How much does Medicare pay for CPT 90836?

Medicare allowed an average of $88.70 per service and paid $68.54 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $170.34, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90836?

Psychotherapy with evaluation and management visit, 45 minutes. It was billed 291,911 times to 59,546 Medicare beneficiaries by 1,985 providers in 2024.

Does 90836 pay differently in an office than a hospital?

Yes. The allowed amount averaged $89.07 in an office setting and $77.74 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 90836 most?

Psychiatry, with 222,098 services from 1,232 clinicians. Next are Nurse Practitioner, Certified Clinical Nurse Specialist, Geriatric Psychiatry.

CPT 90836

Psychotherapy with evaluation and management visit, 45 minutes

$88.70Medicare-allowed amount per service, averaged across 291,911 services

Providers submitted

$170.34

Asking price, not received

Medicare allowed

$88.70

The fee schedule figure

Medicare paid

$68.54

Balance is patient coinsurance

Providers submitted an average of $170.34 for this code and Medicare allowed $88.70 — 1.9× 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 $68.54 (77%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $89.07
Hospital / facility: $77.74

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. 282,497 services were billed in an office setting and 9,414 in a facility.

Services: 291,911
Beneficiaries: 59,546
Providers billing it: 1,985
Total allowed: $25,892,506

What Medicare pays for CPT 90836

Across 291,911 services billed by 1,985 providers to 59,546 beneficiaries, Medicare allowed an average of $88.70 per service. That is 4.9 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 90836

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychiatry	222,098	38,474	$91.98	1,232
Nurse Practitioner	52,299	16,614	$77.10	602
Certified Clinical Nurse Specialist	10,393	1,757	$77.40	73
Geriatric Psychiatry	2,666	606	$87.18	14
Physician Assistant	1,179	521	$73.82	29
Family Practice	876	466	$101.98	3
Neurology	736	291	$91.53	5
Internal Medicine	630	415	$90.27	10
General Practice	359	127	$94.14	4
Neuropsychiatry	160	82	$84.31	3
Addiction Medicine	124	41	$91.76	2
Hospice and Palliative Care	72	14	$91.30	1
Gastroenterology	71	21	$94.07	1
Sleep Medicine	64	28	$90.08	1
Physical Medicine and Rehabilitation	48	13	$95.38	1

90836 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
New York	81,661	$93.55	$67.86	325
California	42,891	$93.46	$67.71	243
Massachusetts	23,832	$86.95	$64.80	156
New Jersey	18,854	$88.92	$66.65	95
Maryland	15,712	$87.30	$65.38	86
Pennsylvania	12,780	$89.17	$67.93	73
Florida	12,068	$84.56	$65.74	156
Illinois	7,944	$86.29	$67.40	48
Arizona	7,684	$77.96	$62.79	50
Texas	7,418	$83.14	$65.72	94
Connecticut	5,076	$87.57	$64.95	35
Virginia	4,531	$81.86	$64.55	33
North Carolina	3,829	$82.20	$66.04	42
Michigan	3,419	$86.23	$66.91	39
Ohio	3,312	$83.90	$66.18	37
Washington	3,259	$86.50	$66.29	30
Nevada	2,563	$76.27	$61.03	21
Georgia	2,533	$83.74	$67.45	29
Colorado	2,274	$82.25	$63.34	28
District of Columbia	2,254	$89.22	$66.77	16
Tennessee	2,211	$78.78	$62.74	27
South Carolina	2,138	$80.50	$64.02	36
Hawaii	2,116	$87.00	$67.45	16
Missouri	1,939	$83.71	$69.09	11
Oregon	1,834	$82.61	$63.75	20
Alaska	1,833	$84.39	$63.62	7
Minnesota	1,369	$81.82	$63.54	19
New Hampshire	1,289	$81.19	$65.32	16
Rhode Island	1,230	$86.02	$66.78	11
Delaware	1,218	$79.87	$61.87	15
Kentucky	1,116	$82.11	$64.89	11
Oklahoma	940	$74.88	$60.57	12
Alabama	902	$80.27	$65.28	21
Wisconsin	885	$83.07	$65.45	14
Kansas	831	$77.62	$61.58	11
Louisiana	751	$82.27	$65.51	13
New Mexico	733	$81.15	$63.12	11
Utah	564	$81.95	$67.19	7
Maine	562	$81.50	$63.17	6
Arkansas	556	$71.51	$59.11	10
Mississippi	467	$79.38	$64.73	8
Idaho	463	$79.38	$63.88	7
Vermont	446	$84.88	$67.45	8
Indiana	396	$81.45	$67.23	6
Nebraska	337	$73.60	$59.27	7
Iowa	239	$73.59	$58.92	7
South Dakota	139	$73.16	$60.38	3
Wyoming	139	$88.50	$70.50	1
North Dakota	115	$82.15	$62.58	2
Montana	114	$82.57	$64.20	3
West Virginia	87	$74.06	$58.30	1
Puerto Rico	58	$88.69	$66.79	2

Related codes

90837Psychotherapy$127.42
90834Psychotherapy$88.04
90832Psychotherapy$65.95
90833Psychotherapy$64.86
90868Treatment using magnetic field to stimulate nerve cells in brain, subs$183.83
90853Group psychotherapy$23.01
90870Therapy using electrical currents$103.73
90838Psychotherapy$113.05
90847Family psychotherapy$92.01
90839Psychotherapy for crisis$113.12
90846Family psychotherapy without patient$83.43
90867Treatment using magnetic field to stimulate nerve cells in brain, init$285.49

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.