Reimbursement rates for mental health services increased in 2026 for the first time in five years. A 60-minute psychotherapy session (CPT 90837) now pays $167 nationally, up 8.2% from $154 in 2025. Commercial payers typically reimburse between 120% and 200% of Medicare rates, though actual amounts vary significantly by state, plan, and individual contract. Medicaid pays approximately 70% to 80% of Medicare rates, with wide variation across states. This guide provides the 2026 rates by CPT code, regional adjustments, commercial benchmarks, and negotiation strategies for providers seeking higher reimbursement.
2026 Medicare Reimbursement Rates for Mental Health
If you have been billing Medicare for mental health services over the past five years, you know the drill. The conversion factor dropped year after year. Reimbursement stagnated while everything else got more expensive. Many providers started limiting how many Medicare patients they would see because the math stopped working.
2026 is different.
The Centers for Medicare & Medicaid Services released the final Physician Fee Schedule rule on October 31, 2025. The new conversion factor for 2026 is 33.42. That represents a 3.3% increase over the 2025 conversion factor of 32.3465. A 3.3% increase does not sound huge, but when you factor in the phased increases to the work RVUs for psychotherapy codes, the actual payment increases are much larger.
The table below shows the national payment amounts for common mental health CPT codes. These are the base rates before geographic adjustments. Your actual rate will vary depending on where you practice.
| CPT Code | Description | 2025 Rate | 2026 Final Rate | Change |
| 90837 | 60 min individual therapy | $154.29 | $167.00 | +8.2% |
| 90834 | 45 min individual therapy | $104.16 | $113.89 | +9.3% |
| 90832 | 30 min individual therapy | $78.93 | $85.84 | +8.8% |
| 90791 | Psychiatric diagnostic evaluation | $166.91 | $173.35 | +3.9% |
| 90847 | Family therapy with patient | ~$94 | ~$103 | +~9% |
| 90853 | Group psychotherapy | $28.14 | $30.39 | +8.0% |
| 90839 | Crisis therapy first 60 min | ~$180 | ~$195 | +~8% |
The average increase across these codes is about 5.4%. That is the first real increase in years. For a full-time therapist seeing 25 Medicare patients per week, the difference adds up to roughly $6,000 to $8,000 in additional annual revenue.
Geographic Adjustments
The national payment amounts in the table above are just the starting point. Medicare adjusts payments based on where you practice using something called the Geographic Practice Cost Index (GPCI).
If you practice in a high-cost area like Manhattan or San Francisco, your actual rate will be higher than the national rate. If you practice in a low-cost rural area, your rate will be lower. The difference can be fifteen to twenty dollars per session.
To find your exact Medicare rate for any CPT code, go to the CMS Medicare Physician Fee Schedule Lookup tool. Enter your zip code, select the CPT code, and choose “non-facility” pricing unless you practice in a hospital outpatient department. Do not guess your rate. Look it up.
Facility vs. Non-Facility Rates
One more thing that confuses many providers. Medicare pays different rates depending on where the service happens.
Non-facility rates apply when you own or rent your own office space. You pay for the lights, the rent, the furniture, the internet. Medicare pays you a higher rate to account for these overhead costs.
Facility rates apply when you provide services in a hospital outpatient department, skilled nursing facility, or other institutional setting. The facility pays for the overhead, so Medicare pays you less. The difference can be fifteen to thirty percent.
Most private practice therapists bill under non-facility rates. If you see patients in a hospital or clinic where someone else owns the space, you are likely looking at facility rates. Check your Medicare remittance advices to confirm which rate you are receiving.
Commercial Payer Reimbursement Rates for Mental Health 2026
Commercial insurance is where things get messy. Unlike Medicare with its published fee schedule, commercial payers negotiate rates individually with each provider or group. Two therapists in the same city, seeing the same patients, billing the same CPT codes, can get paid completely different amounts by the same insurance company.
That said, there are patterns. Industry benchmarking data shows that commercial payers typically reimburse mental health services at 120% to 200% of Medicare rates. In competitive markets with provider shortages, rates skew toward the high end. In saturated markets with many providers competing for patients, rates skew toward the low end.
The table below shows illustrative commercial rate ranges based on the Medicare midpoint for each code.
| CPT Code | Medicare Approximate Midpoint | Typical Commercial Range |
| 90832 | $67 | $80 – $135 |
| 90834 | $107 | $130 – $215 |
| 90837 | $150 | $180 – $300 |
| 90847 | $137 | $165 – $275 |
| 90853 | $52 | $63 – $105 |
While specific rates vary by region and contract, certain patterns hold across the industry.
- Blue Cross Blue Shield varies dramatically by state because BCBS is a federation of independent companies. BCBS of Massachusetts pays higher rates than BCBS of Texas, generally. The in-network rates across BCBS plans typically land in the 130% to 180% of Medicare range.
