I first reported about mental health fees in 2013, and then again last year. The following update is based on all charges submitted to Medicare for these services in 2021 by psychiatrists, psychologists and social workers. In theory, charges to patients who have Medicare are likely to be the same as or very similar to charges to patients who have other insurance, or no insurance. In practice, charges may differ depending on individual patient circumstances and clinician/facility policy such as discounts, sliding scales, or full fee “cash prices.” Of course Medicare, and most insurance, will actually reimburse less than these billed amounts. Neverthless, charges submitted to Medicare likely provide a reasonable estimate of current fees, because these occur in a large population (62.6 million in 2021) and for very large numbers of services.
Average Submitted Charges By Specialty*
| Initial Evaluation | 20-30 min. Therapy | 45-50 min. Therapy | 60 min. Therapy | |
| Psychiatrist | $282.51 | $113.31 | $162.46 | $216.07 |
| Psychologist | $281.73 | $136.17 | $176.82 | $212.02 |
| Social Worker | $249.36 | $115.23 | $157.73 | $187.21 |
Prices increased from 2020 to 2021 for all of these services across all mental health specialties. Increases ranged from 0.6% for a 30 minute therapy session with a psychiatrist, up to 5.6% for an initial evaluation by a social worker and a 30 minute therapy session with a psychologist.
Change in Price for Services 2020-2021
| Service | ||||
| Initial Evaluation | 20-30 min. Therapy | 45-50 min. Therapy | 60 min. Therapy | |
| Psychiatrist | 5.0% | 0.6% | 1.8% | 2.4% |
| Psychologist | 5.4% | 5.6% | 3.8% | 3.5% |
| Social Worker | 5.6% | 4.7% | 3.9% | 3.7% |
Therapy costs (charges) vary by geographic location. For example, here are psychologists’ average charges by state in 2021. Values represent 5,404 psychologists billing 343,807 initial evaluations, 2,750 billing 842,954 30 minute sessions, 4,959 billing 1,255,449 45 minute sessions, and 5,393 billing 1,481,737 60 minute sessions.
| Psychologists’ Average Charges By State and Service | ||||
| State |
Initial Evaluation |
30 min. Therapy | 45 min. Therapy |
60 min. Therapy |
| AE | $250.00 | $200.00 | ||
| AK | $450.00 | $205.66 | $260.95 | $307.22 |
| AL | $240.12 | $135.99 | $159.84 | $202.50 |
| AR | $268.11 | $103.00 | $145.69 | $207.87 |
| AZ | $268.56 | $127.71 | $156.76 | $198.02 |
| CA | $285.50 | $142.93 | $189.63 | $212.61 |
| CO | $274.64 | $138.16 | $164.25 | $188.15 |
| CT | $296.06 | $124.82 | $170.55 | $179.93 |
| DC | $327.20 | $113.57 | $195.07 | $224.30 |
| DE | $218.25 | $104.47 | $138.67 | $169.24 |
| FL | $268.71 | $133.50 | $176.93 | $208.73 |
| GA | $259.59 | $123.43 | $180.42 | $192.96 |
| HI | $270.55 | $166.90 | $190.89 | $245.93 |
| IA | $294.66 | $149.79 | $166.34 | $225.42 |
| ID | $237.71 | $70.00 | $139.21 | $170.28 |
| IL | $303.56 | $142.31 | $177.32 | $230.93 |
| IN | $247.21 | $108.64 | $146.67 | $194.75 |
| KS | $236.30 | $135.59 | $167.44 | $202.52 |
| KY | $284.89 | $138.37 | $174.25 | $213.61 |
| LA | $265.35 | $112.21 | $175.44 | $196.09 |
| MA | $342.33 | $161.35 | $191.02 | $223.78 |
| MD | $251.24 | $108.84 | $147.82 | $186.74 |
| ME | $211.42 | $109.38 | $144.92 | $185.92 |
| MI | $261.44 | $128.96 | $158.58 | $206.87 |
| MN | $345.96 | $174.84 | $221.13 | $259.81 |
| MO | $274.41 | $108.36 | $156.27 | $197.30 |
| MS | $235.52 | $119.90 | $199.48 | $220.14 |
| MT | $242.78 | $144.82 | $189.53 | $201.40 |
| NC | $294.82 | $143.97 | $187.08 | $236.90 |
| ND | $284.07 | $137.05 | $179.34 | $287.10 |
| NE | $302.88 | $124.46 | $179.92 | $225.08 |
| NH | $210.07 | $100.66 | $137.25 | $173.31 |
| NJ | $283.53 | $134.12 | $174.19 | $213.78 |
| NM | $263.36 | $126.20 | $169.57 | $215.75 |
| NV | $266.14 | $137.75 | $184.31 | $209.23 |
| NY | $308.51 | $148.56 | $187.62 | $249.90 |
| OH | $301.21 | $123.00 | $166.38 | $203.54 |
| OK | $224.06 | $96.99 | $143.44 | $166.62 |
| OR | $339.83 | $181.27 | $205.65 | $217.55 |
| PA | $244.33 | $112.00 | $150.47 | $184.02 |
| PR | $231.20 | $105.18 | $134.75 | $174.36 |
| RI | $318.47 | $190.60 | $186.57 | $223.81 |
| SC | $268.88 | $139.92 | $170.18 | $203.03 |
| SD | $226.24 | $98.78 | $133.46 | $183.59 |
| TN | $296.42 | $145.73 | $158.72 | $218.62 |
| TX | $245.92 | $117.49 | $157.08 | $204.59 |
| UT | $253.23 | $133.86 | $151.99 | $187.33 |
| VA | $264.49 | $130.37 | $157.27 | $195.20 |
| VI | $182.65 | $152.23 | ||
| VT | $189.60 | $127.70 | $156.02 | $170.49 |
| WA | $300.43 | $163.57 | $186.41 | $220.88 |
| WI | $379.96 | $175.38 | $243.80 | $285.39 |
| WV | $283.42 | $147.46 | $170.40 | $207.87 |
| WY | $221.85 | $82.39 | $144.00 | $194.10 |
AE = Overseas military address, PR = Puerto Rico, VI = Virgin Islands
Psychologists’ Office Versus Facility Prices 2020-2021
| 2021 | 2020 | |||||||
| Place of Service | Initial Evaluation | 30 min. Therapy | 45 min. Therapy | 60 min. Therapy | Initial Evaluation | 30 min. Therapy | 45 min. Therapy | 60 min. Therapy |
| Facility | $309.35 | $141.80 | $195.52 | $266.68 | $287.94 | $134.85 | $185.00 | $256.95 |
| Office | $272.86 | $133.45 | $173.28 | $207.98 | $260.53 | $126.33 | $167.70 | $201.14 |
| Differential Facility vs. Office | 13.4% | 6.3% | 12.8% | 28.2% | 10.5% | 6.7% | 10.3% | 27.7% |
| Price Change Office 2020-2021 | 4.7% | 5.6% | 3.3% | 3.4% | ||||
| Price Change Facility 2020-2021 | 7.4% | 5.2% | 5.7% | 3.8% |
*The code for a “30 minute session” (90832) technically is for a session of 16-37 minutes, a 45 minute session (90834) is for 38-52 minutes, and a 60 minute session (90837), 53 minutes or more.
Do you have data on use etc., for 96158, 96159, and 96116?
Yes, the data are available in Medicare’s public use files. I have an analysis in progress on testing codes (but it’ll take a little time), hadn’t planned to do that for HBAI codes but clearly of interest.