CPT code 90838: Psychotherapy, with E/M, 60 minutes2026 Medicare rate & RVUs in North Dakota
Report 90838 when a clinician provides at least 53 minutes of psychotherapy during the same encounter as a separately performed evaluation and management service.
In North Dakota, Medicare pays $134.23 for 90838 in the office and $107.84 when it’s performed in a hospital or facility.
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.
On this page 11 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
How North Dakota 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. North Dakota pays $134.23. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$134.23
- Los Angeles, CA · California$145.96+$11.73
- Washington, DC area · District of Columbia$148.82+$14.59
- Miami, FL · Florida$144.26+$10.03
- Chicago, IL · Illinois$142.65+$8.42
- Manhattan, NY · New York$151.08+$16.85
- Alaska · Alaska$184.98+$50.75
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $139.93 | $111.01 |
| Merced, CACalifornia | $139.93 | $111.01 |
| Modesto, CACalifornia | $139.93 | $111.01 |
| Napa, CACalifornia | $152.45 | $117.67 |
| Oxnard, CACalifornia | $144.52 | $113.33 |
| Redding, CACalifornia | $139.93 | $111.01 |
| Rest of CaliforniaCalifornia | $139.93 | $111.01 |
| Riverside, CACalifornia | $141.30 | $112.38 |
| Sacramento, CACalifornia | $144.23 | $113.54 |
| Salinas, CACalifornia | $143.61 | $113.02 |
| San Diego, CACalifornia | $144.91 | $113.35 |
| Marin County, CACalifornia | $158.72 | $121.51 |
| San Francisco, CACalifornia | $158.58 | $121.38 |
| San Benito County, CACalifornia | $161.64 | $123.60 |
| Santa Clara County, CACalifornia | $161.09 | $123.04 |
| San Luis Obispo, CACalifornia | $141.53 | $111.47 |
| Santa Cruz, CACalifornia | $144.73 | $112.67 |
| Santa Maria, CACalifornia | $143.58 | $112.81 |
| Santa Rosa, CACalifornia | $146.07 | $113.67 |
| Stockton, CACalifornia | $139.93 | $111.01 |
| Vallejo, CACalifornia | $152.25 | $117.47 |
| Visalia, CACalifornia | $139.93 | $111.01 |
| Yuba City, CACalifornia | $139.93 | $111.01 |
| ColoradoColorado | $139.25 | $111.18 |
| ConnecticutConnecticut | $142.22 | $113.80 |
| DelawareDelaware | $136.24 | $110.17 |
| Fort Lauderdale, FLFlorida | $140.33 | $113.60 |
| Rest of FloridaFlorida | $136.99 | $111.77 |
| Atlanta, GAGeorgia | $138.30 | $111.49 |
| Rest of GeorgiaGeorgia | $133.38 | $109.84 |
| Hawaii, Guam, HIHawaii | $140.00 | $110.00 |
| IowaIowa | $131.04 | $106.90 |
| IdahoIdaho | $131.53 | $107.26 |
| East St. Louis, ILIllinois | $137.71 | $113.43 |
| Rest of IllinoisIllinois | $135.64 | $111.55 |
| Suburban Chicago, ILIllinois | $141.37 | $114.27 |
| IndianaIndiana | $131.84 | $107.38 |
| KansasKansas | $131.06 | $107.21 |
| KentuckyKentucky | $132.15 | $108.70 |
| New Orleans, LALouisiana | $134.97 | $110.14 |
| Rest of LouisianaLouisiana | $132.18 | $108.83 |
| Metropolitan Boston, MAMassachusetts | $147.28 | $115.77 |
| Rest of MassachusettsMassachusetts | $139.29 | $111.50 |
| Baltimore area, MDMaryland | $141.79 | $113.48 |
| Rest of MarylandMaryland | $137.68 | $110.98 |
| Rest of MaineMaine | $132.13 | $107.85 |
| Southern Maine, MEMaine | $134.80 | $108.65 |
| Detroit, MIMichigan | $138.06 | $112.60 |
| Rest of MichiganMichigan | $133.90 | $109.81 |
| MinnesotaMinnesota | $134.86 | $107.71 |
| Metropolitan Kansas City, MOMissouri | $134.26 | $109.48 |
| Metropolitan St. Louis, MOMissouri | $134.84 | $109.72 |
| Rest of MissouriMissouri | $131.39 | $108.64 |
| MississippiMississippi | $130.41 | $107.69 |
| MontanaMontana | $136.60 | $110.21 |
| North CarolinaNorth Carolina | $132.68 | $108.06 |
| NebraskaNebraska | $131.26 | $106.91 |
| New HampshireNew Hampshire | $137.63 | $110.16 |
| Northern New JerseyNew Jersey | $148.83 | $118.22 |
| Rest of New JerseyNew Jersey | $144.23 | $115.42 |
