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CPT code 90838: Psychotherapy, with E/M, 60 minutes2026 Medicare rate & RVUs in Iowa

Report 90838 when a clinician provides at least 53 minutes of psychotherapy during the same encounter as a separately performed evaluation and management service.

CMS RVU26DEffective Oct 1, 2026One payment locality94.1K Medicare services in 2024

In Iowa, Medicare pays $131.04 for 90838 in the office and $106.90 when it’s performed in a hospital or facility.

$131.04Office (non-facility)
$106.90Hospital or facility
−4.1%vs the national office rate ($136.61)

Check a contract rate as a % of Medicare · 90838 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 90838 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Iowa
  2. What 90838 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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

How Iowa compares for 90838

Across 109 of 109 payment localities, the office rate for 90838 runs from $129.44 in Arkansas to $184.98 in Alaska. Iowa pays $131.04. The RVUs are the same everywhere; the geographic indexes change the dollars.

90838 in Iowa vs other payment areas
  1. Iowa · this page$131.04
  2. Los Angeles, CA · California$145.96+$14.92
  3. Washington, DC area · District of Columbia$148.82+$17.78
  4. Miami, FL · Florida$144.26+$13.22
  5. Chicago, IL · Illinois$142.65+$11.61
  6. Manhattan, NY · New York$151.08+$20.04
  7. Alaska · Alaska$184.98+$53.94

Other areas in Iowa first, then benchmark localities. Bars start at $0.

Every other payment area

90838 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$130.24$107.15
ArkansasArkansas$129.44$106.77
ArizonaArizona$134.88$109.31
Bakersfield, CACalifornia$140.42$111.50
Chico, CACalifornia$139.93$111.01
El Centro, CACalifornia$139.95$111.03
Fresno, CACalifornia$139.93$111.01
Hanford, CACalifornia$139.93$111.01

90838 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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
90838 office rate range by state
State / territoryOffice rate rangeLocalities
AK$184.981
AL$130.241
AR$129.441
AZ$134.881
CA$139.93–$161.6429
CO$139.251
CT$142.221
DC$148.821
DE$136.241
FL$136.99–$144.263
GA$133.38–$138.302
GU$140.001
HI$140.001
IA$131.041
ID$131.531
IL$135.64–$142.654
IN$131.841
KS$131.061
KY$132.151
LA$132.18–$134.972
MA$139.29–$147.282
MD$137.68–$148.823
ME$132.13–$134.802
MI$133.90–$138.062
MN$134.861
MO$131.39–$134.843
MS$130.411
MT$136.601
NC$132.681
ND$134.231
NE$131.261
NH$137.631
NJ$144.23–$148.832
NM$134.341
NV$135.981
NY$133.57–$153.175
OH$133.421
OK$131.751
OR$135.27–$141.232
PA$133.35–$140.622
PR$136.961
RI$139.221
SC$133.191
SD$133.951
TN$131.381
TX$132.99–$138.628
UT$133.981
VA$134.80–$148.822
VI$136.961
VT$134.261
WA$138.86–$149.072
WI$132.281
WV$133.481
WY$135.571

See 90838 in every payment locality

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

Office or facility?

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.

The exact Iowa inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

11,534

Code
90838
Physician work
2.86
Practice expense
1.11
Malpractice
0.12

GPCI2026.csv

53

Locality
Iowa
Physician work
1.000
Practice expense
0.915
Malpractice
0.397
Office calculation for 90838 in Iowa
ComponentRVULocality factorAdjusted
Physician work2.86× 1.0002.8600
Practice expense1.11× 0.9151.0157
Malpractice0.12× 0.3970.0476
Total RVUs3.9233
Conversion factor× 33.4009

Office rate, Iowa$131.04

Office: (2.86 × 1 + 1.11 × 0.915 + 0.12 × 0.397) × $33.4009 = $131.04

Facility: (2.86 × 1 + 0.32 × 0.915 + 0.12 × 0.397) × $33.4009 = $106.90

Open 90838 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)9The concept doesn’t apply.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

Codes related to 90838

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 90838
CodeHow it relatesOffice range, Iowa
Add-on codes
99214Office visit, established patient, moderate complexityAn established-patient E/M service that may be paired with this psychotherapy add-on.$127.11
99204Office visit, new patient, moderate complexityA new-patient E/M service that may be paired with this psychotherapy add-on.$165.51
Same family
90836Psychotherapy, with E/M, 38–52 minutesPsychotherapy with E/M at a shorter duration.$99.21
90833Psychotherapy with E/M, add-on, 30 minutesPsychotherapy with E/M at a shorter duration.$78.21
Used instead
90837Psychotherapy, 60 minutes, no E/MExtended psychotherapy without the accompanying E/M service.$163.19
90839Crisis psychotherapy, initial 60 minutesInitial crisis psychotherapy for an acute crisis encounter.$156.34

How 90838 has changed in Iowa

90838 · Office / nonfacility

$131.04

Effective 2026-10-01

The base rate is $13.02 higher than on 2025-10-01, moving from $118.02 to $131.04 (11.0%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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

  1. January 1, 2026

    RVU26A

    $118.02changed to$131.04

    • Conversion factor 32.3465 changed to 33.4009
    • Work RVU 2.74 changed to 2.86
    • Practice expense RVU 0.93 changed to 1.11
    • Malpractice RVU 0.13 changed to 0.12
    • Practice expense GPCI 0.913 changed to 0.915
    • Malpractice GPCI 0.457 changed to 0.397

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $115.94changed to$118.02

    • Conversion factor 33.2875 changed to 32.3465
    • Work RVU 2.62 changed to 2.74
    • Practice expense RVU 0.89 changed to 0.93
    • Malpractice RVU 0.11 changed to 0.13

