified Medication Aide (QMA)
- Licensed ClinicalSocial Worker (LCSW)
- Licensed Professional Counselor (LPC)
- Licensed Marriage and Family Therapist (LMFT)
- Licensed Master’s Social Worker(LMSW)
- Licensed Associate Professional Counselor (LAPC)
- Licensed Associate Marriage and Family Therapist (LAMFT)
- Certified Clinical Alcohol and Drug Counselor (CCADC)
- Master Addiction Counselor (MAC)
- National Board of Certified Counselors (NBCC)
- Master Addiction Counselor, (MAC) through National Association of Alcohol and Drug Counselors, (NAADC)
- Certified Alcohol and Drug Counselor (CADC)
- Certified Addiction Counselor, Level I (CAC-I)
- Certified Addiction Counselor, Level II (CAC-II)
- Registered Alcohol and Drug Technician I, II, III
- Addiction Counselor Trainees
- Certified Psychiatric Rehabilitation Professional (CPRP)
- Certified Peer Specialist (CPS)
- Paraprofessional (PP)
Medicaid License Practitioner Level Information
Your Medicaid License impacts the “Practitioner Level” that you have which influences your reimbursement rates.
Mental Health License Practitioner Levels:
- Practitioner Level 1: Physician/Psychiatrist
- Practitioner Level 2: Psychologist, CNS-PMH
- Practitioner Level 3: LCSW, LPC, LMFT, RN
- Practitioner Level 4:
- LMSW; LAPC; LAMFT
- Psychologist/LCSW/LPC/LMFT’s supervisee/trainee with at least a Bachelor’s degree in one of the helping professions such as social work, community counseling, counseling, psychology, or criminology, functioning within the scope of the practice acts of the state
- MAC, CAC-II, CADC, CCADC, GCADC (II, III); CAC-I or Addiction Counselor Trainee with at least a Bachelor’s degree in one of the helping professions such as social work, community counseling, counseling, psychology, or criminology (addiction counselors may only perform these functions related to treatment of addictive diseases).
- Practitioner Level 5:
- CAC-I, RADT (I, II, or III), Addiction Counselor Trainees with high school diploma/equivalent (practitioners at this level may only perform these functions related to treatment of addictive diseases and under the supervision of one of the licensed/credentialed professionals above).
Medicaid Mental Health Reimbursement Rates for Individual Therapy
Below is a table showing the rates that have been determined by Medicaid for these differing license levels for commercial insurance polices:
|Practitioner Level 2||$116.90|
|Practitioner Level 3||$90.03|
|Practitioner Level 4||$60.89|
|Practitioner Level 5||$45.38|
|Practitioner Level 2||$194.84|
|Practitioner Level 3||$150.05|
|Practitioner Level 4||$101.48|
|Practitioner Level 5||$75.64|
Now you must be wondering: “What??!! Medicaid doesn’t pay that much!!!” And you’re right.
These are the rates that they established as averages nationally based on a huge survey of insurance policies by their relative license. These are the commercial insurance reimbursement rates for psychotherapy determined by Medicaid.
Medicaid mental health reimbursement rates differ in that medicaidreducesthese rates to providers at Practitioner Levels 2-5, which cover all licensed mental health providers except MDs.
Based on data received through surveys of a large sample of agencies currently providing Community Behavioral Health Rehabilitation Services in multiple states, average allocable direct and indirect cost factors were calculated as a percentage of direct personnel costs.
These costs were then calculated for each service and for each applicable practitioner level. All of these cost components were summed to yield an annual cost for the service for the particular practitioner level.See AlsoDownload [PDF] Ramayana Unravelled eBook11 Great French Movies to Watch on Netflix in November 2022 – BusuuWhat Not to Say to Someone with an Eating Disorder - Avalon Recovery Society13 Best Business Shows on Netflix
Due to the large difference between the median annual salaries in Level 1 (physicians/psychiatrists) and the other levels, it was necessary to adjust the support and administrative factors applied to the highest level versus the other levels so that the support and administrative costs associated with the highest levels were not over-inflated.
This was accomplished by adjusting the direct and indirect cost factors according to the proportion of personnel costs in an average agency accounted for by the top level versus the other four practitioner levels.
