CPT code 90838: Psychotherapy, with E/M, 60 minutes2026 Medicare rate & RVUs
Report 90838 when a clinician provides at least 53 minutes of psychotherapy during the same encounter as a separately performed evaluation and management service.
Medicare pays $136.61 for 90838 nationally in the office and $110.22 in a hospital or facility. Local office rates run $129.44–$184.98.
Medicare rate · 90838
Psychotherapy, with E/M, 60 minutes
- Work RVUs
- 2.86
- Total RVUs
- 4.09
- Global days
- ZZZ
National rate · 2026
$136.61
Office setting, before claim adjustments.
See every locality for 90838 →Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 10 sections
What 90838 covers
This add-on represents an extended psychotherapy session delivered during the same encounter as an evaluation and management service. A psychiatrist or other qualified clinician may use it when addressing a patient’s psychiatric symptoms through psychotherapy while also providing separately identifiable E/M work, such as assessing symptoms or managing medication. Common settings include office visits and facility-based psychiatric encounters.
Select 90838 when psychotherapy time reaches at least 53 minutes; do not count time spent on the E/M service toward that threshold. The record should distinguish the psychotherapy from the E/M work and describe the issues addressed, therapeutic interventions, patient response, and plan. Report it only with an appropriate primary E/M service, not by itself. CMS classifies it as an add-on and pays it within the primary procedure’s global period.
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 90838: Psychotherapy add-on codes · Psychotherapy CPT codes · Mental health billing
Where 90838 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$129.44 to $184.98
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $130.24 | $107.15 |
| Alaska | $184.98 | $156.88 |
| Arizona | $134.88 | $109.31 |
| Arkansas | $129.44 | $106.77 |
| Atlanta, GA | $138.30 | $111.49 |
| Austin, TX | $138.49 | $110.58 |
| Bakersfield, CA | $140.42 | $111.50 |
| Baltimore area, MD | $141.79 | $113.48 |
| Beaumont, TX | $132.99 | $108.98 |
| Brazoria, TX | $136.16 | $110.01 |
| Chicago, IL | $142.65 | $116.14 |
| Chico, CA | $139.93 | $111.01 |
| Colorado | $139.25 | $111.18 |
| Connecticut | $142.22 | $113.80 |
| Dallas, TX | $136.75 | $110.47 |
| Delaware | $136.24 | $110.17 |
| Detroit, MI | $138.06 | $112.60 |
| East St. Louis, IL | $137.71 | $113.43 |
| El Centro, CA | $139.95 | $111.03 |
| Fort Lauderdale, FL | $140.33 | $113.60 |
| Fort Worth, TX | $136.43 | $110.42 |
| Fresno, CA | $139.93 | $111.01 |
| Galveston, TX | $136.42 | $110.22 |
| Hanford, CA | $139.93 | $111.01 |
| Hawaii, Guam, HI | $140.00 | $110.00 |
| Houston, TX | $138.62 | $112.42 |
| Idaho | $131.53 | $107.26 |
| Indiana | $131.84 | $107.38 |
| Iowa | $131.04 | $106.90 |
| Kansas | $131.06 | $107.21 |
| Kentucky | $132.15 | $108.70 |
| King County, WA | $149.07 | $116.69 |
| Los Angeles, CA | $145.96 | $114.75 |
| Madera, CA | $139.93 | $111.01 |
