Therapy session cost by CPT code: 90791, 90834, 90837 and the rest

Why the CPT code is the price

Outpatient psychotherapy is billed like other physician services: one code per service, with a fee schedule amount behind each code. The codes describe the kind of service, such as a diagnostic evaluation, individual psychotherapy, family therapy or group therapy, and for individual psychotherapy the code also names the session length. A practice's price list, a plan's allowed amount and Medicare's payment all hang on that code. Two sessions on the same day of the week with the same therapist can carry different prices if one is billed as 90834 and the other as 90837.

That is the useful starting point for anyone comparing practices or checking a claim. A quoted "session fee" without a code cannot be compared with another practice's fee, and it cannot be checked against what a plan paid. Ask which code a standard session uses, and the comparison becomes code against code.

CY2026 Medicare anchors for the core codes

The amounts below are the CY2026 Medicare Physician Fee Schedule amounts for Michigan Locality 01, computed by MyCarePrice from the CMS RVU26D relative value file (October 2026 release), the CY2026 geographic indices and the $33.4009 conversion factor. The nonfacility column applies in a private office and, under the CMS telehealth rule described below, to a telehealth session at home. The facility column is the clinician's payment when the session is furnished in a hospital or other facility setting, where the facility may bill separately.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026. Computed and checked October 30, 2026. Medicare anchors, not your bill. In the CMS file, 90846 carries status R, which marks a restricted coverage code; ask your plan how it treats family sessions without the patient present.

Three relationships in the table are worth knowing before you look at any price list. First, the step from 45 to 60 minutes is the largest step in the individual codes: 90837 is $52.67 above 90834 in the nonfacility column. Second, the diagnostic evaluation sits close to the 60-minute session rather than the 45-minute one, so a first appointment can cost more than the sessions that follow. Third, group therapy is priced per patient, $30.36 per person, which is why a group's total revenue and a member's price are two very different numbers.

The CPT descriptors name 30, 45 and 60 minutes. CPT itself defines the ranges of face-to-face time that count toward each code, and those ranges are set by the American Medical Association rather than by Medicare. A practice can tell you which code it bills for a session of a given length. If your sessions run a consistent length, the code should be consistent too, and a change in code on the claim with no change in session length is a fair billing question.

Add-on and crisis codes

Some lines appear only alongside another code. When a prescriber, such as a psychiatrist or psychiatric nurse practitioner, provides psychotherapy during the same visit as an evaluation and management service, the psychotherapy is billed with an add-on code instead of 90832, 90834 or 90837. Interactive complexity, 90785, is an add-on for sessions where communication factors complicate the service. Crisis psychotherapy has its own pair of codes.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026. Computed and checked October 30, 2026. Medicare anchors, not your bill.

The add-on psychotherapy codes are lower than the stand-alone codes for the same minutes, $138.06 for 90838 against $166.06 for 90837, because the visit they are added to is billed and paid on its own line. A medication-management visit with therapy therefore produces two lines: an office visit code, such as 99213 or 99214, and the add-on. Each line carries its own cost sharing under most plans, which is the main reason these visits can produce a larger patient share than a therapy-only session of the same length.

Who provides the session changes the Medicare amount

Medicare does not pay every kind of therapist the same fee for the same code. Medicare.gov lists the outpatient mental health professionals it covers: psychiatrists or other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors. The last two were added from January 1, 2024. For those two, the Medicare Claims Processing Manual, chapter 12, sections 240 and 250, sets payment at 75 percent of the amount a clinical psychologist is paid under the fee schedule, and says assignment is required.

Applied to the Michigan Locality 01 anchors, and taking the fee schedule amount as the psychologist's payment, 75 percent of $166.06 is $124.55 for a 60-minute session, and 75 percent of $113.39 is $85.04 for 45 minutes. That arithmetic is ours, from the manual's percentage. For a Medicare patient the practical consequence is in the coinsurance, which is a percentage of the approved amount: a lower approved amount means a lower 20 percent share for the same code.

Assignment matters on its own. A provider who must accept assignment agrees to take the Medicare-approved amount as full payment, so the patient's share is limited to the deductible and coinsurance on that amount. Ask any Medicare provider whether they accept assignment before the first session, and ask a practice that does not bill Medicare how it will price sessions for a Medicare patient, in writing, before the first appointment. The same question changes the arithmetic in other offices: a chiropractor who neither participates nor accepts assignment can bill up to the Medicare limiting charge, as the worked rows on chiropractic visit costs under Medicare show.

