How much does Medicare pay for CPT 90785?

Medicare allowed an average of $12.70 per service and paid $9.93 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $48.85, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90785?

Psychiatric services complicated by communication factor. It was billed 342,519 times to 65,191 Medicare beneficiaries by 1,212 providers in 2024.

Does 90785 pay differently in an office than a hospital?

Yes. The allowed amount averaged $12.75 in an office setting and $12.17 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 90785 most?

Psychologist, Clinical, with 146,719 services from 264 clinicians. Next are Licensed Clinical Social Worker, Nurse Practitioner, Psychiatry.

CPT 90785

Psychiatric services complicated by communication factor

$12.70Medicare-allowed amount per service, averaged across 342,519 services

Providers submitted

$48.85

Asking price, not received

Medicare allowed

$12.70

The fee schedule figure

Medicare paid

$9.93

Balance is patient coinsurance

Providers submitted an average of $48.85 for this code and Medicare allowed $12.70 — 3.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $9.93 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $12.75
Hospital / facility: $12.17

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 314,114 services were billed in an office setting and 28,405 in a facility.

Services: 342,519
Beneficiaries: 65,191
Providers billing it: 1,212
Total allowed: $4,349,991

What Medicare pays for CPT 90785

Across 342,519 services billed by 1,212 providers to 65,191 beneficiaries, Medicare allowed an average of $12.70 per service. That is 5.3 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 90785

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	146,719	23,422	$14.44	264
Licensed Clinical Social Worker	127,199	17,631	$10.84	349
Nurse Practitioner	25,911	13,042	$11.56	284
Psychiatry	20,144	7,440	$14.44	220
Licensed Professional Counselor	15,573	1,540	$10.83	44
Nephrology	1,830	68	$14.67	1
Marriage and Family Therapist	1,758	287	$11.00	11
Physician Assistant	974	573	$11.87	25
Neuropsychiatry	809	754	$14.89	1
Geriatric Psychiatry	403	155	$15.25	2
Gastroenterology	370	13	$15.18	1
Family Practice	299	82	$14.15	2
Pain Management	231	29	$15.29	1
Certified Clinical Nurse Specialist	180	75	$11.47	5
General Practice	67	59	$14.35	1

90785 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	122,557	$14.55	$11.14	189
Texas	43,499	$11.40	$8.91	81
Indiana	29,794	$11.13	$9.02	48
Illinois	17,202	$11.35	$8.66	60
New York	14,037	$12.97	$9.30	63
Michigan	13,480	$11.42	$8.84	72
Florida	12,555	$12.71	$9.96	107
Ohio	11,800	$11.20	$8.76	121
New Jersey	11,779	$12.21	$9.08	52
Oklahoma	8,511	$10.53	$8.52	25
Pennsylvania	5,543	$12.05	$9.45	28
Virginia	5,193	$11.95	$9.67	23
Georgia	4,492	$12.11	$9.09	28
Kentucky	4,086	$11.14	$9.13	14
Colorado	4,073	$11.71	$9.20	33
Nevada	3,277	$11.42	$8.75	11
South Carolina	2,429	$11.99	$9.52	19
Maryland	2,243	$13.27	$10.36	17
Minnesota	2,115	$12.30	$9.66	31
Oregon	2,023	$13.31	$10.27	6
Louisiana	1,858	$11.78	$9.36	15
Massachusetts	1,826	$12.18	$9.26	13
Tennessee	1,795	$12.75	$9.92	12
Missouri	1,695	$11.01	$8.58	6
Arkansas	1,676	$10.46	$8.64	7
North Carolina	1,614	$12.01	$9.63	33
Washington	1,500	$13.11	$10.27	11
Iowa	1,493	$11.20	$8.91	8
Arizona	1,346	$12.99	$10.70	14
Idaho	1,204	$11.39	$9.25	7
Maine	1,178	$9.69	$7.81	1
New Mexico	1,035	$12.92	$9.87	10
Delaware	533	$11.02	$8.71	5
Wisconsin	456	$11.45	$9.42	5
Rhode Island	372	$9.77	$7.26	7
Connecticut	315	$14.83	$10.30	3
New Hampshire	315	$10.85	$8.20	1
Utah	303	$10.58	$8.33	2
West Virginia	292	$11.74	$9.51	2
Nebraska	197	$12.58	$10.08	5
Hawaii	185	$12.47	$9.58	3
Wyoming	180	$10.94	$8.77	2
Kansas	152	$12.85	$10.30	4
Alabama	139	$12.54	$10.12	4
Vermont	105	$13.47	$10.63	1
Alaska	67	$16.43	$8.87	3

Related codes

90791Psychiatric diagnostic evaluation$147.36
90792Psychiatric diagnostic evaluation$163.13
90732Pneumococcal vaccine$128.28
90715Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older$37.48
90714Diphtheria and tetanus vaccine (7 years or older)$27.84
90739Hepatitis b vaccine (hepb)$155.49
90746Hepatitis b vaccine$67.61
90756Influenza vaccine$31.36

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.