Medicare Reimbursement for Mental Health Therapy by State [2025]

medicare reimbursement by stateEnjoy learning about the comparative difference in Medicare Reimbursement Rates for Therapy by State.  You’ll learn how Medicare divides each state and territory by locality, what Medicare pays for CPT Code 90791, and which localities pay the most.

The data below represents Medicare 2025 reimbursement rates for a diagnostic interview by a licensed mental health professional.  Reimbursement rates depend on license level, professional vs facility services, and payment modifiers that may or may not apply.

StateFee Schedule AreaReimbursement Compared to National RateCPT Code 90791 Reimbursement Rate [2024]CPT Code 90791 Reimbursement Rate [2025]
NATIONALNATIONAL100.00%$195.46$166.91
CA - CaliforniaSANTA CLARA (SANTA CLARA COUNTY)115.38%$224.26$192.58
CA - CaliforniaSAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO COUNTY)N/a$225.09N/a
CA - CaliforniaSAN FRANCISCO (SAN FRANCISCO COUNTY)N/a$219.23N/a
CA - CaliforniaSAN MATEO (SAN MATEO COUNTY)116.60%$219.23$194.62
CA - CaliforniaOAKLAND-BERKLEY (ALAMEDA AND CONTRA COSTA)110.72%$219.23$184.80
CA - CaliforniaSAN FRANCISCO-OAKLAND-HAYWARD (MARIN COUNTY)115.43%$219.44$192.66
CA - CaliforniaSALINAS (MONTEREY COUNTY)110.62%$209.01$184.63
CA - CaliforniaNAPA102.81%$209.67$171.60
CA - CaliforniaVALLEJO-FAIRFIELD (SOLANO COUNTY)102.38%$209.67$170.89
CA - CaliforniaSANTA CRUZ-WATSONVILLE102.38%$209.55$170.89
CA - CaliforniaSANTA ROSA (SONOMA COUNTY)102.38%$208.27$170.89
CA - CaliforniaRIVERSIDE-SAN BERNARDINO-ONTARIO (SAN BERNARDINO AND RIVERSIDE COUNTY)102.38%$202.15$170.89
CA - CaliforniaBAKERSFIELD (KERN COUNTY)102.38%$202.42$170.89
CA - CaliforniaSACRAMENTO-ROSEVILLE-ARDEN-ARCADE (SACRAMENTO, PLACER, YOLO, EL DORADO)102.38%$202.86$170.89
CA - CaliforniaCHICO (BUTTE COUNTY)102.38%$200.53$170.89
CA - CaliforniaFRESNO103.03%$200.53$171.97
CA - CaliforniaHANFORD-CORCORAN (KINGS COUNTY)105.36%$200.53$175.86
CA - CaliforniaMADERA105.65%$200.53$176.34
CA - CaliforniaMERCED116.87%$200.53$195.07
CA - CaliforniaMODESTO (STANISLAUS COUNTY)105.35%$200.53$175.84
CA - CaliforniaREDDING (SHASTA COUNTY)106.64%$200.53$177.99
CA - CaliforniaSTOCKTON-LODI (SAN JOAQUIN COUNTY)102.38%$200.53$170.89
CA - CaliforniaVISALIA-PORTERVILLE (TULARE COUNTY)102.38%$200.53$170.89
CA - CaliforniaYUBA CITY (SUTTER, YUBA)102.38%$200.53$170.89
CA - CaliforniaCALIFORNIA (ALL OTHER COUNTIES)102.38%$200.53$170.89
CA - CaliforniaLOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES COUNTY)105.58%$209.34$176.23
CA - CaliforniaLONG BEACH-ANAHEIM (ORANGE COUNTY)107.11%$209.34$178.78
CA - CaliforniaOXNARD-THOUSAND OAKS-VENTURAN/a$206.33N/a