| Manhattan, NY | $151.08 | $120.42 |
| Marin County, CA | $158.72 | $121.51 |
| Merced, CA | $139.93 | $111.01 |
| Metropolitan Boston, MA | $147.28 | $115.77 |
| Metropolitan Kansas City, MO | $134.26 | $109.48 |
| Metropolitan Philadelphia, PA | $140.62 | $113.15 |
| Metropolitan St. Louis, MO | $134.84 | $109.72 |
| Miami, FL | $144.26 | $116.79 |
| Minnesota | $134.86 | $107.71 |
| Mississippi | $130.41 | $107.69 |
| Modesto, CA | $139.93 | $111.01 |
| Montana | $136.60 | $110.21 |
| Napa, CA | $152.45 | $117.67 |
| Nebraska | $131.26 | $106.91 |
| Nevada | $135.98 | $109.56 |
| New Hampshire | $137.63 | $110.16 |
| New Mexico | $134.34 | $110.14 |
| New Orleans, LA | $134.97 | $110.14 |
| North Carolina | $132.68 | $108.06 |
| North Dakota | $134.23 | $107.84 |
| Northern New Jersey | $148.83 | $118.22 |
| NYC suburbs and Long Island, NY | $153.17 | $121.79 |
| Ohio | $133.42 | $109.33 |
| Oklahoma | $131.75 | $108.19 |
| Oxnard, CA | $144.52 | $113.33 |
| Portland, OR | $141.23 | $111.91 |
| Poughkeepsie and northern NYC suburbs, NY | $145.27 | $116.38 |
| Puerto Rico | $136.96 | $110.28 |
| Queens, NY | $151.24 | $120.05 |
| Redding, CA | $139.93 | $111.01 |
| Rest of California | $139.93 | $111.01 |
| Rest of Florida | $136.99 | $111.77 |
| Rest of Georgia | $133.38 | $109.84 |
| Rest of Illinois | $135.64 | $111.55 |
| Rest of Louisiana | $132.18 | $108.83 |
| Rest of Maine | $132.13 | $107.85 |
| Rest of Maryland | $137.68 | $110.98 |
| Rest of Massachusetts | $139.29 | $111.50 |
| Rest of Michigan | $133.90 | $109.81 |
| Rest of Missouri | $131.39 | $108.64 |
| Rest of New Jersey | $144.23 | $115.42 |
| Rest of New York | $133.57 | $108.50 |
| Rest of Oregon | $135.27 | $108.99 |
| Rest of Pennsylvania | $133.35 | $109.13 |
| Rest of Texas | $134.33 | $109.29 |
| Rest of Washington | $138.86 | $111.07 |
| Rhode Island | $139.22 | $111.96 |
| Riverside, CA | $141.30 | $112.38 |
| Sacramento, CA | $144.23 | $113.54 |
| Salinas, CA | $143.61 | $113.02 |
| San Benito County, CA | $161.64 | $123.60 |
| San Diego, CA | $144.91 | $113.35 |
| San Francisco, CA | $158.58 | $121.38 |
| San Luis Obispo, CA | $141.53 | $111.47 |
| Santa Clara County, CA | $161.09 | $123.04 |
| Santa Cruz, CA | $144.73 | $112.67 |
| Santa Maria, CA | $143.58 | $112.81 |
| Santa Rosa, CA | $146.07 | $113.67 |
| South Carolina | $133.19 | $108.81 |
| South Dakota | $133.95 | $107.56 |
| Southern Maine, ME | $134.80 | $108.65 |
| Stockton, CA | $139.93 | $111.01 |
| Suburban Chicago, IL | $141.37 | $114.27 |
| Tennessee | $131.38 | $107.39 |
| Utah | $133.98 | $109.17 |
| Vallejo, CA | $152.25 | $117.47 |
| Vermont | $134.26 | $108.14 |
| Virgin Islands, VI | $136.96 | $110.28 |
| Virginia | $134.80 | $108.86 |
| Visalia, CA | $139.93 | $111.01 |
| Washington, DC area | $148.82 | $117.74 |
| West Virginia | $133.48 | $110.55 |
| Wisconsin | $132.28 | $107.00 |
| Wyoming | $135.57 | $109.18 |
| Yuba City, CA | $139.93 | $111.01 |
90838 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.