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $114.04changed to$115.94

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $111.96changed to$114.04

    • Conversion factor 33.8872 changed to 32.7442
    • Work RVU 2.50 changed to 2.62
    • Practice expense RVU 0.83 changed to 0.89
    • Practice expense GPCI 0.910 changed to 0.913
    • Malpractice GPCI 0.441 changed to 0.457

  5. January 1, 2023

    RVU23A

    $113.72changed to$111.96

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.82 changed to 0.83
    • Malpractice RVU 0.10 changed to 0.11
    • Practice expense GPCI 0.907 changed to 0.910
    • Malpractice GPCI 0.425 changed to 0.441

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $114.67changed to$113.72

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $116.81changed to$114.67

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.77 changed to 0.82
    • Malpractice RVU 0.09 changed to 0.10
    • Malpractice GPCI 0.424 changed to 0.425

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $114.00changed to$116.81

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.68 changed to 0.77
    • Malpractice RVU 0.11 changed to 0.09
    • Malpractice GPCI 0.423 changed to 0.424

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $110.94changed to$114.00

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 0.59 changed to 0.68

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $107.39changed to$110.94

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.49 changed to 0.59
    • Practice expense GPCI 0.902 changed to 0.907
    • Malpractice GPCI 0.458 changed to 0.423

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $107.17changed to$107.39

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 0.493 changed to 0.458

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $107.06changed to$107.17

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 0.48 changed to 0.49
    • Malpractice RVU 0.10 changed to 0.11

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $106.53changed to$107.06

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $106.92changed to$106.53

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.49 changed to 0.48
    • Practice expense GPCI 0.892 changed to 0.896
    • Malpractice GPCI 0.475 changed to 0.493

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $104.95changed to$106.92

    • Conversion factor 34.0230 changed to 35.8228
    • Work RVU 2.56 changed to 2.50
    • Practice expense RVU 0.54 changed to 0.49
    • Practice expense GPCI 0.887 changed to 0.892
    • Malpractice GPCI 0.456 changed to 0.475

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $104.95

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$131.04$106.90RVU26D
2026-07-01$131.04$106.90RVU26C
2026-04-01$131.04$106.90RVU26B
2026-01-01$131.04$106.90RVU26A
2025-10-01$118.02$105.61RVU25D
2025-07-01$118.02$105.61RVU25C
2025-04-01$118.02$105.61RVU25B
2025-01-01$118.02$105.61RVU25A
2024-10-01$115.94$103.78RVU24D
2024-07-01$115.94$103.78RVU24C
2024-04-01$115.94$103.78RVU24B
2024-03-09$115.94$103.78RVU24AR
2024-01-01$114.04$102.08RVU24A
2023-10-01$111.96$100.86RVU23D
2023-07-01$111.96$100.86RVU23C
2023-04-01$111.96$100.86RVU23B
2023-01-01$111.96$100.86RVU23A
2022-10-01$113.72$102.74RVU22D
2022-07-01$113.72$102.74RVU22C
2022-04-01$113.72$102.74RVU22B
2022-01-01$113.72$102.74RVU22A
2021-10-01$114.67$103.27RVU21D
2021-07-01$114.67$103.27RVU21C
2021-04-01$114.67$103.27RVU21B
2021-01-01$114.67$103.27RVU21A
2020-10-01$116.81$106.99RVU20D
2020-07-01$116.81$106.99RVU20C
2020-04-01$116.81$106.99RVU20B
2020-01-01$116.81$106.99RVU20A
2019-10-01$114.00$107.14RVU19D
2019-07-01$114.00$107.14RVU19C
2019-04-01$114.00$107.14RVU19B
2019-01-01$114.00$107.14RVU19A
2018-10-01$110.94$107.02RVU18D
2018-07-01$110.94$107.02RVU18C
2018-04-01$110.94$107.02RVU18B
2018-01-01$110.94$107.02RVU18AR1
2017-10-01$107.39$106.74RVU17D
2017-07-01$107.39$106.74RVU17C
2017-04-01$107.39$106.74RVU17B
2017-01-01$107.39$106.74RVU17A
2016-10-01$107.17$106.53RVU16D
2016-07-01$107.17$106.53RVU16C
2016-04-01$107.17$106.53RVU16B
2016-01-01$107.17$106.53RVU16A
2015-10-01$107.06$106.42RVU15D
2015-07-01$107.06$106.42RVU15C
2015-04-01$106.53$105.89RVU15B
2015-01-01$106.53$105.89RVU15A
2014-10-01$106.92$106.28RVU14D
2014-07-01$106.92$106.28RVU14C
2014-04-01$106.92$106.28RVU14B
2014-01-01$106.92$106.28RVU14A
2013-10-01$104.95$104.34RVU13D
2013-07-01$104.95$104.34RVU13C
2013-04-01$104.95$104.34RVU13B
2013-01-01$104.95$104.34RVU13AR

Price 90838 for an earlier date of service

Where the Iowa rate applies

Iowa is a Medicare payment area, not a city. Our Census mapping connects it to 1026 cities and communities in Iowa. Some span more than one payment area; confirm with the service ZIP.

  • Ackley
  • Ackworth
  • Adair
  • Adel
  • Afton
  • Agency
  • Ainsworth
  • Akron

Browse all communities in Iowa

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
RVUs for 90838PPRRVU2026_Oct_nonQPP.csv, line 11,534 (RVU26D)
Geographic factors for IowaGPCI2026.csv, line 53 (RVU26D)

Open CMS sourceHow we calculate rates

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