- UnitedHealthcare / Optum is the largest behavioral health network in the country. Their rates tend to be on the lower end of the commercial spectrum, often 120% to 150% of Medicare. However, Optum is now managing behavioral health benefits for other plans as well. Sharp Health Plan in California moved its behavioral health benefits to Optum effective January 1, 2026. If you are already in-network with Optum, your existing contract now applies to Sharp members without any additional credentialing.
- Cigna / Evernorth typically sits in the middle of the commercial range, around 140% to 170% of Medicare. Their provider portal is relatively user-friendly, and they process claims faster than many competitors.
- Aetna is similar to Cigna. Rates in the 140% to 170% range are common. Aetna has been expanding its behavioral health networks aggressively, so new providers may have more leverage in negotiations.
- Humana focuses heavily on Medicare Advantage plans. Their rates for behavioral health vary, but many providers report rates comparable to traditional Medicare or slightly higher.
Why Your Commercial Rates Might Be Too Low
Many providers signed their initial contracts years ago when they were building their practices and needed patients. They accepted whatever rate the payer offered. Years passed. The practice grew. The provider never went back to ask for more.
Those old contracts are almost certainly underpaying you. The market has changed. Commercial payers are under pressure from state regulators to maintain adequate behavioral health networks. In many areas, there are not enough providers to meet demand. That gives you leverage.
If your contracted rate for 90837 is below 150% of your local Medicare rate, you have room to negotiate. If it is below 120%, you are leaving a significant amount of money on the table.
How to Check Your Current Rates
Pull your remittance advices from the past three months. For each major commercial payer, find the allowed amount for your most common codes. Compare that allowed amount to the Medicare rate for the same code in your area using the CMS lookup tool.
If your commercial rate is less than or equal to Medicare, you have a serious problem that needs immediate attention. You are being paid less than what the federal government pays, and you can almost certainly do better by either renegotiating or dropping that contract.
If your commercial rate is between 100% and 130% of Medicare, you are in the lower tier. You should consider renegotiation, especially if you have a full caseload and can afford to walk away.
If your commercial rate is above 150% of Medicare, you are doing well. Keep that contract and consider asking for more during your next renegotiation cycle.
Medicaid Mental Health Reimbursement Rates 2026
Medicaid is the largest single payer for mental health services in the United States. Millions of adults with behavioral health conditions rely on Medicaid for their coverage. But the reimbursement rates are significantly lower than both Medicare and commercial insurance.
On average, Medicaid pays about 70% to 80% of Medicare rates for mental health services. If Medicare pays $167 for a 90837 in your area, Medicaid might pay $117 to $134. That gap is substantial.
The variation by state is extreme. Some states have raised behavioral health rates in 2025 and 2026. Illinois and California have made meaningful increases to attract more providers into their Medicaid networks. Other states have not increased rates in years, and providers are dropping out of Medicaid participation as a result.
Most states use managed care organizations to administer their Medicaid behavioral health benefits. These MCOs may negotiate rates slightly above or below the state fee schedule. In some regions, an MCO might pay 90% of Medicare. In others, the same MCO might pay 60% of Medicare. There is no national standard.
Self-Pay Therapy Rates 2026
Not every patient wants to use insurance. Some prefer to pay out of pocket to avoid having a mental health diagnosis on their medical record. Others are in high-deductible plans where paying cash is actually cheaper than filing an insurance claim. And some therapists do not accept insurance at all, operating entirely on a self-pay model.
Self-pay rates vary significantly by geographic location, provider credentials, and market positioning. A survey of provider fee schedules from early 2026 shows the following ranges.
| Service Type | Typical Range | Reported Examples |
| Individual intake session | $150 – $250 | $200, $205, $225 |
| Individual therapy session (45-60 min) | $140 – $220 | $175, $180, $200 |
| Couples/family intake | $200 – $275 | $225, $250 |
| Couples/family therapy session | $175 – $250 | $200, $250 |
A practice in Downers Grove, Illinois reported individual intake at $200 and ongoing sessions at $175 as of January 1, 2026. A Chicago practice reported initial sessions at $205 for master’s level clinicians and $225 for psychologists, with follow-up sessions at $180 and $205 respectively. Another provider listed individual sessions at $200 and couples therapy at $250.
The variation reflects different markets and different positioning strategies. A therapist in downtown Chicago can charge more than a therapist in a rural Illinois town. A psychologist with thirty years of experience can charge more than an LPC who just graduated. A provider who specializes in a niche area with high demand, such as eating disorders or trauma, can command premium rates.
The No Surprises Act requires providers to give self-pay clients a Good Faith Estimate of expected charges before the first appointment. This estimate must list the expected costs for the course of treatment. It protects patients from surprise bills and protects providers by documenting that the patient agreed to the fees upfront.
