What does Medicare pay for 90837 in 2026?

Medicare payment equals the code's total RVUs multiplied by the CY 2026 conversion factor of $33.4009 for non-APM clinicians, then adjusted by your locality's geographic practice cost index. That is why we publish the multiplier rather than a single national dollar figure: the national figure is indicative, and the locality-adjusted figure is the one you are actually paid. For CY 2024, CMS-published national approximations were about $138 for 90837 and about $108 for 90834 — useful as an order of magnitude, and explicitly a 2024 number.

Why will you not just publish commercial rates by payer?

Because they are not public. Commercial reimbursement is contracted practice by practice and those contracts carry confidentiality terms. Pages that publish an 'Aetna 90837 rate' are publishing one practice's contract, a stale figure, or a guess — and a clinician who negotiates against it is negotiating against fiction. The honest substitute is the method for deriving your own, which is on this page.

How do I calculate my own effective rate?

Take one payer and one code. Add the total allowed amount for that code across a defined period, then divide by the number of units of that code paid in the same period. That gives your effective allowed amount per unit, net of downcoding and adjustment. Repeat per payer. Do not blend payers — the blended figure conceals exactly the contract you most need to see.

Is the mental-health rate gap actually documented, or is it a feeling?

Documented. The Kennedy Forum's 2026 Mental Health Parity Index found the four largest commercial insurers pay clinicians less for outpatient mental health care than for physical health care in all 43 states it examined, within the same plans. Separately, the APA's December 2024 Practitioner Pulse Survey found 34% of practicing psychologists were not in-network with any insurance, and 82% of those who left cited low reimbursement.

Therapy Reimbursement Rates 2026 — What Is Public, What Is Not

Where the pathway breaks — and how we close it

Medicare payment for a psychotherapy code is the code's total RVUs multiplied by the conversion factor, adjusted by your locality's geographic practice cost index. That means a single nationwide dollar figure for 90834 or 90837 is indicative, never the amount landing in your account. Commercial rates are worse: they are contracted per practice and covered by confidentiality terms, so the '2026 rate for 90837' that circulates in trade press and forum posts is somebody's contract, not yours.

$33.4009 CY 2026 Medicare conversion factor, non-APM clinicians ^source

Cost when unaddressed: Clinicians negotiate, or decline to negotiate, against a number they have never actually calculated.

Your effective rate per code is already in your remittance advice: total allowed amount for a code over a period, divided by the number of units of that code paid in the same period. That is your real contracted rate net of downcoding and adjustment — the only rate figure that describes your practice. Run it per payer, not blended, because a blended average hides the payer that is dragging the mean down.

Per payer the unit of analysis that actually informs a contract decision

Before Indicative any national dollar figure for a psychotherapy code ^source

After Your own allowed-amount-per-unit, per payer, from remittance

Impact on the rate you are paid is not a number you can look up Methodology →

This is not a matter of behavioral health being a lower-margin line. The Kennedy Forum's 2026 Mental Health Parity Index found that the four largest commercial insurers pay clinicians less for outpatient mental health care than for physical health care in all 43 states examined — inside the same plans. The gap is structural and it is written into the contracts, which is precisely why the contracts are not public.

43 of 43 states where the four largest insurers pay less for mental health than physical health, inside the same plan ^source

Cost when unaddressed: A practice can be fully compliant, fully credentialed, and still structurally underpaid relative to the medical practice down the hall.

Once you have your allowed-amount-per-unit per payer, the panel decision becomes arithmetic rather than sentiment: effective rate, multiplied by realistic volume, minus the administrative hours that payer specifically costs you. Some panels survive that calculation. The ones that do not are visible immediately, and they are usually the ones generating the most rework.

82% of psychologists leaving insurance cite low reimbursement as the reason ^cite

Before 34% of practicing psychologists not in-network with any insurer, APA December 2024 ^source

After Per-payer panel decisions made on measured rate, not on impression ^source

Impact on the mental-health discount is inside the same plan Methodology →

Methodology

How we measure

Every figure on this page is either a published government multiplier or a survey statistic with a named publisher and year. We do not publish commercial per-code rates, because commercial rates are contracted per practice under confidentiality terms and any specific figure would be someone else's contract presented as yours. Where a number is older than the current year it is labelled with its year in the sentence that uses it.

