What insurers actually pay for therapy

How much do insurers pay for therapy?

For a 60-minute individual therapy session (CPT 90837), commercial in-network rates run roughly $125 to $165 depending on the payer, generally below the Medicare rate of about $167. Intake evaluations (90791) sit higher, group therapy (90853) much lower, and psychological testing (96130-96137) varies the most. Use the tool above to see the number for a specific code and state, plus how the major insurers compare.

Which payer matters more than which state

Therapists often assume reimbursement is mostly about geography. In the data it is mostly about the payer. The same CPT code can vary roughly 30% across major insurers for individual therapy, and far more for group therapy and psychological testing. The per-payer view makes that spread concrete so you can see where your fees sit before you set a cash rate or appeal a low reimbursement.

Using this to set or negotiate your private-pay fee

If you are out of network or going cash-pay, this benchmark shows what plans actually pay in-network, which is the floor most patients anchor to. Pair it with the practice savings calculator to model take-home at different fees, and see how a private-pay EHR handles superbills so out-of-network patients can claim reimbursement without extra admin.

Therapy reimbursement rates by CPT code

National medians across 4 major commercial payers, next to the Medicare rate for the same service. Use the tool above to narrow these to your state and see the per-payer breakdown.

Commercial = in-network negotiated rate used as an out-of-network proxy. Snapshot 2026-06-07.

How we calculated these numbers

Every figure traces back to public data and a documented formula. Here is the full method, and the entire dataset and code are open source: coralehr/oon-therapy-benchmark.

1. 1. Real payer files. Under the federal Transparency in Coverage rule, insurers must publish their negotiated rates in machine-readable files. We pull those files from 4 major payers (UnitedHealthcare, Cigna, Centene/Ambetter, and Anthem/Elevance) and stream them through a filter that keeps only the outpatient therapy CPT codes.
2. 2. In-network rates as the proxy. Insurers are also required to publish out-of-network allowed amounts, but in practice those files are effectively empty (the largest we found was 17 KB). So we use published in-network negotiated rates as the proxy for what plans consider a service is worth. We keep only professional (clinician) rates and drop facility and bundled entries.
3. 3. A Medicare anchor. We compute the Medicare Physician Fee Schedule rate for each code from CMS relative value units and the published conversion factor. That gives a stable, public reference every commercial rate is compared against.
4. 4. State adjustment. Commercial rates are negotiated at the provider-group level and rarely tied cleanly to one state, so rather than guess, we scale the national rate by each state's Medicare geographic index (GPCI). The rate signal is real; the geographic variation comes from Medicare's own geography.
5. 5. A multi-payer blend. For each code we pool the payers, weighting by how many observations each contributes, and report the median plus the per-payer breakdown so you can see the spread, not just one number.

Caveats worth stating plainly: this is a sample of plans, not a census; in-network is a proxy, not a measured out-of-network amount; and every figure is an estimate, not a guarantee. It is a benchmark for context, not billing or legal advice.

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