Medicare Reimbursement Rates for Therapy: 2026
Our analysts priced four common psychotherapy codes in all 109 Medicare payment localities for both 2025 and 2026, a total of 872 locality rates drawn from the CMS Physician Fee Schedule files. As of Q4 2026, the data shows where Medicare pays the most for a therapy session, how far rates rose this year, and how much a clinician's license changes the payment.
Key Findings
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Every January, Medicare resets what it pays clinicians through the Physician Fee Schedule. Each service carries relative value units for the clinician's work, the cost of running a practice, and malpractice insurance. Medicare adjusts those units for local costs in each payment locality, then multiplies the total by a conversion factor that CMS sets each year. For 2026, CMS set that factor at $33.4009, up from $32.3465 in 2025, so a therapist billing the same code in the same place is paid more this year than last.
For this study, we pulled the RVU26D and RVU25D relative value files and the geographic practice cost index (GPCI) tables CMS published with each. We calculated non-facility rates, the rates paid when a clinician bills from a private office, for CPT 90791 (diagnostic evaluation), 90834 (45-minute psychotherapy), 90837 (60-minute psychotherapy), and 90847 (family therapy with the patient present). State figures are simple averages of each state's localities.
In the following sections, we compare 2026 rates by state, the change from 2025, the highest and lowest paying localities, and the rates Medicare pays social workers, counselors, and family therapists.
Medicare Therapy Rates by State in 2026
Most states are a single Medicare payment locality, so one rate covers the whole state. California, Texas, New York, Illinois, and a few others are split into several localities, and the table below averages them into one figure per state. Its columns show CPT 90837 (60-minute psychotherapy), 90834 (45-minute psychotherapy), 90791 (diagnostic evaluation), and 90847 (family therapy).
Medicare Psychotherapy Rates by State and Territory (2026)
State or territory | 90837 | 90834 | 90791 | 90847 |
|---|---|---|---|---|
Alaska | $232.44 | $158.15 | $240.07 | $157.89 |
District of Columbia | $181.03 | $123.52 | $188.26 | $117.17 |
New Jersey | $178.62 | $121.85 | $185.61 | $116.22 |
California | $178.57 | $121.73 | $185.78 | $115.12 |
New York | $177.86 | $121.39 | $184.81 | $115.87 |
Washington | $176.45 | $120.33 | $183.47 | $114.29 |
Massachusetts | $175.45 | $119.66 | $182.39 | $113.82 |
Connecticut | $172.76 | $117.88 | $179.48 | $112.63 |
Hawaii | $172.21 | $117.41 | $179.16 | $111.10 |
Colorado | $170.94 | $116.55 | $177.59 | $111.41 |
Rhode Island | $170.65 | $116.36 | $177.18 | $111.74 |
Maryland | $170.40 | $116.24 | $176.96 | $111.42 |
Oregon | $169.98 | $115.88 | $176.57 | $110.85 |
New Hampshire | $168.56 | $114.95 | $175.09 | $110.02 |
Florida | $167.77 | $114.62 | $174.13 | $110.23 |
Minnesota | $167.70 | $114.23 | $174.17 | $109.47 |
Puerto Rico | $167.44 | $114.19 | $173.83 | $109.69 |
U.S. Virgin Islands | $167.44 | $114.19 | $173.83 | $109.69 |
Pennsylvania | $167.37 | $114.15 | $173.64 | $110.19 |
Delaware | $167.09 | $113.92 | $173.39 | $109.80 |
Texas | $167.03 | $113.89 | $173.32 | $109.83 |
Montana | $167.00 | $113.90 | $173.35 | $109.55 |
Nevada | $166.93 | $113.81 | $173.28 | $109.46 |
Wyoming | $166.83 | $113.72 | $173.18 | $109.38 |
Illinois | $166.70 | $113.87 | $172.91 | $110.05 |
North Dakota | $166.61 | $113.50 | $172.95 | $109.16 |
South Dakota | $166.56 | $113.45 | $172.91 | $109.11 |
Vermont | $166.27 | $113.29 | $172.58 | $109.09 |
Virginia | $166.13 | $113.23 | $172.40 | $109.13 |