CA - CaliforniaSANTA MARIA-SANTA BARBARA102.41%$207.59$170.93
CA - CaliforniaSAN DIEGO-CARLSBAD105.77%$206.43$176.54
CA - CaliforniaSAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE103.31%$201.63$172.43
CA - CaliforniaEL CENTRO (IMPERIAL COUNTY)104.92%$200.63$175.12
HI - HawaiiHAWAII, GUAM, AMERICAN SAMOA, MARSHALL ISLANDS, PALAU, NORTHERN MARIANA ISLANDS, FEDERATED STATES OF MICRONESIA102.67%$201.98$171.37
NV - NevadaSTATEWIDE99.69%$197.78$166.40
AK - AlaskaSTATEWIDE138.33%$271.70$230.89
ID - IdahoSTATEWIDE96.78%$187.19$161.53
OR - OregonPORTLAND (CLACKAMAS, MULTNOMAH AND WASHINGTON)102.80%$199.43$171.58
OR - OregonREST OF STATE98.98%$190.93$165.20
WA - WashingtonWASHINGTON SEATTLE (KING COUNTY)108.12%$208.55$180.46
WA - WashingtonREST OF STATE101.08%$194.94$168.72
AZ - ArizonaSTATEWIDE99.13%$192.57$165.45
MT - MontanaSTATEWIDE99.96%$195.36$166.84
ND - North DakotaSTATEWIDE99.07%$192.88$165.35
SD - South DakotaSTATEWIDE98.80%$192.50$164.91
UT - UtahSTATEWIDE98.28%$190.85$164.04
WY - WyomingSTATEWIDE99.49%$194.74$166.06
CO - ColoradoSTATEWIDE101.51%$196.70$169.43
NM - New MexicoSTATEWIDE98.15%$191.46$163.83
OK - OklahomaSTATEWIDE97.06%$189.03$162.00
TX - TexasHOUSTON100.78%$200.98$168.22
TX - TexasGALVESTON (TARRANT COUNTY)100.74%$199.26$168.15
TX - TexasBRAZORIA100.76%$199.12$168.18
TX - TexasDALLAS101.91%$197.93$170.09
TX - TexasFORT WORTH (TARRANT COUNTY)97.60%$195.47$162.91
TX - TexasAUSTIN (TRAVIS COUNTY)100.58%$196.07$167.88
TX - TexasREST OF STATE100.92%$191.52$168.45
TX - TexasBEAUMONT (JEFFERSON COUNTY)98.57%$190.86$164.52
IA - IowaSTATEWIDE96.89%$188.60$161.72
KS - KansasSTATEWIDE96.88%$188.80$161.71
MO - MissouriMETROPOLITAN ST. LOUIS (JEFFERSON, ST. CHARLES, ST. LOUIS AND ST. LOUIS CITY)98.85%$193.86$164.99
MO - MissouriMETROPOLITAN KANSAS CITY (CLAY, JACKSON AND PLATTE)98.75%$192.91$164.83
MO - MissouriREST OF STATE96.61%$187.91$161.26
NE - NebraskaSTATEWIDE96.69%$187.78$161.38
IL - IllinoisCHICAGO (COOK COUNTY)99.58%$203.03$166.21
IL - IllinoisSUBURBAN CHICAGO (DUPAGE, KANE, LAKE AND WILL)102.73%$201.46$171.47
IL - IllinoisEAST ST. LOUIS (BOND, CALHOUN, CLINTON, JERSEY, MACOUPIN, MADISON, MONROE, MONTGOMERY, RANDOLPH, ST. CLAIR AND WASHINGTON)103.04%$195.81$171.98
IL - IllinoisREST OF STATE98.66%$192.26$164.67
MN - MinnesotaSTATEWIDE99.23%$193.12$165.63
WI - WisconsinSTATEWIDE97.69%$189.62$163.05
AR - ArkansasSTATEWIDE95.75%$186.04$159.82
LA - LouisianaNEW ORLEANS (JEFFERSON, ORLEANS, PLAQUEMINES AND ST. BERNARD)98.77%$194.52$164.85
LA - LouisianaREST OF STATE97.15%$191.00$162.15
MS - MississippiSTATEWIDE96.05%$186.74$160.32
IN - IndianaSTATEWIDE97.15%$188.46$162.16
