CPT code 90785: Interactive complexity, communication factors2026 Medicare rate & RVUs in Washington, DC area
Report interactive complexity when communication barriers or other specified factors complicate a psychiatric evaluation or psychotherapy service.
In Washington, DC area, Medicare pays $15.95 for 90785 in the office and $12.40 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 90785 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 90785 covers
Code 90785 captures added communication work during a psychiatric service, not a separate evaluation or a longer psychotherapy session. Examples include using play equipment to communicate with a young child, working through an interpreter, coordinating with a third party whose involvement complicates the exchange, or addressing a disclosure that requires mandated reporting. Psychiatrists, psychologists, clinical social workers, and other qualified mental health clinicians may encounter these circumstances in office or facility settings.
Report 90785 only with an eligible primary psychiatric service, such as a psychiatric diagnostic evaluation or psychotherapy; it is not billed by itself. The record should identify the communication factor and explain how it affected delivery of the primary service. CMS classifies it as an add-on paid within the primary procedure’s global period, so submit it with that procedure rather than as a standalone service.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Billing guides for 90785: Psychotherapy CPT codes · Mental health billing
How Washington, DC area compares for 90785
Across 109 of 109 payment localities, the office rate for 90785 runs from $14.18 in Arkansas to $20.45 in Alaska. Washington, DC area pays $15.95. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Washington, DC area · this page$15.95
- Los Angeles, CA · California$15.82−$0.13
- Miami, FL · Florida$14.85−$1.10
- Chicago, IL · Illinois$14.79−$1.16
- Manhattan, NY · New York$16.00+$0.05
- Alaska · Alaska$20.45+$4.50
- Alabama · Alabama$14.24−$1.71
Other areas in District of Columbia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| ArkansasArkansas | $14.18 | $11.60 |
| ArizonaArizona | $14.58 | $11.67 |
| Bakersfield, CACalifornia | $15.26 | $11.96 |
| Chico, CACalifornia | $15.24 | $11.94 |
| El Centro, CACalifornia | $15.24 | $11.94 |
| Fresno, CACalifornia | $15.24 | $11.94 |
| Hanford, CACalifornia | $15.24 | $11.94 |
| Madera, CACalifornia | $15.24 | $11.94 |
| Merced, CACalifornia | $15.24 | $11.94 |
| Modesto, CACalifornia | $15.24 | $11.94 |
| Napa, CACalifornia | $16.56 | $12.60 |
| Oxnard, CACalifornia | $15.67 | $12.12 |
| Redding, CACalifornia | $15.24 | $11.94 |
| Rest of CaliforniaCalifornia | $15.24 | $11.94 |
| Riverside, CACalifornia | $15.25 | $11.95 |
| Sacramento, CACalifornia | $15.69 | $12.20 |
| Salinas, CACalifornia | $15.62 | $12.14 |
| San Diego, CACalifornia | $15.75 | $12.15 |
| Marin County, CACalifornia | $17.25 | $13.01 |
| San Francisco, CACalifornia | $17.25 | $13.01 |
| San Benito County, CACalifornia | $17.53 | $13.20 |