Clinical social workers follow a parallel rule. Section 150 of the same manual chapter says payment for a clinical social worker is at 75 percent of the physician fee schedule and that assignment of benefits is required. On the Michigan Locality 01 anchor, a 45-minute 90834 session with a clinical social worker is therefore $85.04, and a person who has met the Part B deductible owes 20 percent of it, $17.01, against $22.68 on the same code at the full anchor. Assignment matters as much as the rate. A clinician who must accept assignment cannot bill you for the part of a charge above the Medicare-approved amount. An example in section 210.1 of the same chapter, written in 2012, is a clinical social worker who charged $135 for a session with a $120 approved amount; because assignment is required, the patient was not liable for the $15 difference. If a statement from a social worker, counselor or family therapist shows a balance above 20 percent of the approved amount once the deductible is met, ask what the extra amount is for.

Why a hospital clinic session can cost more

The facility column in the tables above is lower than the nonfacility column for every code, which can look as if a hospital-based session is cheaper. It is not, for the patient, because the facility column is only the clinician's line. When therapy is furnished in a hospital outpatient department, the hospital bills its own line for the setting, and Medicare.gov notes that in a hospital outpatient setting you may have to pay an additional copayment or coinsurance to the hospital. A session in an independent office produces one Medicare line; the same session in a hospital clinic produces two, each with its own share. The facility fee guide explains that split with the hospital clinic visit code and its CY2026 anchor. Ask any practice whether it bills as part of a hospital before the first session.

What a Medicare patient pays per session

Medicare.gov states the cost sharing for outpatient mental health visits plainly: after the Part B deductible, you pay 20 percent of the Medicare-approved amount, and if you receive services in a hospital outpatient setting you may also pay a copayment or coinsurance to the hospital. The 2026 Part B deductible is $283.00.

The 24-session row is an input chosen for the arithmetic, not a suggested course. If the deductible is not met when sessions begin, the first $283.00 of approved amounts goes to the deductible, and coinsurance applies after that. A year that starts with a diagnostic evaluation and continues with 23 sessions of 90834 has approved amounts of $172.25 plus 23 x $113.39, which is $2,780.22 in Michigan Locality 01 anchors. Supplemental coverage, a Medicare Advantage plan's own cost sharing, or Medicaid can change the patient share, so treat these rows as the shape of the arithmetic.

Telehealth sessions: the same rate from home

Behavioral health is where Medicare's telehealth rules are most settled. The CMS Telehealth FAQ, updated October 8, 2026, says the Consolidated Appropriations Act, 2021 permanently removed geographic and place of service restrictions for behavioral health telehealth, so beneficiaries in rural and urban areas can receive these services at home, and two-way audio-only technology is permitted for behavioral health telehealth. It also says claims for telehealth to patients in their homes, billed with place of service 10, are paid at the nonfacility rate. In price terms, a 90837 session by video from your living room has the same Medicare anchor as the same session in the therapist's office: $166.06 in Michigan Locality 01.

One rule changes after the current extension. The same FAQ says the statute requires an in-person, non-telehealth visit within six months before the first mental health telehealth service, effective after December 31, 2027, with in-person visits every 12 months after that and limited exceptions, and that CMS does not believe the six-month requirement applies to patients who began receiving mental health telehealth at home before January 1, 2028. Ask your practice how it plans to handle in-person visits from 2028, because an in-person visit is a billed visit too. Through 2027-12-31, the in-person requirement is not in effect for these services. Our telehealth cost guide covers the wider Medicare telehealth rules and the 2028 changes for other services.

Self-pay sessions and the 12-month estimate

If you are uninsured, or you choose not to use insurance, the No Surprises Act entitles you to a Good Faith Estimate when a service is scheduled at least three business days ahead or when you ask. Therapy is a recurring service, and the federal rule has a provision written for exactly that. Under 45 CFR 149.610(b)(1)(x), a provider may issue a single estimate for recurring primary items or services, if the estimate states the expected scope in a clear way, such as timeframes, frequency and total number of sessions, and the scope does not exceed 12 months. If sessions are expected to continue beyond 12 months, the provider issues a new estimate.

That estimate is worth asking for even when the per-session fee is simple, because it puts the code, the rate and the expected count in one dated document. If a bill from that provider later comes in at least $400 above the estimate, the federal patient-provider dispute process can apply. Our Good Faith Estimate guide explains the dispute window and fee. If income is the obstacle, community health center sliding fee scales are set by a federal poverty-guideline rule; if a center near you offers behavioral health services, ask whether its scale applies to them.

Ask three questions when you set up self-pay sessions: what the fee is for the first appointment and under which code, what the fee is for each later session and under which code, and whether the practice offers a reduced rate for a set number of sessions. Get the answers in writing, alongside the estimate. The cash price guide has the wording for an all-in written price.