Arizona | $165.67 | $112.94 | $171.88 | $109.04 |
Georgia | $165.48 | $112.88 | $171.63 | $109.22 |
Maine | $164.98 | $112.42 | $171.12 | $108.71 |
Wisconsin | $164.86 | $112.27 | $171.02 | $108.53 |
Michigan | $164.83 | $112.48 | $170.91 | $109.02 |
Utah | $164.53 | $112.17 | $170.62 | $108.69 |
North Carolina | $164.08 | $111.80 | $170.13 | $108.42 |
South Carolina | $163.86 | $111.69 | $169.87 | $108.44 |
New Mexico | $163.81 | $111.73 | $169.80 | $108.58 |
Indiana | $163.74 | $111.53 | $169.76 | $108.24 |
Missouri | $163.69 | $111.60 | $169.68 | $108.44 |
Louisiana | $163.55 | $111.52 | $169.52 | $108.43 |
Ohio | $163.52 | $111.49 | $169.49 | $108.40 |
Nebraska | $163.50 | $111.35 | $169.51 | $108.11 |
Idaho | $163.45 | $111.33 | $169.44 | $108.13 |
Iowa | $163.19 | $111.14 | $169.17 | $108.02 |
Tennessee | $163.05 | $111.07 | $169.00 | $108.03 |
Kansas | $162.83 | $110.90 | $168.75 | $107.94 |
Oklahoma | $162.57 | $110.78 | $168.45 | $107.98 |
Kentucky | $162.50 | $110.76 | $168.36 | $108.02 |
West Virginia | $162.04 | $110.55 | $167.82 | $108.09 |
Alabama | $161.70 | $110.14 | $167.51 | $107.59 |
Mississippi | $161.26 | $109.87 | $167.00 | $107.52 |
Arkansas | $161.03 | $109.66 | $166.76 | $107.35 |
Source: Signal Hill Strategies analysis of CMS PFS Relative Value Files, RVU26D, October 2026
Source: Signal Hill Strategies analysis of CMS PFS Relative Value Files, RVU26D, October 2026
Key Findings
Alaska pays $232.44 for a 60-minute session, far above every other state. Federal law sets a 1.5 floor on Alaska's work index, which lifts its rate on every code.
Outside Alaska, the District of Columbia ($181.03) and Arkansas sit at opposite ends, $20.00 apart per 60-minute session. For a clinician seeing 25 Medicare patients a week, that comes to about $500 a week.
A 1.0 floor on the work index keeps low-cost states close to the national rate, and Congress extended it through January 1, 2027. The states at the bottom of this list rely on that floor the most, so its renewal will shape their 2027 rates.
How Much Medicare Therapy Rates Rose From 2025 to 2026
All four codes paid more in 2026 than in 2025, though not by the same amount. CMS changed each code's relative values along with the conversion factor, so the raise depends on the service.
National Medicare Psychotherapy Rates by CPT Code (2025-2026)
CPT code | Service | 2025 | 2026 | Change | % change |
|---|---|---|---|---|---|
90791 | Diagnostic evaluation | $166.91 | $173.35 | +$6.44 | +3.9% |
90837 | Psychotherapy, 60 minutes | $154.29 | $167.00 | +$12.71 | +8.2% |
90834 | Psychotherapy, 45 minutes | $104.16 | $113.90 | +$9.74 | +9.4% |
90847 | Family therapy with patient | $102.86 | $109.55 | +$6.69 | +6.5% |
Source: Signal Hill Strategies analysis of CMS RVU26D and CMS RVU25D, October 2026
Source: Signal Hill Strategies analysis of CMS RVU26D and CMS RVU25D, October 2026
Key Findings
The 45-minute code rose the most, followed by the 60-minute code. The conversion factor alone rose 3.3%, so most of each increase came from higher relative values for these two codes.
The diagnostic evaluation rose 3.9%. Its work value stayed at 3.84 relative value units, so its gain tracks the conversion factor more closely than the session codes do.
Every one of the 109 localities saw its 60-minute rate rise, by between 6.4% and 10.5%. A practice that bills mostly 60-minute sessions got a raise on nearly every visit this year, and the 2027 fee schedule will reset these figures again in January.
Highest and Lowest Paying Medicare Localities for a 60-Minute Session
State averages hide a lot of local variation. California alone has 29 localities, more than any other state, and a session in Silicon Valley pays far more than one in the state's rural counties.