How to Find Rates for Your Practice
Medicare
Go to the CMS Medicare Physician Fee Schedule Lookup tool. Select your state and locality. Enter the CPT code you want to check. Choose “non-facility” for private practice office settings. The tool will return the exact allowed amount for your area.
Medicaid
Contact your state Medicaid agency or your local Medicaid managed care organization. Ask for the current fee schedule for behavioral health services. Some states publish these schedules online. Others require a direct request. If you are already a Medicaid provider, check your remittance advices. The allowed amount on a paid claim is your contracted rate.
Commercial Payers
Log into your payer portals. Each major payer has a fee schedule lookup tool. In Availity (used by BCBS and many others), navigate to the fee schedule research section. In Optum’s Provider Express, look for the reimbursement rate tool. If the portal does not show your rates, call provider services and ask for your contracted allowed amounts for your top five CPT codes.
If you are not yet in-network with a payer, you can still ask for a fee schedule before signing a contract. Do not sign a contract without seeing the rates first. A payer who refuses to share their fee schedule before contract signing is a payer you should think twice about contracting with.
Billing Tips to Maximize Reimbursement
This sounds obvious, but it is violated constantly. A 45-minute session does not become a 60-minute session just because you want more money. Billing 90837 for a 45-minute session is upcoding. Auditors look for this pattern specifically. When they find it, they recoup payments and flag your practice for further review.
The time thresholds are clear. 90832 is for 16 to 37 minutes. 90834 is for 38 to 52 minutes. 90837 is for 53 minutes or longer. Document your start and stop times in every note. If a session runs 50 minutes, bill 90834. If you consistently bill 90837, your documentation must consistently show 53 or more minutes of face-to-face time.
Do Not Bill Multiple Psychotherapy Codes on the Same Day
Some providers try to bill both individual and family therapy for the same patient on the same day. Payers generally deny this as duplicate billing. Pick the code that best represents the primary service provided.
Check Prior Authorization Requirements
Many commercial payers require prior authorization for ongoing therapy after a certain number of sessions. Even if the patient has active coverage and the service is covered, you will not get paid without an authorization number. Verify authorization requirements during your eligibility check. Document the authorization number in the patient account. Include it on the claim.
Use the Add-On Codes Correctly
Codes like 90833 (individual psychotherapy add-on to an E/M service) are useful in integrated care settings. A psychiatrist performing medication management can add 90833 to capture therapy time during the same visit. The documentation must support both services.
How to Negotiate Higher Commercial Rates
Know Your Leverage
You have more leverage than you think. Behavioral health provider shortages affect almost every region of the country. Payers need in-network providers to meet network adequacy requirements imposed by state regulators.
If you have a full caseload and a waiting list, you have leverage. If you are the only provider accepting new patients in your area, you have significant leverage. If your patients would struggle to find another in-network provider, you have leverage.
Prepare Your Data
Before you ask for a rate increase, gather your data. Know your current allowed amounts. Know the Medicare rate for your area. Know what other payers are paying you. Know what the payer reimburses new providers in your region.
Ask your provider representative for the current fee schedule for your specialty and locality. Compare it to your contract. If new providers are getting higher rates than you, use that as a negotiating point.
Make the Ask
Schedule a call with your provider relations representative. Do not try to negotiate through the general customer service line. Those representatives do not have authority to change rates.
State your request clearly. “My contracted rate for 90837 is $135. The Medicare rate in my area is $150. Other commercial payers are reimbursing me at $165 to $180. I am requesting an increase to $175 for this code.”
Be prepared for a no. Some payers will not negotiate individual contracts. Others have rigid fee schedules that apply to all providers in a region. But you never know until you ask. And the act of asking signals that you are paying attention to your rates and might leave the network if they do not improve.
Consider Walking Away
The ultimate negotiating leverage is the ability to walk away. If a payer is consistently underpaying you and refuses to negotiate, consider terminating your contract.
Do this carefully. Review your contract termination notice period. Some contracts require 60 or 90 days’ notice. Build a plan for your existing patients. They will need to find new in-network providers or continue with you on an out-of-network basis.
In many markets, dropping a low-paying payer is a smart business decision. You can fill those appointment slots with self-pay or better-paying insurance patients. Your income may actually increase even though you are seeing the same number of patients.
The Bottom Line
Medicare reimbursement for mental health services finally increased in 2026 after years of cuts and freezes. A 90837 now pays approximately $167 nationally. That is an 8.2% increase from 2025.
Commercial payers typically reimburse between 120% and 200% of Medicare rates. Medicaid pays 70% to 80% of Medicare rates, with significant state variation. Self-pay rates range from $140 to $220 for individual sessions.
Your actual rates depend on your location, your credentials, your contracts, and your willingness to negotiate. The providers who succeed in 2026 are the ones who know their numbers, track their payers, and advocate for themselves.
