The Medicare Physician Fee Schedule sets the floor that most commercial payers reference. A 60-minute therapy session (CPT 90837) pays roughly $132 Medicare, $145 to $185 commercial, $90 to $130 Medicaid. The full code-by-code table sits below, with locality-adjusted ranges and the testing codes that most psychologists undercharge.
Last verified 20 May 2026 · Source: CMS Physician Fee Schedule Look-Up, 2026 final rule
$195
Medicare 90791 intake (60-90 min)
$132
Medicare 90837 therapy (60 min)
$130
Medicare 96130 testing eval first hour
110-140%
Commercial as multiple of Medicare
CPT-by-CPT Rate Table (2026)
The full set of psychologist-billable CPT codes with 2026 Medicare PFS national average, typical Medicaid range (state-dependent), and typical commercial payer range. All Medicare rates are before locality (GAF) adjustment.
CPT
Description
Medicare 2026
Medicaid typical
Commercial typical
90791
Psychiatric diagnostic eval (no medical)
$195
$115 - $175
$215 - $275
90832
Psychotherapy, 30 minutes
$70
$45 - $65
$80 - $105
90834
Psychotherapy, 45 minutes
$105
$70 - $95
$120 - $150
90837
Psychotherapy, 60 minutes
$132
$90 - $130
$145 - $185
90839
Crisis psychotherapy, first 60 min
$182
$130 - $170
$210 - $265
90840
Crisis, each additional 30 min
$86
$60 - $80
$95 - $125
90846
Family therapy, patient not present
$86
$55 - $80
$100 - $130
90847
Family therapy, patient present (50 min)
$108
$75 - $105
$125 - $165
90853
Group psychotherapy
$31
$20 - $30
$35 - $55
96130
Psychological testing eval, first hour
$130
$85 - $115
$145 - $190
96131
Psych testing eval, each addl hour
$97
$65 - $90
$110 - $145
96132
Neuropsych testing eval, first hour
$143
$95 - $130
$165 - $215
96133
Neuropsych testing eval, each addl hour
$108
$75 - $100
$120 - $160
96136
Test administration first 30 min (by technician)
$45
$30 - $42
$50 - $70
96137
Test administration, each addl 30 min
$42
$28 - $40
$48 - $65
96146
Single automated test (Q-LES-Q, PHQ-9)
$2.50
$1.50 - $3
$3 - $6
Source: CMS Physician Fee Schedule Look-Up, national-average rates from the 2026 final rule effective 1 January 2026. Locality adjustment ranges roughly minus 8 percent in rural areas to plus 23 percent in San Francisco-Oakland. Medicaid ranges aggregated from state Medicaid fee schedules (NY, CA, TX, FL, IL, OH, PA published rates 2024-25). Commercial ranges from APA Practice Org payer reports and aggregated clinician self-reported contracted rates.
Worked Example: Typical Insurance Caseload Annual Revenue
Assume a clinician carries 25 sessions per week, 48 working weeks per year, mostly 90837. Three payer mixes:
Scenario
Per-session avg
Annual gross (1,200 sessions)
Net after 35% overhead
100% Medicare 90837
$132
$158,400
$103,000
50% Medicare / 50% commercial
~$148
$177,600
$115,400
100% commercial (mid)
~$165
$198,000
$128,700
100% cash-pay ($225)
$225
$270,000
$175,500
Assumes 25 sessions per week x 48 weeks = 1,200 billable units. Overhead 35 percent covers rent, EHR, malpractice, billing, marketing, CE, and unpaid documentation hours. The cash-pay scenario assumes the clinician absorbs the patient-acquisition cost (currently $80 to $150 per new client through Psychology Today, Headway directory, or paid search), which is included in the 35 percent overhead.
How the CMS Rate Is Computed
Each CPT code has a Relative Value Unit (RVU) total made of work RVU, practice expense RVU, and malpractice RVU. The total RVU is multiplied by the year's conversion factor and a locality adjustment (Geographic Practice Cost Index, GPCI) to produce the final payment. The 2026 conversion factor is approximately $33.28 per RVU, a partial restoration after the 2024 cut. Locality adjustments range from approximately 0.92 in Mississippi rural to 1.23 in San Francisco-Oakland.
