CMS finalized higher reimbursement rates for the majority of psychological services in 2026. If you bill Medicare, that should translate directly into more revenue per session.
It won't, if your documentation is vague.
What the Rates Actually Are
The 2026 Medicare national average for CPT 90834 — the 45-minute individual psychotherapy code — is approximately $134.25 in non-facility settings. Practices in high-cost metros like New York or Los Angeles may see $155 or higher.
For context: commercial payers typically reimburse at 130–250% of Medicare rates depending on your contract. A Medicare rate increase compounds across your entire payer mix.
Which Codes Went Up — and Which Went Down
Most behavioral health codes saw increases. But four codes actually went in the wrong direction: 96132, 96112, 96170, and 96171. These are neuropsychological and psychological testing administration codes. The decreases came from CMS's Practice Expense methodology — a recalculation of overhead costs. If you bill any of these codes, pull your current fee schedule and compare it against 2025.
Why Clean Documentation Determines Whether You Capture the Increase
Medicare time-based codes are billed based on time spent with the patient. To bill them correctly, your documentation needs to include: the exact start and stop time of the session, the specific interventions used (not just "supportive therapy" — the actual techniques), the patient's mental status, and documented progress toward treatment goals linked to ICD-10 diagnosis codes.
"Patient presented in good spirits. Therapy continued." doesn't support a 90837. It won't survive an audit.
The Audit Risk Is Real
Medicare has increased behavioral health claim scrutiny. Zone Program Integrity Contractors specifically target high-volume therapy providers. Vague progress notes are one of the most common audit findings.
Billing a higher-rate code you can't document is worse than billing a lower-rate code you can. The higher the code, the more specific the documentation requirement.
What to Fix Before Your Next Claim
Look at your current progress note template. Does it have a field for start and stop time? Does it prompt you to document specific interventions by name? Does it connect the session to the patient's treatment goals and diagnosis?
Those are three additions. One hour of work on your template protects every Medicare claim you file going forward.
The rate went up. Make sure you're actually collecting it.
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