| New MexicoNew Mexico | $134.34 | $110.14 |
| NevadaNevada | $135.98 | $109.56 |
| NYC suburbs and Long Island, NYNew York | $153.17 | $121.79 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $145.27 | $116.38 |
| Queens, NYNew York | $151.24 | $120.05 |
| Rest of New YorkNew York | $133.57 | $108.50 |
| OhioOhio | $133.42 | $109.33 |
| OklahomaOklahoma | $131.75 | $108.19 |
| Portland, OROregon | $141.23 | $111.91 |
| Rest of OregonOregon | $135.27 | $108.99 |
| Metropolitan Philadelphia, PAPennsylvania | $140.62 | $113.15 |
| Rest of PennsylvaniaPennsylvania | $133.35 | $109.13 |
| Puerto RicoPuerto Rico | $136.96 | $110.28 |
| Rhode IslandRhode Island | $139.22 | $111.96 |
| South CarolinaSouth Carolina | $133.19 | $108.81 |
| South DakotaSouth Dakota | $133.95 | $107.56 |
| TennesseeTennessee | $131.38 | $107.39 |
| Austin, TXTexas | $138.49 | $110.58 |
| Beaumont, TXTexas | $132.99 | $108.98 |
| Brazoria, TXTexas | $136.16 | $110.01 |
| Dallas, TXTexas | $136.75 | $110.47 |
| Fort Worth, TXTexas | $136.43 | $110.42 |
| Galveston, TXTexas | $136.42 | $110.22 |
| Houston, TXTexas | $138.62 | $112.42 |
| Rest of TexasTexas | $134.33 | $109.29 |
| UtahUtah | $133.98 | $109.17 |
| VirginiaVirginia | $134.80 | $108.86 |
| Virgin Islands, VIUnited States Virgin Islands | $136.96 | $110.28 |
| VermontVermont | $134.26 | $108.14 |
| Rest of WashingtonWashington | $138.86 | $111.07 |
| King County, WAWashington | $149.07 | $116.69 |
| WisconsinWisconsin | $132.28 | $107.00 |
| West VirginiaWest Virginia | $133.48 | $110.55 |
| WyomingWyoming | $135.57 | $109.18 |
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.
The exact North Dakota 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
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.86 | × 1.000 | 2.8600 |
| Practice expense | 1.11 | × 1.000 | 1.1100 |
| Malpractice | 0.12 | × 0.406 | 0.0487 |
| Total RVUs | 4.0187 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$134.23
Office: (2.86 × 1 + 1.11 × 1 + 0.12 × 0.406) × $33.4009 = $134.23
Facility: (2.86 × 1 + 0.32 × 1 + 0.12 × 0.406) × $33.4009 = $107.84
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. |
How 90838 has changed in North Dakota
90838 · Office / nonfacility
$134.23
Effective 2026-10-01
The base rate is $13.34 higher than on 2025-10-01, moving from $120.89 to $134.23 (11.0%).
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
$120.89changed to$134.23
- 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
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$118.73changed to$120.89
- 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.
March 9, 2024
RVU24AR
$116.79changed to$118.73
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$114.61changed to$116.79
- 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
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$116.38changed to$114.61
- 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
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$117.35changed to$116.38
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$119.59changed to$117.35
- 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 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$116.75changed to$119.59
- 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 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$113.38changed to$116.75
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 0.59 changed to 0.68
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$109.47changed to$113.38
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 0.49 changed to 0.59
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$109.24changed to$109.47
- Conversion factor 35.8043 changed to 35.8887
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$109.07changed to$109.24
- 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.