The work RVU for psychotherapy codes has been a CMS-AMA RUC negotiation point for years. The 2024 increase to 90837 work RVU from 2.10 to 2.20 was the first rise in over a decade and reflects rising mental health utilization. Whether that pace continues in the 2027 rule is uncertain. APA Practice Org publishes a tracker.
What does Medicare pay psychologists for a 60-minute therapy session (90837)?
Medicare pays approximately $132 for CPT 90837 (psychotherapy, 60 minutes) under the 2026 Physician Fee Schedule, before locality adjustment. Locality-adjusted rates range from roughly $115 in rural areas to $162 in San Francisco. The 2026 rate reflects the partial restoration of the conversion factor after years of cuts. Psychologists in non-facility settings receive the full rate; facility settings (hospital outpatient) receive a slightly lower professional-component-only rate.
How much does Medicare reimburse for the diagnostic intake 90791?
Medicare reimburses approximately $195 for CPT 90791 (psychiatric diagnostic evaluation without medical services) under the 2026 PFS, before locality adjustment. This single-use intake code typically runs 60 to 90 minutes and is billed once per episode of care. Commercial payers usually reimburse the intake at 110 to 140 percent of the Medicare rate, putting commercial 90791 in the $215 to $275 range. Medicaid 90791 rates vary widely by state, generally $115 to $175.
What are the psychological testing CPT codes worth?
Testing has two relevant code pairs. Test administration: 96136 (first 30 minutes by technician) and 96137 (each additional 30 minutes). Test evaluation: 96130 (psychological test evaluation, first hour by psychologist) and 96131 (each additional hour). 2026 Medicare PFS reimburses 96130 at approximately $130 and 96131 at approximately $97. A typical 6-hour neuropsychological battery (intake 90791 + 4 hours admin under 96136/37 + 4 hours interpretation under 96130/31) Medicare-bills out at roughly $700 to $900 depending on locality.
Are commercial insurance rates higher than Medicare for psychologists?
Generally yes, but the gap has narrowed since 2020. Commercial payers (Aetna, Cigna, BCBS, UnitedHealthcare) typically reimburse doctoral psychologists 110 to 140 percent of the Medicare PFS rate. Pre-2020 the multiple was often 150 to 180 percent. Optum (United Behavioral Health) and Cigna Evernorth have been particularly aggressive in narrowing toward Medicare. Anthem and Aetna Behavioral remain closer to the 130 to 140 percent range. Cash-pay clinicians charging $200 to $300 per 90837 session are at roughly 150 to 225 percent of Medicare.
What is the difference between 90837 (60 min) and 90834 (45 min) reimbursement?
CPT 90834 (psychotherapy, 45 minutes) pays approximately $105 under the 2026 Medicare PFS; CPT 90837 (60 minutes) pays approximately $132. The per-minute rate is similar, slightly favouring 90837. The clinical and economic decision is whether the additional 15 minutes generates enough therapeutic value to justify the schedule density loss. Many payers have informal soft caps or audit thresholds on 90837 usage above 50 to 60 percent of a clinician's sessions, because the code is the third-most-audited psychotherapy code per Medicare CERT data.
Can psychologists bill 90847 (family/couples therapy)?
Yes. CPT 90847 (family or couples psychotherapy with the patient present, 50 minutes) reimburses approximately $108 under the 2026 Medicare PFS. CPT 90846 (family therapy without the patient present, 50 minutes) reimburses approximately $86. The patient must be identified and the session must focus on that patient's care plan. Many commercial payers reimburse 90847 at slightly higher rates than 90837 (60-min individual) reflecting the additional clinical complexity. Couples therapy as a standalone (no identified patient) is generally not insurance-reimbursable and is typically billed cash.
How do crisis psychotherapy codes 90839 and 90840 pay?
CPT 90839 (psychotherapy for crisis, first 60 minutes) reimburses approximately $182 under the 2026 Medicare PFS. CPT 90840 (each additional 30 minutes) reimburses approximately $86. These codes require documented imminent psychiatric crisis and cannot be used for routine therapy regardless of clinical intensity. Used appropriately, a 90-minute crisis intervention bills at approximately $268 (90839 + 90840), about double the 90837 rate. These codes are heavily audit-flagged, so documentation of acute crisis criteria (suicidal ideation, severe dissociation, acute psychotic break) must be explicit.
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