The overall direct services cost factor is 39% and indirect is 15%. Once the factors were adjusted to account for the disparity between physician salaries and the other levels the cost factors became 19% for direct costs and 7% for indirect costs for Level 1 and 45% for direct costs and 17% indirect costs for the remaining four levels.
So, take the above charts and then reduce their numbers and you can expect to get payment more like the following:
|45-50 minute therapy session|
Medicaid Mental Health Rate
|Practitioner Level 2||$116.90||$72.48|
|Practitioner Level 3||$90.03||$55.82|
|Practitioner Level 4||$60.89||$37.75|
|Practitioner Level 5||$45.38||$28.14|
|75-80 minute therapy session|
|Practitioner Level 2||$194.84||$120.80|
|Practitioner Level 3||$150.05||$93.03|
|Practitioner Level 4||$101.48||$62.92|
|Practitioner Level 5||$75.64||$46.90|
There are other factors that influence Medicaid rates by state, license, practitioner level, and subcontract with the Medicaid program in that state, so these rates are not exact but will give you a better sense of the differences in license levels and therefore reimbursement rates for mental health services covered by Medicaid.
Here is another example of Medicaid determined private rates; specifically Medicaid Reimbursement Rates for Mental Health Services in Mississippi:
|Psychiatric Diagnostic Evaluation||90792||$134|
|Prolonged Service 60 min.||99354||$111|
|Prolonged Service 30 min add on||99355||$85|
|Multi-Family Group Therapy||90849||$35|
|Psychological Evaluation (First Hour)||96130||$102|
|Psychological Evaluation (Each Additional Hour)||96131||$78|
|Psychological Evaluation (First 30 Minutes)||96136||$39|
|Psychological Evaluation (Each Additional 30 Minutes)||96137||$36|
|Crisis Response (Face to Face)||H2011||$30|
|Crisis Response (Phone)||H2011||$22|
Again, these are the rates that have been determined as average payment rates by insurance based on research done by that State’s medicaid program, in this case Mississippi.
These rates get reduced but these are useful to look at to see what they believe are the average reimbursement rates by procedure code.
This information does not take into account the effect of the license or practitioner level on total reimbursement rate.
How Your Taxonomy Code Impacts Your Insurance Reimbursement Rates for Psychotherapy
Here is a list of the taxonomy codes or specializations that are declared in the National Provider Identifier Registry.
You can simply Google your NPI number to find your license information including your taxonomy. It’s likely to be one of the following:
Psychiatry Taxonomy Codes
- Addiction Psychiatry – 2084P0802X
- Child & Adolescent Psychiatry – 2084P0804X
- Geriatric Psychiatry – 2084P0805X
- Psychiatry – 2084P0800X
Behavioral Health & Social Service Provider Taxonomy Codes
- Counselor – 101Y00000X
- Addiction (Substance Use Disorder) – 101YA0400X
- Marriage & Family Therapist – 106H00000X
- Psychoanalyst – 102L00000X
- Psychologist – 103T00000X
- Addiction (Substance Use Disorder) – 103TA0400X
- Adult Development & Aging – 103TA0700X
- Clinical Child & Adolescent – 103TC2200X
- Cognitive & Behavioral – 103TB0200X
- Counseling – 103TC1900X
- Group Psychotherapy – 103TP2701X
- Developmental Disabilities – 103TM1800X
- Psychoanalysis – 103TP0814X
- Psychotherapy – 103TP2700X
- Social Worker – 104100000X
These taxonomy codes reflect specializations of treatment related to your specific mental health provider license. Insurance companies are trying to fill out a map of providers across specific locations, as we discussed before, and they are also trying to maximize their specializations within those offerings.
Insurance companies are all trying to fill in the gaps of service offerings per area as well.
Medicaid License Example Case
Imagine a hospital. It would be convenient for them to have multiple mental health providers on staff who specialize in different things.
Some clients need help with homelessness and substance abuse and require specific treatment related to their situations, whereas others are looking for psychotherapy specific to their family or eating disorder or gambling addiction.
For that hospital to top notch, they hire providers who specialize in a variety of services. Insurance companies operate in a similar way.
Treatment specializations require different training and education which are reflected in their licensing and also reimbursement rates.
This is the least predictable factor in influencing your reimbursement rates and is more a reflection of your license and that insurance company needing to fill a gap in service offerings or not.