Top and Bottom 10 Medicare Localities for CPT 90837 (2025-2026)
Rank | Locality | State | 2025 | 2026 |
|---|---|---|---|---|
1 | Alaska | AK | $214.72 | $232.44 |
2 | San Jose-Sunnyvale-Santa Clara (San Benito County) | CA | $179.81 | $198.30 |
3 | San Jose-Sunnyvale-Santa Clara (Santa Clara County) | CA | $179.45 | $198.21 |
4 | San Francisco-Oakland-Berkeley (Marin County) | CA | $177.62 | $195.07 |
5 | San Francisco-Oakland-Berkeley (San Francisco, San Mateo, Alameda, and Contra Costa Counties) | CA | $177.56 | $195.05 |
6 | Napa | CA | $170.49 | $187.38 |
7 | Vallejo | CA | $170.36 | $187.34 |
8 | NYC Suburbs/Long Island | NY | $171.14 | $183.23 |
9 | Queens | NY | $169.81 | $182.67 |
10 | Seattle (King County) | WA | $166.50 | $182.29 |
100 | Kansas | KS | $149.88 | $162.83 |
101 | Rest of Georgia | GA | $150.60 | $162.80 |
102 | Oklahoma | OK | $150.07 | $162.57 |
103 | Kentucky | KY | $149.85 | $162.50 |
104 | Rest of Louisiana | LA | $150.17 | $162.37 |
105 | West Virginia | WV | $150.42 | $162.04 |
106 | Alabama | AL | $148.70 | $161.70 |
107 | Rest of Missouri | MO | $149.39 | $161.46 |
108 | Mississippi | MS | $148.62 | $161.26 |
109 | Arkansas | AR | $148.25 | $161.03 |
Source: Signal Hill Strategies analysis of CMS RVU26D and CMS RVU25D, October 2026
Source: Signal Hill Strategies analysis of CMS PFS Relative Value Files, RVU26D, October 2026
Key Findings
Six of the 10 highest-paying localities are in Northern California, led by the two San Jose localities. Alaska, Seattle, Queens, and the New York City suburbs fill the other four spots.
The 10 lowest-paying localities are statewide or rest-of-state areas in the South and Midwest. They fall within about $2 of each other, from $161.03 to $162.83.
A 60-minute session in San Jose pays $37.27 more than the same session in Arkansas. Over a 25-session week, that is roughly $930 for the same work.
What Social Workers, Counselors, and Family Therapists Receive From Medicare
Since January 1, 2024, marriage and family therapists and mental health counselors can bill Medicare on their own, joining clinical social workers. Under 42 CFR 414.53, all three are paid 75% of what a clinical psychologist receives for the same service.
National Medicare Psychotherapy Rates by Clinician Type (2026)
CPT code | Service | Psychologist (100%) | LCSW, MFT, or MHC (75%) | Difference |
|---|---|---|---|---|
90791 | Diagnostic evaluation | $173.35 | $130.01 | $43.34 |
90837 | Psychotherapy, 60 minutes | $167.00 | $125.25 | $41.75 |
90834 | Psychotherapy, 45 minutes | $113.90 | $85.42 | $28.47 |
90847 | Family therapy with patient | $109.55 | $82.17 | $27.39 |
Source: Signal Hill Strategies analysis of CMS RVU26D; 42 CFR 414.53
Source: Signal Hill Strategies analysis of CMS RVU26D; 42 CFR 414.53
Key Findings
A counselor or social worker billing a 60-minute session nationally receives $125.25. That is less than a psychologist earns for a 60-minute session in any locality.
MFTs and MHCs became eligible to bill Medicare directly on January 1, 2024, according to CMS. Their rates move with the psychologist rate each year, so this year's increases reached them as well.
The 75% rule applies in every locality. In San Jose, a social worker or counselor billing CPT 90837 receives about $148.72, which is still below the national psychologist rate.
For therapists, where they practice and what license they hold both change what Medicare pays, but outside Alaska the license matters more. San Jose pays $37.27 more than Arkansas for a 60-minute session, while a psychologist receives $41.75 more than a counselor billing the same code at the national rate.
Medicare raised its therapy rates faster than its conversion factor this year, and it has opened direct billing to two new license types since 2024. Together, those changes describe a program paying more for psychotherapy and relying on a wider set of clinicians to deliver it.
So if you bill Medicare for psychotherapy, your 2026 rate depends first on your license and then on your locality, and the tables above show both.
Sources
Signal Hill Strategies analysis of CMS Calendar Year 2026 and 2025 Physician Fee Schedule relative value and GPCI files, conducted October 29, 2026
CMS, Marriage and Family Therapists and Mental Health Counselors
Methodology
Payment = (work RVU × work GPCI + non-facility practice expense RVU × practice expense GPCI + malpractice RVU × malpractice GPCI) × conversion factor.
We used non-facility RVUs from the October releases of RVU26D and RVU25D, the 2026 non-QPP conversion factor ($33.4009), and the 2025 conversion factor ($32.3465).
National rates use GPCIs of 1.0. Locality rates use each year's published GPCIs. State figures are unweighted averages of each state's localities.
Derived figures, including percentage changes, 75% rates, and dollar differences, were calculated from these data and rounded once, to the cent or to one decimal place.
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