Where does this rate data come from?

Medicare national rates are from the CMS 2026 Physician Fee Schedule final rule. Locality adjustments use approximate GPCI-style multipliers — use CMS PFS lookup for exact county-level amounts. Medicaid figures are estimated from published state %‑of‑Medicare ratios, not line-by-line fee schedule dollars. Commercial ranges are market benchmarks only.

Why do behavioral health reimbursement rates vary so much by state?

Three forces drive variation: Medicare geographic practice cost indices (GPCI), state Medicaid funding and political priorities, and commercial payer market power. Medicaid alone can differ fivefold between the highest and lowest-paying states for identical psychotherapy CPT codes.

How do provider credentials affect reimbursement?

Higher credentials typically command higher rates across nearly all payers. Under Medicare, psychologists bill at 100% of the PFS rate; clinical social workers at 75%; LMFTs and LMHCs at 75% of the psychologist rate (independent billing since 2024). LPC/LCPC cannot bill Medicare Part B independently. Medicaid credential tiers vary by state fee schedule.

Is telehealth reimbursed at the same rate as in-person?

Under Medicare in 2026, behavioral health telehealth sessions are reimbursed at parity with in-person visits with no geographic restrictions. Use POS 02 and modifier 95. Most major commercial insurers have aligned telehealth rates, though some still require prior authorization. State Medicaid telehealth parity varies by state.

What CPT codes matter most for outpatient mental health?

The core psychotherapy codes are 90832 (30 min), 90834 (45 min), and 90837 (60 min). Diagnostic evaluations use 90791 or 90792. Family therapy with patient present is 90847. Group therapy is 90853. For addiction treatment, IOP and PHP programs use HCPCS codes like H0015 and H0035 where payer policies allow.

Which states have the highest Medicaid psychotherapy rates?

Nebraska, Alaska, North Dakota, and Wyoming are among the highest Medicaid payers relative to Medicare. Pennsylvania, New Jersey, Rhode Island, and West Virginia are among the lowest.

Are commercial insurance rates included?

Commercial figures are estimated ranges based on market tier and published industry benchmarks — not actual contracted rates. In-network negotiated rates are typically lower than out-of-network but come with higher patient volume.

How often is this data updated?

Medicare rates update annually with the CMS fee schedule (typically January). Medicaid rates change on state legislative cycles. We surface an effective date and source link for every rate shown.

Reimbursement Intelligence

Behavioral Health Reimbursement Rates by State

Interactive reference for Medicare, Medicaid, and commercial behavioral health reimbursement across all 50 states — with GPCI locality adjustments, credential differentials, telehealth modifier guidance, and state-by-state Medicaid inequality data sourced from public fee schedules.

States

CPT codes

2026

CMS data

Public

Fee schedules

Rate Explorer

Filter by state, payer, CPT code, and provider credential

State

County / Medicare locality

Payer

Credential

CPT code

Modality

California detail page

US State Map

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Same CPT code and payer — up to 3 states side by side

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State 3

State	Rate	vs National
California	$187.04	+12%
Texas	$165.33	-1%
Pennsylvania	$165.33	-1%

Revenue Estimator

Sessions per week × blended payer rate for California

Sessions / week

Medicare mix %

Medicaid mix %

Commercial mix %

40%

Estimated monthly revenue

$14,787.00

Blended rate: $170.76/session (CPT 90837)

90837High-cost marketEstimated

California Medicare (locality approx.)

Psychotherapy, 60 min

$213.76

+28% vs national Medicare

What affects this rate in California

Locality amount uses a rounded GPCI-style multiplier — verify exact locality payment via CMS PFS lookup.
California Medi-Cal uses managed care organizations (MCOs) with county-specific contracts. Urban GPCI localities command 15–25% above national Medicare for psychotherapy.

Medicare national rates are from the CMS 2026 Physician Fee Schedule. Locality and Medicaid figures use approximate multipliers or %‑of‑Medicare ratios — verify exact amounts on CMS PFS lookup and your state Medicaid fee schedule before billing. Commercial ranges are market estimates only. Last updated 2026-06-21.

All States — Rate Table

Sort and filter all 50 states by Medicare rate, Medicaid generosity, and market tier. Click a state name to load it in the explorer above.