July 1, 2015
RVU15C
$108.53changed to$109.07
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$109.03changed to$108.53
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 0.49 changed to 0.48
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$107.23changed to$109.03
- 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
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $107.23
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $134.23 | $107.84 | RVU26D |
| 2026-07-01 | $134.23 | $107.84 | RVU26C |
| 2026-04-01 | $134.23 | $107.84 | RVU26B |
| 2026-01-01 | $134.23 | $107.84 | RVU26A |
| 2025-10-01 | $120.89 | $107.30 | RVU25D |
| 2025-07-01 | $120.89 | $107.30 | RVU25C |
| 2025-04-01 | $120.89 | $107.30 | RVU25B |
| 2025-01-01 | $120.89 | $107.30 | RVU25A |
| 2024-10-01 | $118.73 | $105.42 | RVU24D |
| 2024-07-01 | $118.73 | $105.42 | RVU24C |
| 2024-04-01 | $118.73 | $105.42 | RVU24B |
| 2024-03-09 | $118.73 | $105.42 | RVU24AR |
| 2024-01-01 | $116.79 | $103.70 | RVU24A |
| 2023-10-01 | $114.61 | $102.41 | RVU23D |
| 2023-07-01 | $114.61 | $102.41 | RVU23C |
| 2023-04-01 | $114.61 | $102.41 | RVU23B |
| 2023-01-01 | $114.61 | $102.41 | RVU23A |
| 2022-10-01 | $116.38 | $104.27 | RVU22D |
| 2022-07-01 | $116.38 | $104.27 | RVU22C |
| 2022-04-01 | $116.38 | $104.27 | RVU22B |
| 2022-01-01 | $116.38 | $104.27 | RVU22A |
| 2021-10-01 | $117.35 | $104.79 | RVU21D |
| 2021-07-01 | $117.35 | $104.79 | RVU21C |
| 2021-04-01 | $117.35 | $104.79 | RVU21B |
| 2021-01-01 | $117.35 | $104.79 | RVU21A |
| 2020-10-01 | $119.59 | $108.76 | RVU20D |
| 2020-07-01 | $119.59 | $108.76 | RVU20C |
| 2020-04-01 | $119.59 | $108.76 | RVU20B |
| 2020-01-01 | $119.59 | $108.76 | RVU20A |
| 2019-10-01 | $116.75 | $109.18 | RVU19D |
| 2019-07-01 | $116.75 | $109.18 | RVU19C |
| 2019-04-01 | $116.75 | $109.18 | RVU19B |
| 2019-01-01 | $116.75 | $109.18 | RVU19A |
| 2018-10-01 | $113.38 | $109.06 | RVU18D |
| 2018-07-01 | $113.38 | $109.06 | RVU18C |
| 2018-04-01 | $113.38 | $109.06 | RVU18B |
| 2018-01-01 | $113.38 | $109.06 | RVU18AR1 |
| 2017-10-01 | $109.47 | $108.75 | RVU17D |
| 2017-07-01 | $109.47 | $108.75 | RVU17C |
| 2017-04-01 | $109.47 | $108.75 | RVU17B |
| 2017-01-01 | $109.47 | $108.75 | RVU17A |
| 2016-10-01 | $109.24 | $108.52 | RVU16D |
| 2016-07-01 | $109.24 | $108.52 | RVU16C |
| 2016-04-01 | $109.24 | $108.52 | RVU16B |
| 2016-01-01 | $109.24 | $108.52 | RVU16A |
| 2015-10-01 | $109.07 | $108.35 | RVU15D |
| 2015-07-01 | $109.07 | $108.35 | RVU15C |
| 2015-04-01 | $108.53 | $107.81 | RVU15B |
| 2015-01-01 | $108.53 | $107.81 | RVU15A |
| 2014-10-01 | $109.03 | $108.31 | RVU14D |
| 2014-07-01 | $109.03 | $108.31 | RVU14C |
| 2014-04-01 | $109.03 | $108.31 | RVU14B |
| 2014-01-01 | $109.03 | $108.31 | RVU14A |
| 2013-10-01 | $107.23 | $106.55 | RVU13D |
| 2013-07-01 | $107.23 | $106.55 | RVU13C |
| 2013-04-01 | $107.23 | $106.55 | RVU13B |
| 2013-01-01 | $107.23 | $106.55 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
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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