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

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 Dallas, TX, Medicare pays $136.75 for 90838 in the office and $110.47 when it’s performed in a hospital or facility.

$136.75Office (non-facility)
$110.47Hospital or facility
+0.1%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 Dallas, TX
  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 Dallas, TX 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. Dallas, TX pays $136.75. The RVUs are the same everywhere; the geographic indexes change the dollars.

90838 in Dallas, TX vs other payment areas
  1. Dallas, TX · this page$136.75
  2. Austin, TX · Texas$138.49+$1.74
  3. Beaumont, TX · Texas$132.99−$3.76
  4. Brazoria, TX · Texas$136.16−$0.59
  5. Fort Worth, TX · Texas$136.43−$0.32
  6. Galveston, TX · Texas$136.42−$0.33
  7. Houston, TX · Texas$138.62+$1.87

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

Every other payment area

90838 in every other Medicare payment locality
Payment localityOfficeFacility
Rest of TexasTexas$134.33$109.29
Los Angeles, CACalifornia$145.96$114.75
Washington, DC areaDistrict of Columbia$148.82$117.74
Miami, FLFlorida$144.26$116.79
Chicago, ILIllinois$142.65$116.14
Manhattan, NYNew York$151.08$120.42
AlaskaAlaska$184.98$156.88
AlabamaAlabama$130.24$107.15

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
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 Dallas, TX 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

99

Locality
Dallas, TX
Physician work
1.009
Practice expense
0.996
Malpractice
0.858
Office calculation for 90838 in Dallas, TX
ComponentRVULocality factorAdjusted
Physician work2.86× 1.0092.8857
Practice expense1.11× 0.9961.1056
Malpractice0.12× 0.8580.1030
Total RVUs4.0943
Conversion factor× 33.4009

Office rate, Dallas, TX$136.75

Office: (2.86 × 1.009 + 1.11 × 0.996 + 0.12 × 0.858) × $33.4009 = $136.75

Facility: (2.86 × 1.009 + 0.32 × 0.996 + 0.12 × 0.858) × $33.4009 = $110.47

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.

How 90838 has changed in Dallas, TX

90838 · Office / nonfacility

$136.75

Effective 2026-10-01

The base rate is $13.17 higher than on 2025-10-01, moving from $123.58 to $136.75 (10.7%).

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

    $123.58changed to$136.75

    • 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
    • Work GPCI 1.011 changed to 1.009
    • Practice expense GPCI 1.007 changed to 0.996
    • Malpractice GPCI 0.877 changed to 0.858

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $121.22changed to$123.58

    • 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

    $119.24changed to$121.22

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $117.41changed to$119.24

    • 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
    • Work GPCI 1.017 changed to 1.011
    • Practice expense GPCI 1.017 changed to 1.007
    • Malpractice GPCI 0.711 changed to 0.877
  5. January 1, 2023

    RVU23A

    $119.51changed to$117.41

    • 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
    • Work GPCI 1.023 changed to 1.017
    • Practice expense GPCI 1.026 changed to 1.017
    • Malpractice GPCI 0.546 changed to 0.711

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $120.50changed to$119.51

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $122.33changed to$120.50

    • 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
    • Work GPCI 1.018 changed to 1.023
    • Practice expense GPCI 1.020 changed to 1.026
    • Malpractice GPCI 0.657 changed to 0.546

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $119.07changed to$122.33

    • 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
    • Work GPCI 1.012 changed to 1.018
    • Practice expense GPCI 1.014 changed to 1.020
    • Malpractice GPCI 0.768 changed to 0.657

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $115.66changed to$119.07

    • 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

    $111.90changed to$115.66

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 0.49 changed to 0.59
    • Work GPCI 1.015 changed to 1.012
    • Practice expense GPCI 1.012 changed to 1.014
    • Malpractice GPCI 0.770 changed to 0.768

