$161.70
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.
On this page
CMS RVU26D · Effective 2026-10-01
90838 Psychotherapy Medicare reimbursement rates in Alabama
Report 90838 when a clinician provides at least 53 minutes of psychotherapy during the same encounter as a separately performed evaluation and management service. Compare 90838 office and facility rates across CMS payment localities in Alabama.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 90838 in Alabama?
Alabama has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$130.24
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
Facility setting
$107.15
1 of 1 localities have a supported rate.
Payment area: Alabama
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Psychotherapy
About 90838: Psychotherapy with E/M, 60 minutes
Report 90838 when a clinician provides at least 53 minutes of psychotherapy during the same encounter as a separately performed evaluation and management service.
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.
CMS billing rules for 90838
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU2.86 · 70%
- Practice expense (office) RVU1.11 · 27%
- Malpractice RVU0.12 · 3%
94.1K
Medicare services in 2024 · #581 by national volume
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.
90838 compared with similar codes
Office rates for Alabama, from the same CMS release.
$98.54
Both codes include psychotherapy with E/M, but 90836 is for a shorter psychotherapy duration. Use 90838 when psychotherapy reaches at least 53 minutes.
$77.73
90833 is the shorter-duration psychotherapy-with-E/M option. 90838 requires at least 53 minutes of psychotherapy, separate from E/M time.
$154.92
90839 is for psychotherapy addressing an acute crisis. 90838 describes extended psychotherapy with an E/M service, not crisis psychotherapy.
Compare 90838 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Alabama →
Office / nonfacility
$130.24
Facility
$107.15
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 90838 in Alabama.
PPRRVU2026_Oct_nonQPP.csv
11,534
- Code
- 90838
- Physician work
- 2.86
- Practice expense
- 1.11
- Malpractice
- 0.12
GPCI2026.csv
4
- Locality
- Alabama
- Physician work
- 1.000
- Practice expense
- 0.875
- Malpractice
- 0.566
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 2.86 | × 1.000 | 2.8600 |
| Practice expense | 1.11 | × 0.875 | 0.9713 |
| Malpractice | 0.12 | × 0.566 | 0.0679 |
| Total RVUs | 3.8992 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Alabama$130.24
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.86 | 1 |
| Practice expense | 1.11 | 0.875 |
| Malpractice | 0.12 | 0.566 |
(2.86 × 1 + 1.11 × 0.875 + 0.12 × 0.566) × $33.4009 = $130.24
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 2.86 | 1 |
| Practice expense | 0.32 | 0.875 |
| Malpractice | 0.12 | 0.566 |
(2.86 × 1 + 0.32 × 0.875 + 0.12 × 0.566) × $33.4009 = $107.15
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
11,53190834,,Psytx w pt 45 minutes,A,,2.56,0.83,,0.17,,0.02,3.41,2.75,0,XXX,0.00,0.00,0.00,0,0,9,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,53290836,,Psytx w pt w e/m 45 min,A,,2.17,0.84,,0.24,,0.08,3.09,2.49,0,ZZZ,0.00,0.00,0.00,0,0,9,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,53390837,,Psytx w pt 60 minutes,A,,3.78,1.20,,0.25,,0.02,5.00,4.05,0,XXX,0.00,0.00,0.00,0,0,9,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,53490838,,Psytx w pt w e/m 60 min,A,,2.86,1.11,,0.32,,0.12,4.09,3.30,0,ZZZ,0.00,0.00,0.00,0,0,9,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,53590839,,Psytx crisis initial 60 min,A,,3.58,1.19,,0.27,,0.03,4.80,3.88,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,53690840,,Psytx crisis ea addl 30 min,A,,1.71,0.58,,0.14,,0.02,2.31,1.87,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
11,53790845,,Psychoanalysis,A,,2.40,0.83,,0.20,,0.04,3.27,2.64,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
1ADDENDUM E. FINAL CY 2026 GEOGRAPHIC PRACTICE COST INDICES (GPCIs) BY STATE AND MEDICARE LOCALITY,,,,,,
2,,,,,,
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515