			Commercial (est.)	Detail
Lower-cost market	$156.98	72%	$100–$135	View
High-cost market	$230.46	190%	$180–$210	View
Mid-range market	$163.66	76%	$140–$170	View
Lower-cost market	$158.65	74%	$100–$135	View
High-cost market	$187.04	82%	$180–$210	View
Mid-range market	$170.34	80%	$140–$170	View
High-cost market	$183.70	70%	$180–$210	View
Mid-range market	$167.00	75%	$140–$170	View
Mid-range market	$163.66	78%	$140–$170	View
Mid-range market	$161.99	77%	$140–$170	View
High-cost market	$192.05	85%	$180–$210	View
Lower-cost market	$160.32	73%	$100–$135	View
Mid-range market	$167.00	62%	$140–$170	View
Lower-cost market	$160.32	76%	$100–$135	View
Lower-cost market	$158.65	79%	$100–$135	View
Lower-cost market	$158.65	74%	$100–$135	View
Lower-cost market	$156.98	75%	$100–$135	View
Lower-cost market	$158.65	76%	$100–$135	View
Lower-cost market	$161.99	80%	$100–$135	View
Mid-range market	$173.68	78%	$140–$170	View
High-cost market	$187.04	84%	$180–$210	View
Mid-range market	$161.99	77%	$140–$170	View
Mid-range market	$167.00	81%	$140–$170	View
Lower-cost market	$155.31	71%	$100–$135	View
Lower-cost market	$158.65	74%	$100–$135	View
Lower-cost market	$161.99	82%	$100–$135	View
Mid-range market	$160.32	234%	$140–$170	View
Mid-range market	$167.00	79%	$140–$170	View
Mid-range market	$170.34	76%	$140–$170	View
High-cost market	$183.70	55%	$180–$210	View
Mid-range market	$160.32	80%	$140–$170	View
High-cost market	$190.38	88%	$180–$210	View
Mid-range market	$160.32	77%	$140–$170	View
Mid-range market	$161.99	120%	$140–$170	View
Lower-cost market	$160.32	75%	$100–$135	View
Lower-cost market	$156.98	73%	$100–$135	View
Mid-range market	$170.34	83%	$140–$170	View
Mid-range market	$165.33	46%	$140–$170	View
Mid-range market	$170.34	58%	$140–$170	View
Lower-cost market	$158.65	74%	$100–$135	View
Lower-cost market	$160.32	81%	$100–$135	View
Lower-cost market	$158.65	76%	$100–$135	View
Mid-range market	$165.33	76%	$140–$170	View
Mid-range market	$163.66	78%	$140–$170	View
Mid-range market	$165.33	82%	$140–$170	View
Mid-range market	$168.67	77%	$140–$170	View
Mid-range market	$175.35	84%	$140–$170	View
Lower-cost market	$155.31	60%	$100–$135	View
Mid-range market	$163.66	78%	$140–$170	View
Lower-cost market	$163.66	115%	$100–$135	View

Showing 50 states

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Medicare National Benchmarks

Medicare sets the foundation for behavioral health reimbursement nationwide. Geographic Practice Cost Index (GPCI) locality adjustments create significant regional variation — urban high-cost areas like San Francisco and New York City can run 15–25% above these national figures, while rural localities may fall 5–10% below.

CPT 90791

Diagnostic Evaluation

$173.35

CMS 2026 national non-facility

CPT 90832

Psychotherapy, 30 min

$85.84

CMS 2026 national non-facility

CPT 90834

Psychotherapy, 45 min

$113.90

CMS 2026 national non-facility

CPT 90837

Psychotherapy, 60 min

$167.00

CMS 2026 national non-facility

Factors That Influence Behavioral Health Reimbursement

Geographic & market dynamics

Urban areas typically reimburse 10–25% more than rural areas due to higher costs of living and demand for mental health services. Commercial insurance often reimburses between $140 and $210 for a 60-minute therapy session in high-cost states, compared to $100–$135 in lower-cost markets.

Provider credentials & plan type

Higher provider credentials command 10–25% rate differentials across nearly all payers. Insurance plan types — HMO, PPO, and EPO — have different authorization and payment structures. In-network providers receive negotiated rates, often lower than out-of-network, but benefit from higher patient volume.

Medicaid: the wild card

Medicaid is the largest payer for mental health services in the U.S., but reimbursement varies dramatically by state — from 46% of Medicare in Pennsylvania to 234% in Nebraska for psychotherapy. State funding, managed care models, and political priorities all shape Medicaid behavioral health rates.

Telehealth in 2026

Medicare reimburses behavioral health telehealth at parity with in-person sessions in 2026, with no geographic restrictions. Use place-of-service code 02 and modifier 95. Most major commercial insurers have aligned telehealth rates, though prior authorization may still apply.

Frequently Asked Questions

Medicare rates are derived from the CMS Physician Fee Schedule 2026 with geographic (GPCI) locality adjustments. Medicaid figures come from published state fee schedules and state Medicaid agency rate documents. Commercial ranges are estimated from published behavioral health market benchmarks — they are not contracted rates.

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