How much does Medicare pay for CPT 90869?

Medicare allowed an average of $242.82 per service and paid $192.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $1042.73, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 90869 pay differently in an office than a hospital?

Yes. The allowed amount averaged $248.09 in an office setting and $96.59 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 90869 most?

Psychiatry, with 2,179 services from 63 clinicians. Next are Physician Assistant, Nurse Practitioner, Geriatric Psychiatry.

CPT 90869

Treatment using magnetic field to stimulate nerve cells in brain, subsequent motor threshold redetermination with delivery and management

$242.82Medicare-allowed amount per service, averaged across 2,273 services

Providers submitted

$1042.73

Asking price, not received

Medicare allowed

$242.82

The fee schedule figure

Medicare paid

$192.59

Balance is patient coinsurance

Providers submitted an average of $1042.73 for this code and Medicare allowed $242.82 — 4.3× 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 $192.59 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $248.09
Hospital / facility: $96.59

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. 2,194 services were billed in an office setting and 79 in a facility.

Services: 2,273
Beneficiaries: 1,368
Providers billing it: 68
Total allowed: $551,930

What Medicare pays for CPT 90869

Across 2,273 services billed by 68 providers to 1,368 beneficiaries, Medicare allowed an average of $242.82 per service. That is 1.7 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 90869

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychiatry	2,179	1,304	$244.69	63
Physician Assistant	34	22	$173.06	2
Nurse Practitioner	22	14	$168.97	1
Geriatric Psychiatry	19	17	$277.96	1
Internal Medicine	19	11	$203.78	1

90869 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
Florida	538	$271.07	$213.41	16
California	350	$212.08	$168.00	10
Washington	336	$200.27	$161.97	4
New York	175	$314.21	$250.27	7
Nebraska	160	$128.17	$112.00	1
Alabama	80	$385.01	$331.06	1
Illinois	76	$306.72	$252.15	2
Oregon	75	$179.64	$141.33	4
Maryland	70	$264.69	$222.92	4
Iowa	57	$89.81	$71.56	2
New Hampshire	53	$314.28	$246.80	1
Colorado	42	$256.00	$203.97	3
Minnesota	38	$314.21	$250.35	1
Kentucky	32	$169.14	$138.83	1
New Jersey	26	$253.68	$222.63	2
Georgia	25	$336.31	$317.13	1
Texas	24	$242.58	$208.59	1
Connecticut	21	$314.21	$250.35	1
Massachusetts	19	$314.23	$249.58	1
Pennsylvania	19	$277.96	$219.44	1
New Mexico	16	$258.79	$206.19	1
Wisconsin	15	$298.50	$237.83	1
Ohio	14	$299.47	$237.84	1
Indiana	12	$133.95	$115.84	1

Related codes

90837Psychotherapy$127.42
90834Psychotherapy$88.04
90832Psychotherapy$65.95
90833Psychotherapy$64.86
90836Psychotherapy$88.70
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

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.