Therapist Reimbursement Rates 2026: What Medicare Pays For 90837, 90834 And 90791

Credentialing

For 2026, Medicare’s national allowed amount for a 60 minute psychotherapy session (90837) in an office is $167.00 for a clinical psychologist and $125.25 for a licensed clinical social worker, marriage and family therapist or mental health counselor. Those numbers come straight from the CMS fee schedule files. They show what Medicare pays, not what a commercial insurer will pay you.

Where These Numbers Come From

Medicare sets what it pays through the Physician Fee Schedule. Each service has relative value units for work, practice expense and malpractice, and CMS multiplies them by a conversion factor to get dollars. For 2026, CMS published two conversion factors. Qualifying APM Participants for the year are paid on $33.5675, and everyone else on $33.4009. The table below uses $33.4009, which applies to a therapist in private practice who isn’t a Qualifying APM Participant. If you are one, your amounts run about half a percent higher.

The amounts here are national allowed amounts, before CMS adjusts for the cost of practicing in a particular county. Medicare pays 80% of the allowed amount and the patient owes the other 20%, according to the CMS booklet on mental health coverage. CMS publishes each code at two rates. The office column below is the one CMS labels non facility, and the facility column is the other, depending on the place of service on the claim.

2026 Medicare Amounts For The Codes Therapists Bill Most

Calculated from the CMS CY 2026 PFS relative value file (January 2026 release, nonQP version) at a $33.4009 conversion factor, with national geographic indices of 1.0. Each amount is total relative value units times the conversion factor, rounded to the cent. The 75% column is 75% of the psychologist amount. Code 90846 carries status R, restricted coverage, in the CMS file.

A Worked Example For 90837

In the CMS file, 90837 carries 3.78 work relative value units, 1.20 practice expense units in the office setting and 0.02 malpractice units. Those add up to 5.00 total units for an office session, and 5.00 times $33.4009 is $167.00, the national allowed amount for a psychologist. Seventy five percent of that is $125.25 for an LCSW, LMFT or MHC. Medicare pays 80% of it, $100.20 to the counselor, and the patient owes the other 20%, $25.05.

For the facility rate, the same code carries 0.25 practice expense units instead of 1.20, so the total drops to 4.05 units and the psychologist amount to $135.27. That gap is why the place of service on your claim matters.

What Accepting Assignment Means For You

CMS says a clinical social worker, marriage and family therapist or mental health counselor must accept assignment. For a clinical psychologist, CMS pays 100% of the fee schedule amount only if the psychologist accepts assignment. Accepting assignment means you take the Medicare allowed amount as payment in full, with the patient’s 20% covering the rest. So the table is more than a reference: for a Medicare patient, it is the whole fee for that session, whatever your usual rate is.

Why Social Workers, Counselors And Family Therapists Are Paid 75%

CMS pays a clinical psychologist 100% of the fee schedule amount. For clinical social workers, CMS says it pays 75% of the psychologist amount. Marriage and family therapists and mental health counselors can bill Medicare directly as of January 1, 2024, and CMS lists the same 75% for both. That is why a licensed professional counselor and a licensed clinical social worker see the same Medicare number for 90837, and a psychologist sees one third higher.

Those percentages are about Medicare and don’t carry over to commercial plans. If you are an LPC or LMFT who has been told your rate is 75% of a psychologist’s, that is a Medicare rule and says nothing about what a commercial contract will say.

What Medicare Numbers Do And Don’t Tell You About Commercial Rates

A commercial insurer pays whatever is in your contract with that insurer. The rate lives in the fee schedule attached to that contract and can differ by insurer, by state and by plan. Two therapists in the same city can be on different rates for the same code because they signed different contracts.

So there is no single “therapist reimbursement rate” to quote, and we aren’t going to print commercial numbers we can’t trace to a payer’s own document. Instead, ask each insurer for the fee schedule for your license type before you sign, then set it next to the Medicare amounts in the table. If you are weighing your own contracts against a platform’s rates, our guide on what happens to your insurance contracts when you leave a platform walks through the order of steps.

Prescribers have their own version of this math. The PMHNP reimbursement rates guide covers how nurse practitioner payment works, with Medicare rates by locality.

Frequently Asked Questions

What Does Medicare Pay An LPC For 90837?

The national allowed amount in 2026 is $125.25 in an office, which is 75% of the clinical psychologist amount of $167.00. Your local amount moves with the geographic index for your county.

Can LPCs And LMFTs Bill Medicare Directly?

Yes. Marriage and family therapists and mental health counselors can bill Medicare directly beginning January 1, 2024, once they enroll. Our guide to Medicare enrollment for counselors and MFTs covers that process.

Is The Medicare Rate The Same In Every State?

Not exactly. The relative value units and conversion factor are national, but CMS adjusts each locality with geographic practice cost indices, so the amount shifts by county or region.

Do Commercial Insurers Pay More Than Medicare?

It depends on the insurer, the state and the contract. We don’t publish commercial rates because they are private to each contract; the only reliable number is the fee schedule an insurer gives you.

Official Sources

• CMS, RVU26A (CY 2026 Physician Fee Schedule relative value files, January 2026 release)
• Federal Register, CY 2026 Physician Fee Schedule final rule (CMS-1832-F), November 5, 2025
• CMS, MLN1986542 Medicare & Mental Health Coverage (March 2026)
• CMS, Marriage and Family Therapists and Mental Health Counselors Provider Enrollment FAQs (May 2024)

Getting Your Own Contracts In Place

If you have decided to take your own insurance contracts, Individual Provider credentialing starts at $1,200 for two payers ($500 setup plus $350 per payer). We prepare and submit each application and follow it until the payer gives its decision in writing. You can also see the full cost breakdown before you decide.