Pennsylvania Behavioral Health Reimbursement Rates
Pennsylvania behavioral health billing requires state-specific Medicaid enrollment, payer-specific authorization rules, and credential verification before claim submission.
Medicare 90837
$165.33
Medicaid 90837
$76.05
Commercial (est.)
$140.00–$170.00
Medicare Locality Rates — CPT 90837
GPCI-adjusted Medicare psychotherapy rates by county and metro locality in Pennsylvania.
| Locality | Medicare 90837 | vs National |
|---|---|---|
| Pennsylvania Metropolitan Philadelphia | $177.02 | +6% |
| Rest of Pennsylvania | $156.98 | -6% |
Key CPT Code Rates — Pennsylvania
CPT 90791
Diagnostic Evaluation
Medicare: $171.62
Medicaid: $78.94
CPT 90832
Psychotherapy, 30 min
Medicare: $84.98
Medicaid: $39.09
CPT 90834
Psychotherapy, 45 min
Medicare: $112.76
Medicaid: $51.87
CPT 90837
Psychotherapy, 60 min
Medicare: $165.33
Medicaid: $76.05
Medicaid in Pennsylvania
Pennsylvania Medicaid uses a managed care model. Published estimates approximate 46% of Medicare for key outpatient behavioral health CPT codes — actual fee schedule dollars vary by code and provider type. Pennsylvania Medicaid psychotherapy rates are among the lowest nationally — published estimates approximate 46–55% of Medicare depending on code and provider type; verify on MA fee schedule.
Master's-level clinicians typically receive 75–80% of psychologist rates for identical psychotherapy CPT codes under most state Medicaid fee schedules.
Source: Pennsylvania Medicaid fee schedule (effective 2026-01-01).
Explore Pennsylvania Rates
Use the interactive explorer below — pre-loaded for Pennsylvania.