What counts

The CY 2026 Medicare Physician Fee Schedule conversion factor, as a published multiplier
Survey statistics from named publishers with the survey year stated
The arithmetic method for deriving a clinician's own effective rate from remittance advice

What doesn't count

Commercial per-code rates for any named payer — these are confidential and we will not invent them
Blended 'average therapy rate' figures that mix payers, localities and code sets
Any rate figure whose original source we could not name and date

Sources: cms-2026-pfs-conversion-factor , cms-2024-medicare-mhssp-rates , kennedy-forum-2026-parity-index , apa-2024-practitioner-pulse-insurance

How we compare

Sourced from primary citations — not vendor marketing claims.

	Us Medicare	vs State Medicaid	vs Commercial
Is the rate published? ^cite	Yes — conversion factor $33.4009 (CY 2026, non-APM), RVUs and GPCI all public	Yes — per-state fee schedules, published by each state Medicaid agency	No — contracted per practice, under confidentiality terms
Who sets it?	CMS, through annual rulemaking with a public comment period	The state, through its Medicaid agency and legislature	The payer, in a contract offered to your practice
Can you negotiate it?	No	No	Sometimes — and only if you know your current effective rate
How you find your actual number	RVU × conversion factor × your locality GPCI	Look up your state's current fee schedule	Allowed amount ÷ units paid, from your own remittance advice
Documented pay gap vs physical health? ^cite	Set by formula, not by service line	Varies by state	Yes — lower for mental health in all 43 states examined, inside the same plans

Frequently asked questions

What does Medicare pay for 90837 in 2026?: Medicare payment equals the code's total RVUs multiplied by the CY 2026 conversion factor of $33.4009 for non-APM clinicians, then adjusted by your locality's geographic practice cost index. That is why we publish the multiplier rather than a single national dollar figure: the national figure is indicative, and the locality-adjusted figure is the one you are actually paid. For CY 2024, CMS-published national approximations were about $138 for 90837 and about $108 for 90834 — useful as an order of magnitude, and explicitly a 2024 number.
Cited: cms-2026-pfs-conversion-factor , cms-2024-medicare-mhssp-rates
Why will you not just publish commercial rates by payer?: Because they are not public. Commercial reimbursement is contracted practice by practice and those contracts carry confidentiality terms. Pages that publish an 'Aetna 90837 rate' are publishing one practice's contract, a stale figure, or a guess — and a clinician who negotiates against it is negotiating against fiction. The honest substitute is the method for deriving your own, which is on this page.
How do I calculate my own effective rate?: Take one payer and one code. Add the total allowed amount for that code across a defined period, then divide by the number of units of that code paid in the same period. That gives your effective allowed amount per unit, net of downcoding and adjustment. Repeat per payer. Do not blend payers — the blended figure conceals exactly the contract you most need to see.
Is the mental-health rate gap actually documented, or is it a feeling?: Documented. The Kennedy Forum's 2026 Mental Health Parity Index found the four largest commercial insurers pay clinicians less for outpatient mental health care than for physical health care in all 43 states it examined, within the same plans. Separately, the APA's December 2024 Practitioner Pulse Survey found 34% of practicing psychologists were not in-network with any insurance, and 82% of those who left cited low reimbursement.
Cited: kennedy-forum-2026-parity-index , apa-2024-practitioner-pulse-insurance

Every therapist I know can tell you what they charge. Almost none can tell you what they are actually paid.

— Matthew Sexton, LCSW

Every therapist I know can tell you what they charge and almost none can tell you what they are actually paid, per payer, per code. That is not a competence problem. It is that the number is deliberately hard to assemble, and the people who benefit from it being hard to assemble are not the clinicians. Publishing the multiplier and the arithmetic is the least a company in this space can do.

Matthew Sexton, LCSW Founder · Mental Wealth Solutions Inc.