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $111.86changed to$111.90

    • Conversion factor 35.8043 changed to 35.8887
    • Work GPCI 1.018 changed to 1.015
    • Practice expense GPCI 1.009 changed to 1.012
    • Malpractice GPCI 0.772 changed to 0.770

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $111.63changed to$111.86

    • 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

    $111.07changed to$111.63

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $111.47changed to$111.07

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 0.49 changed to 0.48
    • Work GPCI 1.014 changed to 1.018
    • Practice expense GPCI 1.013 changed to 1.009
    • Malpractice GPCI 0.803 changed to 0.772

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $109.41changed to$111.47

    • 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
    • Work GPCI 1.009 changed to 1.014
    • Practice expense GPCI 1.017 changed to 1.013
    • Malpractice GPCI 0.834 changed to 0.803

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $109.41

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$136.75$110.47RVU26D
2026-07-01$136.75$110.47RVU26C
2026-04-01$136.75$110.47RVU26B
2026-01-01$136.75$110.47RVU26A
2025-10-01$123.58$109.90RVU25D
2025-07-01$123.58$109.90RVU25C
2025-04-01$123.58$109.90RVU25B
2025-01-01$123.58$109.90RVU25A
2024-10-01$121.22$107.81RVU24D
2024-07-01$121.22$107.81RVU24C
2024-04-01$121.22$107.81RVU24B
2024-03-09$121.22$107.81RVU24AR
2024-01-01$119.24$106.05RVU24A
2023-10-01$117.41$105.01RVU23D
2023-07-01$117.41$105.01RVU23C
2023-04-01$117.41$105.01RVU23B
2023-01-01$117.41$105.01RVU23A
2022-10-01$119.51$107.08RVU22D
2022-07-01$119.51$107.08RVU22C
2022-04-01$119.51$107.08RVU22B
2022-01-01$119.51$107.08RVU22A
2021-10-01$120.50$107.61RVU21D
2021-07-01$120.50$107.61RVU21C
2021-04-01$120.50$107.61RVU21B
2021-01-01$120.50$107.61RVU21A
2020-10-01$122.33$111.28RVU20D
2020-07-01$122.33$111.28RVU20C
2020-04-01$122.33$111.28RVU20B
2020-01-01$122.33$111.28RVU20A
2019-10-01$119.07$111.40RVU19D
2019-07-01$119.07$111.40RVU19C
2019-04-01$119.07$111.40RVU19B
2019-01-01$119.07$111.40RVU19A
2018-10-01$115.66$111.28RVU18D
2018-07-01$115.66$111.28RVU18C
2018-04-01$115.66$111.28RVU18B
2018-01-01$115.66$111.28RVU18AR1
2017-10-01$111.90$111.18RVU17D
2017-07-01$111.90$111.18RVU17C
2017-04-01$111.90$111.18RVU17B
2017-01-01$111.90$111.18RVU17A
2016-10-01$111.86$111.14RVU16D
2016-07-01$111.86$111.14RVU16C
2016-04-01$111.86$111.14RVU16B
2016-01-01$111.86$111.14RVU16A
2015-10-01$111.63$110.90RVU15D
2015-07-01$111.63$110.90RVU15C
2015-04-01$111.07$110.35RVU15B
2015-01-01$111.07$110.35RVU15A
2014-10-01$111.47$110.74RVU14D
2014-07-01$111.47$110.74RVU14C
2014-04-01$111.47$110.74RVU14B
2014-01-01$111.47$110.74RVU14A
2013-10-01$109.41$108.71RVU13D
2013-07-01$109.41$108.71RVU13C
2013-04-01$109.41$108.71RVU13B
2013-01-01$109.41$108.71RVU13AR

Price 90838 for an earlier date of service

Where the Dallas, TX rate applies

Dallas, TX is a Medicare payment area, not a city. Our Census mapping connects it to 32 cities and communities in Texas. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in Texas

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 Dallas, TXGPCI2026.csv, line 99 (RVU26D)

Open CMS sourceHow we calculate rates

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