| Santa Clara County, CACalifornia | $17.53 | $13.20 |
| San Luis Obispo, CACalifornia | $15.39 | $11.97 |
| Santa Cruz, CACalifornia | $15.72 | $12.07 |
| Santa Maria, CACalifornia | $15.61 | $12.11 |
| Santa Rosa, CACalifornia | $15.86 | $12.17 |
| Stockton, CACalifornia | $15.24 | $11.94 |
| Vallejo, CACalifornia | $16.56 | $12.60 |
| Visalia, CACalifornia | $15.24 | $11.94 |
| Yuba City, CACalifornia | $15.24 | $11.94 |
| ColoradoColorado | $15.06 | $11.87 |
| ConnecticutConnecticut | $15.20 | $11.96 |
| DelawareDelaware | $14.71 | $11.74 |
| Fort Lauderdale, FLFlorida | $14.74 | $11.70 |
| Rest of FloridaFlorida | $14.53 | $11.66 |
| Atlanta, GAGeorgia | $14.79 | $11.73 |
| Rest of GeorgiaGeorgia | $14.30 | $11.62 |
| Hawaii, Guam, HIHawaii | $15.20 | $11.78 |
| IowaIowa | $14.38 | $11.63 |
| IdahoIdaho | $14.40 | $11.64 |
| East St. Louis, ILIllinois | $14.40 | $11.64 |
| Rest of IllinoisIllinois | $14.38 | $11.63 |
| Suburban Chicago, ILIllinois | $14.87 | $11.79 |
| IndianaIndiana | $14.43 | $11.64 |
| KansasKansas | $14.34 | $11.63 |
| KentuckyKentucky | $14.29 | $11.62 |
| New Orleans, LALouisiana | $14.48 | $11.65 |
| Rest of LouisianaLouisiana | $14.27 | $11.61 |
| Metropolitan Boston, MAMassachusetts | $15.86 | $12.27 |
| Rest of MassachusettsMassachusetts | $15.07 | $11.90 |
| Baltimore area, MDMaryland | $15.14 | $11.92 |
| Rest of MarylandMaryland | $14.85 | $11.81 |
| Rest of MaineMaine | $14.40 | $11.64 |
| Southern Maine, MEMaine | $14.66 | $11.68 |
| Detroit, MIMichigan | $14.57 | $11.67 |
| Rest of MichiganMichigan | $14.38 | $11.63 |
| MinnesotaMinnesota | $14.80 | $11.71 |
| Metropolitan Kansas City, MOMissouri | $14.47 | $11.65 |
| Metropolitan St. Louis, MOMissouri | $14.52 | $11.66 |
| Rest of MissouriMissouri | $14.19 | $11.60 |
| MississippiMississippi | $14.19 | $11.60 |
| MontanaMontana | $14.70 | $11.69 |
| North CarolinaNorth Carolina | $14.45 | $11.65 |
| North DakotaNorth Dakota | $14.70 | $11.69 |
| NebraskaNebraska | $14.41 | $11.64 |
| New HampshireNew Hampshire | $14.85 | $11.72 |
| Northern New JerseyNew Jersey | $15.98 | $12.49 |
| Rest of New JerseyNew Jersey | $15.48 | $12.19 |
| New MexicoNew Mexico | $14.39 | $11.63 |
| NevadaNevada | $14.70 | $11.69 |
| NYC suburbs and Long Island, NYNew York | $16.10 | $12.52 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $15.54 | $12.25 |
| Queens, NYNew York | $16.07 | $12.52 |
| Rest of New YorkNew York | $14.51 | $11.66 |
| OhioOhio | $14.38 | $11.63 |
| OklahomaOklahoma | $14.30 | $11.62 |
| Portland, OROregon | $15.28 | $11.94 |
| Rest of OregonOregon | $14.68 | $11.69 |
| Metropolitan Philadelphia, PAPennsylvania | $15.05 | $11.92 |
| Rest of PennsylvaniaPennsylvania | $14.40 | $11.64 |
| Puerto RicoPuerto Rico | $14.74 | $11.70 |
| Rhode IslandRhode Island | $15.03 | $11.92 |
| South CarolinaSouth Carolina | $14.42 | $11.64 |
| South DakotaSouth Dakota | $14.70 | $11.69 |
| TennesseeTennessee | $14.36 | $11.63 |
| Austin, TXTexas | $14.93 | $11.75 |
| Beaumont, TXTexas | $14.37 | $11.63 |
| Brazoria, TXTexas | $14.75 | $11.77 |
| Dallas, TXTexas | $14.78 | $11.79 |