As a result, it’s better to think about your taxonomy code and insurance reimbursement rates for mental health more in terms of your level of education and license in your state. Your specialization is “optimized” when deciding what you’re going to study or what you will choose to study in the future.
If you don’t want to deal with this mess, consider hiring us to do your billing and handle this for you.
Medicare Reimbursement Rates for Psychotherapy 
Please see our updated Medicare Rates:
|CPT Code||Description||Medicare Reimbursement Rate 2020||Medicare Reimbursement Rate 2021||Medicare Reimbursement Rate 2022|
|90791||Psychological Diagnostic Evaluation||$140.19||$180.75||$195.46|
|90792||Psychological Diagnostic Evaluation with Medication Management||$157.49||$201.68||$218.90|
|90832||Individual Psychotherapy, 30 Minutes||$68.47||$77.81||$85.07|
|90833||Individual Psychotherapy with Evaluation and Management Services, 30 minutes||$71.00||$71.18||$77.88|
|90834||Individual Psychotherapy, 45 Minutes||$91.18||$103.28||$112.29|
|90836||Individual Psychotherapy with Evaluation and Management Services, 45 minutes||$89.74||$90.02||$98.30|
|90837||Individual Psychotherapy, 60 Minutes||$136.95||$152.48||$164.84|
|90838||Individual Psychotherapy with Evaluation and Management Services, 60 minutes||$118.57||$119.33||$129.30|
|90839||Individual Crisis Psychotherapy initial 60 min||$157.66|
|90840||Individual Crisis Psychotherapy initial 60 min, each additional 30 min||$78.64|
|99201||Evaluation and Management Services, Outpatient, New Patient||$46.49||Not Covered||Not covered|
|99202||Evaluation and Management Services, Outpatient, New Patient||$77.48||$73.97||$80.91|
|99203||Evaluation and Management Services, Outpatient, New Patient||$109.92||$113.75||$124.39|
|99204||Evaluation and Management Services, Outpatient, New Patient||$166.86||$169.93||$185.26|
|99205||Evaluation and Management Services, Outpatient, New Patient||$209.75||$224.36||$244.99|
|99211||Evaluation and Management Services, Outpatient, Established Patient||$23.07||$23.03||$25.71|
|99212||Evaluation and Management Services, Outpatient, Established Patient||$45.77||$56.88||$62.76|
|99213||Evaluation and Management Services, Outpatient, Established Patient||$75.32||$92.47||$100.57|
|99214||Evaluation and Management Services, Outpatient, Established Patient||$110.28||$131.20||$141.78|
|99215||Evaluation and Management Services, Outpatient, Established Patient||$147.76||$183.19||$200.00|
|99355||Prolong Services with E/M||$100.91||$100.33||$101.32|
|90846||Family psychotherapy without patient, 50 minutes||$103.58||$99.10||$107.37|
|90847||Family psychotherapy with patient, 50 minutes||$107.19||$102.59||$111.15|
|96105||Assessment of aphasia and cognitive performance||$101.54||$109.26|
|96112||Developmental testing administration by a physician or qualified health care professional, 1st hr||$131.55||$141.02|
|96113||Developmental testing administration by a physician or qualified health care professional, each additional hour||$58.62||$66.54|
|96116||Neurobehavioral status exam performed by a physician or qualified health professional, first hour||$97.00||$104.73|
|96121||Neurobehavioral status exam performed by a physician or qualified health professional, additional hour||$82.35||$87.34|
|96125||Standardized cognitive performance test administered by health care professional||$107.12||$115.69|
|96127||Brief emotional and behavioral assessment||$4.89||$5.29|
|96130||Psychological testing and evaluation by a physician or qualified health care professional, first hour||$120.73||$132.70|
|96131||Psychological testing and evaluation by a physician or qualified health care professional, each additional hour||$91.42||$98.68|
|96132||Neuropsychological testing and evaluation by a physician or qualified health care professional, first hour||$133.29||$144.80|
|96133||Neuropsychological testing and evaluation by a physician or qualified health care professional, each additional hour||$103.98||$112.29|
|96136||Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, first hour||$46.76||$49.15|
|96137||Neuropsychological or psychological test administration and scoring by a physician or qualified health care professional, each additional hour||$41.87||$44.24|
|96138||Neuropsychological or psychological test administration and scoring by a technician, first hour||$37.34||$38.56|
|96139||Neuropsychological or psychological test administration and scoring by a technician, each additional hour||$37.34||$$39.32|
