CPT Reimbursement Calculator
Build a typical week of sessions, set your payer mix, and watch your estimated practice revenue print out - by week, month, and year.
1Build a typical week
21 sessions · 18.0 hrsTap + to add the sessions you run in an average week. Know your contracted rate? Click any dollar amount to use it instead of our estimate.
2Who pays you?
Drag the sliders to match your caseload. Whatever's left is self-pay.
3Reality check
Based on 2026 Medicare national non-facility rates. Estimates only - actual contracts vary by payer, state & locality.
2026 Medicare rates used in this calculator
National non-facility rates from the CMS Medicare Physician Fee Schedule, rounded. Your locality's rates will differ slightly based on geographic adjustment (GPCI).
| CPT code | Service | Medicare national rate |
|---|---|---|
| 90791 | Psychiatric diagnostic evaluation - the first appointment. | $173.35 |
| 90832 | Individual psychotherapy, 30 minutes. | $85.84 |
| 90834 | Individual psychotherapy, 45 minutes - the most-billed code in outpatient therapy. | $113.90 |
| 90837 | Individual psychotherapy, 60 minutes. | $167.00 |
| 90846 | Family psychotherapy without the client present. | $105.88 |
| 90847 | Family or couples psychotherapy with the client present. | $109.55 |
| 90853 | Group psychotherapy, per participant. | $30.39 |
Frequently asked questions
How much does insurance reimburse for CPT code 90834?
Medicare's national non-facility rate for 90834 (45-minute individual psychotherapy) is around $114 in 2026, up from about $102 in 2025 after CMS revalued the psychotherapy work RVUs. Commercial insurance typically pays between 80% and 200% of the Medicare rate depending on the payer and your contract - most therapists see somewhere in the 110-150% range.
What is the difference between 90834 and 90837 reimbursement?
90837 (60-minute psychotherapy) reimburses roughly 45% more than 90834 (45-minute) under Medicare - about $167 vs. $114 nationally in 2026. Some commercial payers flag frequent 90837 billing, so many therapists bill a mix of both.
How accurate is this calculator?
It uses CMS Medicare Physician Fee Schedule national non-facility rates as a baseline, with your own assumptions for commercial contracts and self-pay rates. Actual reimbursement varies by state, locality (GPCI), payer contract, and modifiers - treat the output as a planning estimate, not a guarantee.
What payer mix should I assume for a private practice?
It varies widely. Insurance-panel-heavy practices often run 70-90% commercial, while cash-pay practices in major metros may be majority self-pay. If you're modeling a new practice, a 60% commercial / 20% Medicare / 20% self-pay split is a reasonable starting point to stress-test.
This calculator provides estimates for planning purposes only and does not constitute billing, legal, or financial advice. Reimbursement depends on your payer contracts, state, locality, credentials, and modifiers. Want sessions, notes, and billing codes in one place? See how HIPAAtherapy handles it.