MI - MichiganDETROIT (MACOMB, OAKLAND, WASHTENAW AND WAYNE)101.28%$198.15$169.05
MI - MichiganREST OF STATE98.23%$191.30$163.96
FL - FloridaMIAMI (DADE AND MONROE COUNTY)101.44%$203.91$169.32
FL - FloridaFORT LAUDERDALE (BROWARD, COLLIER, INDIAN RIVER, LEE, MARTIN, PALM BEACH, AND ST. LUCIE)103.55%$199.41$172.83
FL - FloridaREST OF STATE99.48%$194.65$166.05
PR - Puerto RicoPUERTO RICO100.13%$195.77$167.13
VI - Virgin IslandsVIRGIN ISLANDS100.13%$195.77$167.13
AL - AlabamaSTATEWIDE96.08%$189.98$160.36
GA - GeorgiaATLANTA (BUTTS, CHEROKEE, CLAYTON, COBB, DEKALB, DOUGLAS, FAYETTE, FORSYTH, FULTON, GWINNETT, NEWTON, ROCKDALE AND WALTON)100.17%$194.94$167.20
GA - GeorgiaREST OF STATE97.48%$189.45$162.70
TN - TennesseeSTATEWIDE96.66%$188.22$161.33
SC - South CarolinaSTATEWIDE97.59%$189.64$162.88
VA - VirginiaSTATEWIDE99.29%$194.77$165.73
WV - West VirginiaSTATEWIDE97.38%$189.87$162.54
NC - North CarolinaSTATEWIDE97.60%$191.35$162.90
DE - DelawareSTATEWIDE100.38%$196.87$167.55
DC - Washington, DCDC + MD/VA SUBURBS (DISTRICT OF COLUMBIA; ALEXANDRIA CITY, ARLINGTON, FAIRFAX, FAIRFAX CITY, FALLS CHURCH CITY IN VIRGINIA; MONTGOMERY AND PRINCE GEORGE'S IN MARYLAND)109.11%$215.43$182.11
MD - MarylandBALTIMORE/SURROUNDING COUNTIES103.93%$205.34$173.47
MD - MarylandREST OF STATE101.22%$199.07$168.94
NJ - New JerseyNORTHERN NEW JERSEY (BERGEN, ESSEX, HUDSON, HUNTERDON, MIDDLESEX, MORRIS, PASSAIC, SOMERSET, SUSSEX, UNION AND WARREN)108.89%$211.50$181.75
NJ - New JerseyREST OF STATE105.76%$207.10$176.53
PA - PennsylvaniaMETROPOLITAN PHILADELPHIA (BUCKS, CHESTER, DELAWARE, MONTGOMERY AND PHILADELPHIA)103.38%$203.36$172.55
PA - PennsylvaniaREST OF STATE98.12%$192.17$163.78
CT - ConnecticutSTATEWIDE104.19%$205.75$173.90
NY - New YorkNYC SUBURBS/LONG ISLAND (BRONX, KINGS, NASSAU, RICHMOND, ROCKLAND, SUFFOLK AND WESTCHESTER)110.03%$220.07$183.65
NY - New YorkMANHATTAN111.33%$217.56$185.82
NY - New YorkPOUGHKPSIE/N NYC SUBURBS (COLUMBIA, DELAWARE, DUTCHESS, GREENE, ORANGE, PUTNAM, SULLIVAN AND ULSTER)106.45%$207.12$177.67
NY - New YorkREST OF STATE98.27%$192.28$164.03
NY - New YorkQUEENS110.34%$221.56$184.17
ME - MaineSOUTHERN MAINE (CUMBERLAND AND YORK COUNTY)99.62%$193.75$166.27
ME - MaineREST OF STATE97.26%$189.22$162.34
MA - MassachusettsMETROPOLITAN BOSTON (MIDDLESEX, NORFOLK AND SUFFOLK)107.58%$211.15$179.56
MA - MassachusettsREST OF STATE102.31%$201.31$170.77
NH - New HampshireSTATEWIDE100.61%$196.83$167.92
RI - Rhode IslandSTATEWIDE102.49%$200.62$171.06
VT - VermontSTATEWIDE98.90%$193.55$165.07
KY - KentuckySTATEWIDE96.92%$188.69$161.77
OH - OhioSTATEWIDE97.96%$191.91$163.50

(Source)

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