Medicare pays $167.00 for a 60-minute therapy session in 2026

Medicare’s 2026 national rate for a 60-minute individual psychotherapy session is $167.00 in a non-facility setting.1 cms.gov In a facility it is $135.27. The difference is not clinical. It is practice expense: 1.20 RVUs when you carry the overhead, 0.25 when the hospital does.

Two numbers drive everything below. The 2026 conversion factor is 33.4009, and every rate is simply total RVUs multiplied by it. There is a second conversion factor of 33.5675 for clinicians in qualifying alternative payment models — worth about half a percent, and easy to forget you are entitled to.

The 2026 behavioral health fee schedule

National unadjusted, standard conversion factor 33.4009. Source: CMS Physician Fee Schedule, 2026 Indicators.1 cms.gov

The 90834 to 90837 gap is the whole game

90837 pays $167.00. 90834 pays $113.90. The same clinician, the same client, fifteen more minutes of documented session time, and $53.10 more — a 47% premium for roughly a third more time.

That gap is why 90837 draws more payer scrutiny than any other code in behavioral health. It is also why the scrutiny is frequently misdirected: the code is defined by time, the time thresholds are published, and a session that meets the threshold is billed correctly whether or not a payer’s utilization pattern says otherwise.

The practical point is narrower than the argument usually gets. If your sessions run 53 minutes or longer and your notes record start and stop times, 90837 is the correct code. If they do not, it is not. Nothing about the payer’s denial rate changes either fact.

Group psychotherapy pays $30.39. Ten people in a room for an hour bills less than one person for thirty minutes.

What the conversion factor did

The conversion factor is the single lever that moves every rate at once, and 2026 was a year it moved up. CMS also revalued the psychotherapy work RVUs, which is why the psychotherapy codes moved more than the arithmetic on the conversion factor alone would predict.

Worth noting what that does not mean. Medicare rates are a floor and a reference point, not what most behavioral health practices are actually paid. Commercial contracts are frequently expressed as a percentage of Medicare, which is where the number matters: if your contract says 130% of Medicare and you do not know Medicare moved, you do not know your rate moved either.

The facility differential is a site-of-service decision

For 90837 the facility rate is $135.27 against $167.00 non-facility — a $31.73 difference on every session, entirely explained by who carries the practice expense.

For hospital-affiliated outpatient behavioral health programs this is a structural fact worth modelling rather than discovering. The professional claim is only part of the revenue; the facility bills separately. Practices that moved into a hospital-affiliated structure without modelling the professional-fee reduction have been surprised by it.

Check your locality before you use any of this

Every figure above is national and unadjusted. Geographic practice cost indices move real rates meaningfully in both directions, and a national figure is the wrong number to put in a contract.

We are building a lookup that resolves rates by payer, code and state. Until it ships, the CMS Physician Fee Schedule Look-Up Tool will give you locality-adjusted Medicare amounts.2 cms.gov