Psytx w pt w e/m 60 min
A 60-minute psychiatric therapy session with evaluation and management (CPT 90838) carries a Medicare facility rate of $110.77, making it essential to verify your bill matches this benchmark before payment.
About the analyst
David Park researches procedure pricing and insurance reimbursement patterns at BillRazor Research. He specializes in cost comparison across care settings and metropolitan areas. Expertise: procedure pricing, insurance reimbursement, cost comparison.
Code 90838 represents a psychiatric therapy session lasting 60 minutes that includes both psychotherapy and medical evaluation/management services during the same visit. Patients with mental health conditions requiring both therapeutic intervention and medication monitoring typically receive this service. This code charges approximately 8-12 times the standard Medicare reimbursement rate depending on the provider and facility type.
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Facility rate
$111
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
2
22 data points
Key insights for CPT 90838
Facility vs office setting
$12 differenceNon-facility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $111 | +12% |
| Non-facility (office) | $99 | Lowest |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Related procedures
Related pricing data
Data: Federal physician fee schedules, hospital payment data, surgery center rates, lab fee schedules, and drug pricing data. FY 2024. All publicly available from federal sources.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use