| Fort Worth, TXTexas | $14.74 | $11.78 |
| Galveston, TXTexas | $14.76 | $11.77 |
| Houston, TXTexas | $14.76 | $11.77 |
| Rest of TexasTexas | $14.51 | $11.66 |
| UtahUtah | $14.48 | $11.65 |
| VirginiaVirginia | $14.63 | $11.68 |
| Virgin Islands, VIUnited States Virgin Islands | $14.74 | $11.70 |
| VermontVermont | $14.66 | $11.68 |
| Rest of WashingtonWashington | $15.03 | $11.87 |
| King County, WAWashington | $16.08 | $12.39 |
| WisconsinWisconsin | $14.54 | $11.66 |
| West VirginiaWest Virginia | $14.22 | $11.60 |
| WyomingWyoming | $14.70 | $11.69 |
90785 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$14.18
$20.45
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $20.45 | 1 |
| AL | $14.24 | 1 |
| AR | $14.18 | 1 |
| AZ | $14.58 | 1 |
| CA | $15.24–$17.53 | 29 |
| CO | $15.06 | 1 |
| CT | $15.20 | 1 |
| DC | $15.95 | 1 |
| DE | $14.71 | 1 |
| FL | $14.53–$14.85 | 3 |
| GA | $14.30–$14.79 | 2 |
| GU | $15.20 | 1 |
| HI | $15.20 | 1 |
| IA | $14.38 | 1 |
| ID | $14.40 | 1 |
| IL | $14.38–$14.87 | 4 |
| IN | $14.43 | 1 |
| KS | $14.34 | 1 |
| KY | $14.29 | 1 |
| LA | $14.27–$14.48 | 2 |
| MA | $15.07–$15.86 | 2 |
| MD | $14.85–$15.95 | 3 |
| ME | $14.40–$14.66 | 2 |
| MI | $14.38–$14.57 | 2 |
| MN | $14.80 | 1 |
| MO | $14.19–$14.52 | 3 |
| MS | $14.19 | 1 |
| MT | $14.70 | 1 |
| NC | $14.45 | 1 |
| ND | $14.70 | 1 |
| NE | $14.41 | 1 |
| NH | $14.85 | 1 |
| NJ | $15.48–$15.98 | 2 |
| NM | $14.39 | 1 |
| NV | $14.70 | 1 |
| NY | $14.51–$16.10 | 5 |
| OH | $14.38 | 1 |
| OK | $14.30 | 1 |
| OR | $14.68–$15.28 | 2 |
| PA | $14.40–$15.05 | 2 |
| PR | $14.74 | 1 |
| RI | $15.03 | 1 |
| SC | $14.42 | 1 |
| SD | $14.70 | 1 |
| TN | $14.36 | 1 |
| TX | $14.37–$14.93 | 8 |
| UT | $14.48 | 1 |
| VA | $14.63–$15.95 | 2 |
| VI | $14.74 | 1 |
| VT | $14.66 | 1 |
| WA | $15.03–$16.08 | 2 |
| WI | $14.54 | 1 |
| WV | $14.22 | 1 |
| WY | $14.70 | 1 |
How the 90785 rate is calculated
Each of 90785’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 90785
RVUs × geographic indexes × conversion factor
Work0.33
0.33 RVUs× 1.000 GPCI
Practice expense0.11
0.11 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.4400
Conversion factor
$33.4009
Medicare rate
$14.70
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Washington, DC area inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
11,526
- Code
- 90785
- Physician work
- 0.33
- Practice expense
- 0.11
- Malpractice
- 0.00
GPCI2026.csv
39
- Locality
- Washington, DC area
- Physician work
- 1.054
- Practice expense
- 1.178
- Malpractice
- 1.113
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.33 | × 1.054 | 0.3478 |
| Practice expense | 0.11 | × 1.178 | 0.1296 |
| Malpractice | 0.00 | × 1.113 | 0.0000 |
| Total RVUs | 0.4774 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Washington, DC area$15.95
Office: (0.33 × 1.054 + 0.11 × 1.178 + 0 × 1.113) × $33.4009 = $15.95
Facility: (0.33 × 1.054 + 0.02 × 1.178 + 0 × 1.113) × $33.4009 = $12.40
Payment rules and modifiers for 90785
The CMS indicators that decide how 90785 is paid alongside other services.