Medicare has approached this problem in a similar way by averaging service costs and using those as a basis to reduce fees. Here’s a look at what they suggest normal private insurance rates are by CPT code, nationally:
|90832||Psytx w pt 30 minutes||$68.47|
|90833||Psytx w pt w e/m 30 min||$71.00|
|90834||Psytx w pt 45 minutes||$91.18|
|90836||Psytx w pt w e/m 45 min||$89.74|
|90837||Psytx w pt 60 minutes||$136.95|
|90838||Psytx w pt w e/m 60 min||$118.57|
|90839||Psytx crisis initial 60 min||$142.71|
|90840||Psytx crisis ea addl 30 min||$68.47|
|90846||Family psytx w/o pt 50 min||$110.28|
|90847||Family psytx w/pt 50 min||$114.60|
|90849||Multiple family group psytx||$42.17|
Medicare reduces insurance reimbursement rates for psychotherapy on a relative basis. Here’s that same charge but with a calculated reduction on rates of 40%:
|Suggested Private Rate|
Reduced Rate (40% Reduction)
|90832||Psychotherapy with patient for 30 minutes||$68.47||$41.08|
|90833||Psychotherapy and evaluation and management with patient for 30 min||$71.00||$42.60|
|90834||Psychotherapy with patient for 45 minutes||$91.18||$54.71|
|90836||Psychotherapy and evaluation and management with patient for 45 min||$89.74||$53.84|
|90837||Psychotherapy with patient for 60 minutes||$136.95||$82.17|
|90838||Psychotherapy and evaluation and management with patient for 60 min||$118.57||$71.14|
|90839||Mental health crisis, first 60 minutes||$142.71||$85.63|
|90840||Mental health crisis, each additional 30 minutes||$68.47||$41.08|
|90846||Family psychotherapy without the patient, 50 min||$110.28||$66.17|
|90847||Family psychotherapy with the patient, 50 min||$114.60||$68.76|
|90849||Multiple family group psychotherapy||$42.17||$25.30|
The reduced rate here isn’t the exact amount Medicare pays out but represents a rough estimate of the suggested reduction to expect from Medicare. In our experience, Medicare over-estimates the contracted rate for most private insurance companies so their total reduction, while large, still leaves providers with a modest but much higher earning than Medicaid.
Part of the reason why is Medicare is more selective with their network.
Mental Health License Requirements for Medicare
Medicare doesn’t cover all licenses and is far more selective than Medicaid about which providers they will allow into their network. As a result, mental health reimbursement rates for Medicare are higher than Medicaid rates by a substantial margin.
Medicare Accepted Mental Health Licenses:
- Clinical Nurse Practitioners
- Clinical Social Workers
Mental Health Licenses Not Accepted by Medicare:
If you do want to serve an older demographic or have specialized in care tailored to their needs, it’s important to understand the license required for you to be able to be accepted within Medicare.
Mental Health Provider Demand Effecting Reimbursement Rates for Therapy
The sad truth is some of the best panels are totally full and their network map of mental health providers is saturated. There’s nothing you can do when a company like Florida Blue hasn’t accepted mental health providers in years.
The amount of contracted providers per insurance company will have a larger influence on your ability to get in that network or not than it will on what you’ll be paid.
But on the other hand, if a company is easy to get accepted into their network, odds are higher they do not reimburse as much. Again, this is a case by case situation you’ll need to research and address.
How to Choose Mental Health Insurance Companies for Credentialing
Choosing which companies to apply to depends on a number of factors but can fall cleanly into three buckets:
- Increasing caseload
- Increasing revenue per appointment
- Working with a specific demographic
For the best possible guidance, try to pick only two of these three possible options and weight their significance to you in your current private practice.
Are you looking to increase the number of sessions you do? Work with lower paying but higher supplying networks like Medicaid.
Want higher income per client? Look at the Blue Card network (all “Blue” plans in your state).
And if you don’t even know what Blue Card programs apply to your state or you need a free customized quote that’s specific to your needs, we are happy to help. (But not required!) You can reach out about that at our mental health credentialing services page.
Summary of Insurance Reimbursement Rates for Psychotherapy
Mental health reimbursement rates vary dramatically. They depend on your:
- your specialty,
- your location,
- and the service map for each insurance company you’re applying to.