$129.44
$184.98
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 | $184.98 | 1 |
| AL | $130.24 | 1 |
| AR | $129.44 | 1 |
| AZ | $134.88 | 1 |
| CA | $139.93–$161.64 | 29 |
| CO | $139.25 | 1 |
| CT | $142.22 | 1 |
| DC | $148.82 | 1 |
| DE | $136.24 | 1 |
| FL | $136.99–$144.26 | 3 |
| GA | $133.38–$138.30 | 2 |
| GU | $140.00 | 1 |
| HI | $140.00 | 1 |
| IA | $131.04 | 1 |
| ID | $131.53 | 1 |
| IL | $135.64–$142.65 | 4 |
| IN | $131.84 | 1 |
| KS | $131.06 | 1 |
| KY | $132.15 | 1 |
| LA | $132.18–$134.97 | 2 |
| MA | $139.29–$147.28 | 2 |
| MD | $137.68–$148.82 | 3 |
| ME | $132.13–$134.80 | 2 |
| MI | $133.90–$138.06 | 2 |
| MN | $134.86 | 1 |
| MO | $131.39–$134.84 | 3 |
| MS | $130.41 | 1 |
| MT | $136.60 | 1 |
| NC | $132.68 | 1 |
| ND | $134.23 | 1 |
| NE | $131.26 | 1 |
| NH | $137.63 | 1 |
| NJ | $144.23–$148.83 | 2 |
| NM | $134.34 | 1 |
| NV | $135.98 | 1 |
| NY | $133.57–$153.17 | 5 |
| OH | $133.42 | 1 |
| OK | $131.75 | 1 |
| OR | $135.27–$141.23 | 2 |
| PA | $133.35–$140.62 | 2 |
| PR | $136.96 | 1 |
| RI | $139.22 | 1 |
| SC | $133.19 | 1 |
| SD | $133.95 | 1 |
| TN | $131.38 | 1 |
| TX | $132.99–$138.62 | 8 |
| UT | $133.98 | 1 |
| VA | $134.80–$148.82 | 2 |
| VI | $136.96 | 1 |
| VT | $134.26 | 1 |
| WA | $138.86–$149.07 | 2 |
| WI | $132.28 | 1 |
| WV | $133.48 | 1 |
| WY | $135.57 | 1 |
How the 90838 rate is calculated
Each of 90838’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 · 90838
RVUs × geographic indexes × conversion factor
Work2.86
2.86 RVUs× 1.000 GPCI
Practice expense1.11
1.11 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
4.0900
Conversion factor
$33.4009
Medicare rate
$136.61
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90838
The CMS indicators that decide how 90838 is paid alongside other services.
CMS payment indicators · 90838
Psychotherapy, with E/M, 60 minutes
| 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. |
90838 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90837Psychotherapy60 minutes, no E/M
- 90837 represents extended psychotherapy without an accompanying E/M service. Choose 90838 when a separately performed E/M service is also part of the encounter.
- 90836PsychotherapyWith E/M, 38–52 minutes
- Both codes include psychotherapy with E/M, but 90836 is for a shorter psychotherapy duration. Use 90838 when psychotherapy reaches at least 53 minutes.
- 90833Psychotherapy with E/MAdd-on, 30 minutes
- 90833 is the shorter-duration psychotherapy-with-E/M option. 90838 requires at least 53 minutes of psychotherapy, separate from E/M time.
- 90839Crisis psychotherapyInitial 60 minutes
- 90839 is for psychotherapy addressing an acute crisis. 90838 describes extended psychotherapy with an E/M service, not crisis psychotherapy.
90838 billing questions
When should 90838 be chosen over 90837?
Use 90838 when the encounter includes at least 53 minutes of psychotherapy and a separately performed E/M service. Use 90837 for the corresponding extended psychotherapy service without E/M.
Can 90838 be billed by itself?
No. It is an add-on code and must be reported with an appropriate primary E/M service.
Does E/M time count toward the psychotherapy threshold?
No. Count psychotherapy time separately; time spent evaluating or managing the patient as part of the E/M service does not establish the psychotherapy duration.
What documentation supports reporting 90838?
Document the psychotherapy duration, the therapeutic work and patient response, and the separately performed E/M service. The record should make the two service components distinguishable.
Is 90838 an add-on within the primary service's global period?
Yes. CMS identifies 90838 as an add-on paid within the primary procedure’s global period, so report it with the qualifying 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
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