CMS payment indicators · 90785
Interactive complexity, communication factors
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 9 | The concept doesn’t apply. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
How 90785 has changed in Washington, DC area
90785 · Office / nonfacility
$15.95
Effective 2026-10-01
The base rate is $0.43 higher than on 2025-10-01, moving from $15.52 to $15.95 (2.8%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$15.52changed to$15.95
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.10 changed to 0.11
- Malpractice RVU 0.01 changed to 0.00
- Work GPCI 1.057 changed to 1.054
- Practice expense GPCI 1.192 changed to 1.178
- Malpractice GPCI 1.168 changed to 1.113
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$15.97changed to$15.52
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$15.71changed to$15.97
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$16.34changed to$15.71
- Conversion factor 33.8872 changed to 32.7442
- Work GPCI 1.056 changed to 1.057
- Practice expense GPCI 1.214 changed to 1.192
- Malpractice GPCI 1.231 changed to 1.168
January 1, 2023
RVU23A
$16.33changed to$16.34
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.09 changed to 0.10
- Work GPCI 1.054 changed to 1.056
- Practice expense GPCI 1.236 changed to 1.214
- Malpractice GPCI 1.294 changed to 1.231
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$16.47changed to$16.33
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$16.92changed to$16.47
- Conversion factor 36.0896 changed to 34.8931
- Work GPCI 1.049 changed to 1.054
- Practice expense GPCI 1.221 changed to 1.236
- Malpractice GPCI 1.277 changed to 1.294
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$16.36changed to$16.92
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 0.08 changed to 0.09
- Work GPCI 1.045 changed to 1.049
- Practice expense GPCI 1.205 changed to 1.221
- Malpractice GPCI 1.261 changed to 1.277
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$15.90changed to$16.36
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.07 changed to 0.08
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$15.03changed to$15.90
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.05 changed to 0.07
- Work GPCI 1.048 changed to 1.045
- Malpractice GPCI 1.271 changed to 1.261
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$15.03changed to$15.03
- Conversion factor 35.8043 changed to 35.8887
- Work GPCI 1.051 changed to 1.048
- Malpractice GPCI 1.280 changed to 1.271
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$15.52changed to$15.03
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 0.06 changed to 0.05
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$15.44changed to$15.52
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$15.43changed to$15.44
- Conversion factor 35.8228 changed to 35.7547
- Work GPCI 1.050 changed to 1.051
- Practice expense GPCI 1.202 changed to 1.205
- Malpractice GPCI 1.205 changed to 1.280
Held through RVU15B.
January 1, 2014
RVU14A
$5.13changed to$15.43
- Conversion factor 34.0230 changed to 35.8228
- Work RVU 0.11 changed to 0.33
- Practice expense RVU 0.02 changed to 0.06
- Work GPCI 1.049 changed to 1.050
- Practice expense GPCI 1.198 changed to 1.202
- Malpractice GPCI 1.130 changed to 1.205
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $5.13
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $15.95 | $12.40 | RVU26D |
| 2026-07-01 | $15.95 | $12.40 | RVU26C |
| 2026-04-01 | $15.95 | $12.40 | RVU26B |
| 2026-01-01 | $15.95 | $12.40 | RVU26A |