Your reimbursement rates are most dramatically influenced by your education and license, baring living in a few locations that are dying for more mental health providers (e.g. Alaska).
Strategically speaking, your first big decision is your level of licensing and continued education you have sought or will seek. Next will be picking an area that is undeserved to the best of your estimation. Finally, consider choosing a specialization that fills in a service gap that is regularly sought after.
From there, pick which insurance companies you’re most interested in working with depending on the demographic you aim to serve. Some companies may pay less but provide you a higher inbound flow of clients (like Medicaid), whereas others might be very challenging to get in-network with but pay much higher (like Blue Card plans).
For specific recommendations for credentialing in your state, feel free to reach out to us at TheraThink for help.
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Is 90832 an add on code? ›
CPT Codes 90832-90838 represent psychotherapy. Psychotherapy without medical evaluation and management services are reported as 90832, 90834 and 90837. Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833; 90836; 90838).Does Blue Cross cover therapy? ›
Blue Cross Blue Shield plans cover most types of therapy, including individual therapy and child therapy, as well as different types of therapy approaches, including: Cognitive Behavioral Therapy (CBT) Dialectical Behavioral Therapy (DBT)Can 90832 be billed as telehealth? ›
These codes are approved for mental health telehealth billing by both the current procedural terminology (CPT) and the Centers for Medicare Services (CMS): 99201 – 99215 – Evaluation and Management Service Codes. 90791 & 90792 – Diagnostic Interview. 90832 – Psychotherapy for 30 Minutes.How long is a 90832 session? ›
The times for these codes are: 90832 – Psychotherapy 30 minutes. 90834 – Psychotherapy 45 minutes. 90837 – Psychotherapy 60 minutes.Can 99214 and 90832 be billed together? ›
Medication management (evaluation and management) and psychotherapy Do not bill CPT codes 99201-99215 and 90832 or 90834 or 90837. It is acceptable to bill CPT codes 99201-99215 and 90833 or 90836 or 90838.What is the reimbursement for 90832? ›
CPT Code 90832 Reimbursement Rates. This has increased to $77.81 in 2021. 90832 always reimburses less than 90834 and 90837, but similar per unit of time. This is usually around 75% of the 90834 reimbursement rate and around 50% of 90837.Can therapists bill for phone calls? ›
Typically, therapists will charge for phone calls with the client if the conversation exceeds a certain amount of time. Calls to family members: Sometimes therapists need additional information from family members, especially if the client is a child.What modifier should be used with 90837? ›
A common modifier used with CPT code 90837 is modifier 95. This is the modifier for teletherapy. Before using this modifier or scheduling teletherapy with a patient, make sure their plan covers this modifier.Can 90837 and 90834 be billed together? ›
Since it is an add-on code it must be billed with 90837 or 90847 (90791 and 90834 are not allowed).How do you bill for a 75 minute psychotherapy session? ›
If the session lasts for 75 minutes or more, you would use both 90839 and the add-on code 90840 when billing patients and filing claims.
How do you bill for a 90 minute psychotherapy session? ›
Units vs Extended Session CPT Codes
Rather, what is required to bill for 90 minutes is an add-on code on a new line in box 24 of your CMS1500 form. To bill an insurance claim for a 90 minute individual therapy session: bill 90837. with add-on code 99354.
It's mostly for logistical reasons. People tend to schedule appointments on the hour. And, most therapists provide 50 minute sessions so that they can take a 10-minute break between sessions to use the bathroom, grab something to drink and review notes before the next session.Why is therapy not covered in insurance? ›
In some instances, people choose to pay out of pocket for therapeutic services rather than claim coverage through their insurer. Why? Insurance companies only pay for medically necessary services. They require a mental health diagnosis before they will pay claims.What treatments are not covered by insurance? ›
- Adult Dental Services. ...
- Vision Services. ...
- Hearing Aids. ...
- Uncovered Prescription Drugs. ...
- Acupuncture and Other Alternative Therapies. ...
- Weight Loss Programs and Weight Loss Surgery. ...
- Cosmetic Surgery. ...
- Infertility Treatment.