Citations

Centers for Medicare and Medicaid Services (2026). Medicare Physician Fee Schedule CY 2026 Final Rule: conversion factor. CMS CY 2026 Medicare Physician Fee Schedule Final Rule (released 2025-10-31); figures as reported by the Alliance for Physical Therapy Quality and Innovation. Source
- The CY 2026 Medicare Physician Fee Schedule conversion factor is $33.4009 for clinicians who are not qualifying Alternative Payment Model participants, and $33.5675 for those who are — increases of 3.26% and 3.77% respectively over the CY 2025 conversion factor of $32.3465.
- Almost all solo and small-group behavioral health clinicians bill under the non-APM conversion factor of $33.4009, because APM participation requires risk-bearing arrangements that outpatient psychotherapy practices are rarely party to.
- Medicare payment for a psychotherapy code equals that code's total RVUs multiplied by the conversion factor and adjusted by the locality GPCI, which is why any single nationwide dollar figure for 90834 or 90837 is indicative rather than the amount a specific clinician is actually paid.
“The CY 2026 Medicare conversion factor is $33.4009 for non-APM clinicians — which is nearly every solo therapist in the country.”
Centers for Medicare and Medicaid Services (2024). Medicare Physician Fee Schedule CY 2024 Final Rule: Mental Health and Substance Use Disorder Services. CMS Federal Register Final Rule CMS-1784-F. Source
- Medicare CY 2024 added Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) as recognized Medicare providers for the first time, expanding Medicare's enrolled mental health workforce by an estimated 400,000 eligible clinicians.
- Medicare reimbursement for 90837 (60-minute psychotherapy with patient) approximately $138 in 2024 national rate, with geographic adjustment; 90834 (45-minute psychotherapy) approximately $108; rates remain below most commercial insurance medians but above Medicaid in most states.
- CMS expanded telehealth waivers for mental health services made permanent under Consolidated Appropriations Act 2023; in-person visit requirement before initial telehealth visit waived through December 31, 2024 with subsequent extensions, materially expanding telehealth-only practice viability.
“Medicare CY 2024 added MFTs and MHCs as recognized providers — expanding Medicare's enrolled mental health workforce by an estimated 400,000 eligible clinicians.”
The Kennedy Forum (2026). Mental Health Parity Index (2026). The Kennedy Forum (reported by AHA News, April 2026). Source
- The four largest commercial insurers (Aetna, BlueCross BlueShield, Cigna, and UnitedHealthcare) pay clinicians less for outpatient mental health care than for physical health care in all 43 states examined, inside the same plans.
“The four largest commercial insurers pay less for outpatient mental health than for physical health in all 43 states examined, inside the same plans.”
American Psychological Association (2024). 2024 Practitioner Pulse Survey: Insurance Participation and Reimbursement. American Psychological Association. Source
- In the APA's 2024 Practitioner Pulse Survey (December 2024), 34% of practicing psychologists were not in-network with any insurance.
- The most-cited reason for leaving insurance was low reimbursement rates (82%).
- Patients are more than ten times as likely to go out-of-network for mental health care as for other specialty medical care.
Sammons MT, Elliott TR, Schmidt JD, & Olvey CDV (2020). Private practice in psychology: Economic and structural realities. Professional Psychology Research and Practice. doi:10.1037/pro0000299
- Solo and small-group private psychology practice gross revenue per FTE clinician ranges from $90,000 to $180,000 annually depending on payer mix, geographic market, and session volume — net after overhead and benefits typically 50 to 65 percent of gross.
- Insurance-panel reimbursement rates for psychologists in 2020 ranged from $80 to $130 per 60-minute session for commercial payers; Medicaid rates ranged from $40 to $90 — driving the documented shift toward cash-pay practice (out-of-network or self-pay only) at the higher end of the market.
- Private practice overhead components: rent and utilities 18 percent, billing and admin labor 14 percent, malpractice insurance 4 percent, EHR and telehealth software 3 percent, continuing education and licensing 2 percent — totaling roughly 41 percent overhead before personal benefits.
“Solo and small-group private psychology practice gross revenue per FTE clinician ranges $90,000 to $180,000 annually; net after overhead typically 50 to 65 percent.”

Where the pathway breaks — and how we close it

The rate you are paid is not a number you can look up

Derive your effective rate from remittance, not from a listicle

The mental-health discount is inside the same plan

Price the panel, then decide whether to stay on it