| 2025-10-01 | $15.52 | $13.20 | RVU25D |
| 2025-07-01 | $15.52 | $13.20 | RVU25C |
| 2025-04-01 | $15.52 | $13.20 | RVU25B |
| 2025-01-01 | $15.52 | $13.20 | RVU25A |
| 2024-10-01 | $15.97 | $13.98 | RVU24D |
| 2024-07-01 | $15.97 | $13.98 | RVU24C |
| 2024-04-01 | $15.97 | $13.98 | RVU24B |
| 2024-03-09 | $15.97 | $13.98 | RVU24AR |
| 2024-01-01 | $15.71 | $13.76 | RVU24A |
| 2023-10-01 | $16.34 | $14.28 | RVU23D |
| 2023-07-01 | $16.34 | $14.28 | RVU23C |
| 2023-04-01 | $16.34 | $14.28 | RVU23B |
| 2023-01-01 | $16.34 | $14.28 | RVU23A |
| 2022-10-01 | $16.33 | $14.20 | RVU22D |
| 2022-07-01 | $16.33 | $14.20 | RVU22C |
| 2022-04-01 | $16.33 | $14.20 | RVU22B |
| 2022-01-01 | $16.33 | $14.20 | RVU22A |
| 2021-10-01 | $16.47 | $14.31 | RVU21D |
| 2021-07-01 | $16.47 | $14.31 | RVU21C |
| 2021-04-01 | $16.47 | $14.31 | RVU21B |
| 2021-01-01 | $16.47 | $14.31 | RVU21A |
| 2020-10-01 | $16.92 | $15.16 | RVU20D |
| 2020-07-01 | $16.92 | $15.16 | RVU20C |
| 2020-04-01 | $16.92 | $15.16 | RVU20B |
| 2020-01-01 | $16.92 | $15.16 | RVU20A |
| 2019-10-01 | $16.36 | $15.05 | RVU19D |
| 2019-07-01 | $16.36 | $15.05 | RVU19C |
| 2019-04-01 | $16.36 | $15.05 | RVU19B |
| 2019-01-01 | $16.36 | $15.05 | RVU19A |
| 2018-10-01 | $15.90 | $15.04 | RVU18D |
| 2018-07-01 | $15.90 | $15.04 | RVU18C |
| 2018-04-01 | $15.90 | $15.04 | RVU18B |
| 2018-01-01 | $15.90 | $15.04 | RVU18AR1 |
| 2017-10-01 | $15.03 | $15.03 | RVU17D |
| 2017-07-01 | $15.03 | $15.03 | RVU17C |
| 2017-04-01 | $15.03 | $15.03 | RVU17B |
| 2017-01-01 | $15.03 | $15.03 | RVU17A |
| 2016-10-01 | $15.03 | $15.03 | RVU16D |
| 2016-07-01 | $15.03 | $15.03 | RVU16C |
| 2016-04-01 | $15.03 | $15.03 | RVU16B |
| 2016-01-01 | $15.03 | $15.03 | RVU16A |
| 2015-10-01 | $15.52 | $15.52 | RVU15D |
| 2015-07-01 | $15.52 | $15.52 | RVU15C |
| 2015-04-01 | $15.44 | $15.44 | RVU15B |
| 2015-01-01 | $15.44 | $15.44 | RVU15A |
| 2014-10-01 | $15.43 | $15.43 | RVU14D |
| 2014-07-01 | $15.43 | $15.43 | RVU14C |
| 2014-04-01 | $15.43 | $15.43 | RVU14B |
| 2014-01-01 | $15.43 | $15.43 | RVU14A |
| 2013-10-01 | $5.13 | $5.13 | RVU13D |
| 2013-07-01 | $5.13 | $5.13 | RVU13C |
| 2013-04-01 | $5.13 | $5.13 | RVU13B |
| 2013-01-01 | $5.13 | $5.13 | RVU13AR |
Where the Washington, DC area rate applies
Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.
- Washington
90785 billing questions
When should 90785 be added to a psychiatric service?
Use it when a specific communication factor complicates delivery of the primary psychiatric service, such as interpreter use or communication through play equipment. The record should explain the factor and its effect on the encounter.
Can 90785 be billed by itself?
No. It is an add-on code and must be reported with an eligible primary psychiatric procedure, such as 90791, 90792, or a psychotherapy service.
Does a difficult or lengthy session alone support 90785?
No. Session difficulty or length alone does not establish interactive complexity; document the specific communication circumstance that complicated the service.
Is interpreter use an example of interactive complexity?
It can be when an interpreter is needed to overcome a communication barrier during the psychiatric service. Document the interpreter’s role in facilitating the clinical exchange.
How does CMS treat payment for 90785?
CMS treats 90785 as an add-on paid within the primary procedure’s global period. Submit it with the primary service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets · Coming soon
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