In network, out of network and the superbill

With a commercial plan, an in-network therapist bills the plan directly, and your share is the plan's copay or coinsurance on its contracted rate, after any deductible. Some plans apply a flat copay to therapy visits and others apply coinsurance; the plan's Summary of Benefits and Coverage names which. The insured cost worksheet turns an allowed amount, your deductible status and your coinsurance into a per-session figure.

Many therapists do not join plan networks. If your plan has out-of-network benefits, you pay the therapist and submit a superbill: an itemized receipt with the CPT code, the diagnosis code, the dates of service and the provider's identifiers. The plan then pays its out-of-network share of its own allowed amount, which is not necessarily the therapist's charge.

This example is hypothetical. Every figure in it is invented to show the arithmetic. Suppose a therapist charges $180 for a 90834 session. Suppose the plan's out-of-network allowed amount for 90834 is $120, the out-of-network deductible is already met, and the plan pays 60 percent of its allowed amount. The plan reimburses 60 percent of $120, which is $72.00. You paid $180, so your net cost is $180 minus $72.00, which is $108.00. Change any one input, the allowed amount, the percentage or the deductible status, and the net cost changes with it, which is why the plan's allowed amount for the specific code is the number to ask the plan for before relying on reimbursement.

The explanation of benefits for a superbill claim shows the allowed amount the plan used, line by line. How to read an explanation of benefits shows where that column is and how it relates to what you paid. If the plan denies a claim, the appeal guide covers the filing windows.

Three billing patterns worked through

Some therapy services combine codes in ways that are easy to misread on a statement. The arithmetic below uses the CY2026 Michigan Locality 01 nonfacility anchors from the tables above and the code descriptors in the CMS file.

A longer crisis session. The crisis codes are built in time blocks: 90839 for the first 60 minutes and 90840 for each additional 30 minutes. A session billed as 90839 plus one unit of 90840 therefore has Medicare anchors of $159.62 plus $76.94, which is $236.56. Seeing two lines for one crisis session is the expected pattern, not a duplicate.

A group session. Group psychotherapy, 90853, is billed once for each patient in the group, $30.36 per person in the Medicare anchor. As an illustration, if eight Medicare patients attend one session, the practice bills eight claims, $242.88 in total anchors, and each patient's 20 percent share is calculated on their own $30.36 line. Your bill should show one unit of 90853 for each session you attended, not the group's total.

A year of self-pay sessions. These rates are invented for the arithmetic. Suppose a practice charges $200 for the first appointment and $150 per later session, and you expect 20 later sessions in a year. The year's total is $200 plus 20 x $150, which is $3,200.00. That is exactly the figure a 12-month Good Faith Estimate for recurring services should state, with the codes beside each rate, and it is the figure any later bill is compared with.

The same three patterns explain most surprises. Two lines on one date are often a time-block or add-on pattern. A small per-session amount on a group claim is per person, not per group. And a self-pay year adds up faster than a single session fee suggests, which is the reason to get the year's figure in writing at the start.

A code-check worksheet for therapy claims

The worksheet is a set of questions, not accusations. Therapy practices often bill through a separate billing service, and a code change can be a data-entry slip as easily as a deliberate choice. A precise question with a date and a code gets a precise answer. The itemized-bill check gives the general procedure for working a disputed line.

Session price questions from therapy clients

Fee schedule, manual and regulation citations

• CMS, Physician Fee Schedule relative value file RVU26D (October 2026 release) and CY2026 GPCIs, Michigan Locality 01, $33.4009 conversion factor: every code amount on this page, and the status indicator for 90846. Computed October 30, 2026.
• CMS, Medicare Claims Processing Manual, chapter 12, section 150 (clinical social workers: 75 percent of the fee schedule, assignment required), section 210.1 (the $135 charge and $120 approved amount example) and sections 240 and 250: marriage and family therapist and mental health counselor services, assignment required, payment at 75 percent of the clinical psychologist amount, effective January 1, 2024. Checked October 30, 2026.
• Medicare.gov, Mental health care (outpatient): covered professionals and cost sharing. Checked October 30, 2026.
• Medicare.gov, Medicare costs: 2026 Part B deductible of $283. Checked October 30, 2026.
• CMS, Telehealth FAQ, updated 10/8/26: behavioral health telehealth at home, audio-only, the in-person requirement after December 31, 2027, and place of service 10 at the nonfacility rate. Checked October 30, 2026.
• eCFR, 45 CFR 149.610: Good Faith Estimates for uninsured or self-pay individuals, including recurring services. Checked October 30, 2026.

General billing information, not medical, legal or insurance advice. Medicare anchors are not your bill, and a practice's own rates and a plan's allowed amounts can differ widely from them. Confirm your price in writing before service.