Health insurance typically covers most doctor and hospital visits, prescription drugs, wellness care, and medical devices. Most health insurance will not cover elective or cosmetic procedures, beauty treatments, off-label drug use, or brand-new technologies.What is the CPT time rule for psychotherapy? ›
As per the CPT time rule, family psychotherapy codes require at least 26 minutes of service (i.e., greater than ½ of 50 minutes). One may NOT report interactive complexity (90785) with these codes.Can therapists Bill E and M codes? ›
Psychologists are NOT permitted to bill E&M codes. E&M are for medical services and not within their "scope of practice".How much can you charge for a 99214? ›
|CPT Code||MD Cost||Description|
|99212||$85||Standard 10-19 Minute Office Visit|
|99213||$125||Standard 20-29 Minute Office Visit|
|99214||$175||Standard 30-39 Minute Office Visit|
|99215||$225||Standard 40-54 Minute Office Visit|
Medicare 2022 90834 Reimbursement Rate: $112.29
There has been a 9.2% increase in reimbursement from 2020 to 2021.
CPT Code 90839 typically pays slightly more than CPT code 90837 for a 60 minute individual psychotherapy session. 90840 pays a similar rate per time period, about half of what 90839 allows.
What is the Medicare reimbursement rate for 90837? ›
A therapist does not have a legal or ethical obligation to allow a client to record sessions. Therefore, it is solely within the therapist's discretion as to whether to allow recordings of sessions.Why do therapists not answer the phone? ›
Some therapists don't return calls because they lack openings in their schedule. However, the honest thing to do in such instances is to call back prospective clients and tell them this. Avoiding such conversations because they are uncomfortable (or unprofitable) violates the principle of integrity.Can a therapist text a client? ›
Some therapists use texting for scheduling and other practical matters. Other therapists only want to use email or phone calls. In general, texting or other forms of communication between sessions should be on an as needed basis and should not be social in nature. It's best to address therapeutic matters in session.How do you justify 90837? ›
- Psychotherapy times are for face-to-face services with the patient and/or family member.
- The patient must be present for all or some of the service.
- In reporting, choose the code closest to the actual time (i.e., 53 or more minutes for 90837).
- Document start and end times.
If two psychotherapy sessions took place on the same day, you would add the two and code one claim with the combined time. Since it is 90 minutes, you would code 90837.Can you bill 90837 family session? ›
If a family member is brought into individual psychotherapy sessions intermittently or briefly, you don't have to bill these family codes. You can use individual psychotherapy codes, 90832, 90834 or 90837. Just make sure the intent of the session/s is not the family member's benefit.How many minutes is a 90837 code? ›
Both 90834 and 90837 are designed to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes. Want to learn more about CPT codes?What is the CPT code for 50 minute psychotherapy session? ›
Therapists who conduct a traditional 50-minute therapy session should be aware that these should generally be billed as a 90834, as less than 53 minutes are spent in clinical discussion and therapy.How do you bill a 2 hour therapy session? ›
This is a super short guide on billing a typical 2 hour individual therapy session for outpatient mental health therapy. You'll want to use your typical 90837 CPT code. Then you'll also want to use the Add On CPT code 99354 which declares an additional 30 to 74 minutes of therapy.
How many therapy units is 40 minutes? ›
40 minutes total treatment time. The 40 total treatment time falls within the range for 3 units (see chart). In this instance, you would bill 2 units of 97110 and 1 unit of 97140. You count the first 30 minutes of 97110 as 2 full units.How many minutes is 3 units therapy? ›
|8 – 22 minutes||1 unit|
|23 – 37 minutes||2 units|
|38 – 52 minutes||3 units|
|53 – 67 minutes||4 units|
|68 – 82 minutes||5 units|
According to the chart you can bill 3 units again based on total time. Your bill would need to have 2 units of therapeutic exercises which equals 30 minutes with 2 minutes remainder.How many therapy units is 35 minutes? ›
I. If you perform an initial evaluation that lasts 35 minutes and a 7-minute therapeutic exercise, you can only bill one units for the initial evaluation.Is therapy an hour or 50 minutes? ›
You don't get an hour with the therapist or psychologist, as you may have been led to believe. Instead you get 50 minutes — what therapists refer to as the “50 minute hour.” Why 50 minutes?How many therapy units is 45 minutes? ›
However, billing is based ultimately on total timed minutes – 45 in this case, and equivalent to 3 billable units.How many patients should a therapist see in a day? ›
Maybe you are planning on seeing 25 clients in a week. If you're going to work Monday through Friday, this means you'll likely see about five clients a day. Five to six patients a day is a pretty typical number of clients for a therapist in private practice to see.Is 10 therapy sessions enough? ›
Recent research indicates that on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures.Why do therapists pause for so long? ›
Silence can enable the counsellor to collect their thoughts and feelings, and to process what the client is saying. There are times where the client will bring something and the counsellor needs time to understand this and how it might feel to the client.Can CPT code 90832 be billed as inpatient? ›
Clinical Social Workers may not render inpatient services (defined as inpatient hospital settings, partial hospitalization settings or skilled nursing homes for beneficiaries who are at that time receiving benefits under Medicare Part A payment for skilled services) represented by these CPT codes: 90832, 90833, 90834, ...
Is there an add-on code for EMDR? ›
On the CMD-1500 form, CPT code 90899 is used when a psychiatric service (EMDR therapy) cannot be described specifically by any other psychiatric CPT code. In this situation, EMDR would be considered content of service.What are add-on codes CPT? ›
An Add-on Code (AOC) is a Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) code that describes a service that is performed in conjunction with the primary service by the same practitioner.What is a 90832? ›
Descriptor. 90832. Psychotherapy, 30 minutes with patient. 90834. Psychotherapy, 45 minutes with patient.How do I bill a 75 minute therapy session? ›
If the session lasts for 75 minutes or more, you would use both 90839 and the add-on code 90840 when billing patients and filing claims.What is the CPT time rule for psychotherapy? ›
As per the CPT time rule, family psychotherapy codes require at least 26 minutes of service (i.e., greater than ½ of 50 minutes). One may NOT report interactive complexity (90785) with these codes.How do you justify 90837? ›
- Psychotherapy times are for face-to-face services with the patient and/or family member.
- The patient must be present for all or some of the service.
- In reporting, choose the code closest to the actual time (i.e., 53 or more minutes for 90837).
- Document start and end times.
Does insurance cover EMDR? Yes, if your health insurance covers therapy, then it likely covers EMDR as part of trauma treatment. However, since many sessions of EMDR are longer than the standard 45-60 minutes, it is important to clarify with your insurance company whether they will cover longer sessions.Can I bill for 90 minutes of psychotherapy? ›
If you want to try billing for an extended session using the Prolonged Services codes, the session must be a minimum of 30 minutes beyond the original code. This means, for a 90837 (60 minutes) the session minimum would be 90 minutes; for a 50-minute 90847, the session must be a minimum of 80 minutes.How much can you charge for EMDR? ›
The average cost of EMDR therapy ranges on average from $150 – $200 for a 60-minute session. With that said, this type of treatment is considered to be the most cost-effective treatment for individuals suffering with PTSD. Sessions will also differ in length depending on your treatment plan.Are add on codes reimbursable? ›
Add-on codes are reimbursable services when reported in addition to the appropriate primary service by the Same Individual Physician or Other Qualified Health Care Professional reporting the same Federal Tax Identification Number on the same date of service unless otherwise specified within the policy.
Can you bill an add on code by itself? ›
Submitting an add-on code by itself without its designated primary or parent code will cause an edit and be denied reimbursement. Add-on codes are tied to the status of the primary/parent code. If the primary or parent code is denied reimbursement, the add-on code will also be denied reimbursement.Can add on codes be billed alone? ›
Add-on codes are always performed in addition to the primary service or procedure and must never be reported as a stand-alone code. All add-on codes found in the CPT codebook are exempt from the multiple procedure concept (see the modifier 51 definition in Appendix A).How do you bill a 2 hour therapy session? ›
You'll want to use your typical 90837 CPT code. Then you'll also want to use the Add On CPT code 99354 which declares an additional 30 to 74 minutes of therapy. So any time you do 90 to 2 hours and 14 minutes of therapy, make sure to use the combination of CPT Codes 90837 and +99354.What is the reimbursement for 90834? ›
Medicare 2022 90834 Reimbursement Rate: $112.29
There has been a 9.2% increase in reimbursement from 2020 to 2021.
CPT code 90837 is another one of the most common CPT codes used by mental health professionals along with 90834 and 90791. Its typical use is for a normal psychotherapy session with a client. Insurers will reimburse this code only once per day, and some only as frequently as twice per week.