Medicare Reimbursement for Therapy by State [2022]

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 2022 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 AreaCPT Code 90791 Reimbursement Rate 2022Reimbursement Compared to National Rate
NATIONALNATIONAL$195.46100.00%
CA - CaliforniaSANTA CLARA (SANTA CLARA COUNTY)$224.26114.73%
CA - CaliforniaSAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO COUNTY)$225.09115.16%
CA - CaliforniaSAN FRANCISCO (SAN FRANCISCO COUNTY)$219.23112.16%
CA - CaliforniaSAN MATEO (SAN MATEO COUNTY)$219.23112.16%
CA - CaliforniaOAKLAND-BERKLEY (ALAMEDA AND CONTRA COSTA)$219.23112.16%
CA - CaliforniaSAN FRANCISCO-OAKLAND-HAYWARD (MARIN COUNTY)$219.44112.27%
CA - CaliforniaSALINAS (MONTEREY COUNTY)$209.01106.93%
CA - CaliforniaNAPA$209.67107.27%
CA - CaliforniaVALLEJO-FAIRFIELD (SOLANO COUNTY)$209.67107.27%
CA - CaliforniaSANTA CRUZ-WATSONVILLE$209.55107.21%
CA - CaliforniaSANTA ROSA (SONOMA COUNTY)$208.27106.55%
CA - CaliforniaRIVERSIDE-SAN BERNARDINO-ONTARIO (SAN BERNARDINO AND RIVERSIDE COUNTY)$202.15103.42%
CA - CaliforniaBAKERSFIELD (KERN COUNTY)$202.42103.56%
CA - CaliforniaSACRAMENTO-ROSEVILLE-ARDEN-ARCADE (SACRAMENTO, PLACER, YOLO, EL DORADO)$202.86103.79%
CA - CaliforniaCHICO (BUTTE COUNTY)$200.53102.59%
CA - CaliforniaFRESNO$200.53102.59%
CA - CaliforniaHANFORD-CORCORAN (KINGS COUNTY)$200.53102.59%
CA - CaliforniaMADERA$200.53102.59%
CA - CaliforniaMERCED$200.53102.59%
CA - CaliforniaMODESTO (STANISLAUS COUNTY)$200.53102.59%
CA - CaliforniaREDDING (SHASTA COUNTY)$200.53102.59%
CA - CaliforniaSTOCKTON-LODI (SAN JOAQUIN COUNTY)$200.53102.59%
CA - CaliforniaVISALIA-PORTERVILLE (TULARE COUNTY)$200.53102.59%
CA - CaliforniaYUBA CITY (SUTTER, YUBA)$200.53102.59%
CA - CaliforniaCALIFORNIA (ALL OTHER COUNTIES)$200.53102.59%
CA - CaliforniaLOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES COUNTY)$209.34107.10%
CA - CaliforniaLONG BEACH-ANAHEIM (ORANGE COUNTY)$209.34107.10%
CA - CaliforniaOXNARD-THOUSAND OAKS-VENTURA$206.33105.56%
CA - CaliforniaSANTA MARIA-SANTA BARBARA$207.59106.21%
CA - CaliforniaSAN DIEGO-CARLSBAD$206.43105.61%
CA - CaliforniaSAN LUIS OBISPO-PASO ROBLES-ARROYO GRANDE$201.63103.16%
CA - CaliforniaEL CENTRO (IMPERIAL COUNTY)$200.63102.65%
HI - HawaiiHAWAII, GUAM, AMERICAN SAMOA, MARSHALL ISLANDS, PALAU, NORTHERN MARIANA ISLANDS, FEDERATED STATES OF MICRONESIA$201.98103.34%
NV - NevadaSTATEWIDE$197.78101.19%
AK - AlaskaSTATEWIDE$271.70139.01%
ID - IdahoSTATEWIDE$187.1995.77%
OR - OregonPORTLAND (CLACKAMAS, MULTNOMAH AND WASHINGTON)$199.43102.03%
OR - OregonREST OF STATE$190.9397.68%
WA - WashingtonWASHINGTON SEATTLE (KING COUNTY)$208.55106.70%
WA - WashingtonREST OF STATE$194.9499.73%
AZ - ArizonaSTATEWIDE$192.5798.52%
MT - MontanaSTATEWIDE$195.3699.95%
ND - North DakotaSTATEWIDE$192.8898.68%
SD - South DakotaSTATEWIDE$192.5098.49%
UT - UtahSTATEWIDE$190.8597.64%
WY - WyomingSTATEWIDE$194.7499.63%
CO - ColoradoSTATEWIDE$196.70100.63%
NM - New MexicoSTATEWIDE$191.4697.95%
OK - OklahomaSTATEWIDE$189.0396.71%
TX - TexasHOUSTON$200.98102.82%
TX - TexasGALVESTON (TARRANT COUNTY)$199.26101.94%
TX - TexasBRAZORIA$199.12101.87%
TX - TexasDALLAS$197.93101.26%
TX - TexasFORT WORTH (TARRANT COUNTY)$195.47100.01%
TX - TexasAUSTIN (TRAVIS COUNTY)$196.07100.31%
TX - TexasREST OF STATE$191.5297.98%
TX - TexasBEAUMONT (JEFFERSON COUNTY)$190.8697.65%
IA - IowaSTATEWIDE$188.6096.49%
KS - KansasSTATEWIDE$188.8096.59%
MO - MissouriMETROPOLITAN ST. LOUIS (JEFFERSON, ST. CHARLES, ST. LOUIS AND ST. LOUIS CITY)$193.8699.18%
MO - MissouriMETROPOLITAN KANSAS CITY (CLAY, JACKSON AND PLATTE)$192.9198.70%
MO - MissouriREST OF STATE$187.9196.14%
NE - NebraskaSTATEWIDE$187.7896.07%
IL - IllinoisCHICAGO (COOK COUNTY)$203.03103.87%
IL - IllinoisSUBURBAN CHICAGO (DUPAGE, KANE, LAKE AND WILL)$201.46103.07%
IL - IllinoisEAST ST. LOUIS (BOND, CALHOUN, CLINTON, JERSEY, MACOUPIN, MADISON, MONROE, MONTGOMERY, RANDOLPH, ST. CLAIR AND WASHINGTON)$195.81100.18%
IL - IllinoisREST OF STATE$192.2698.36%
MN - MinnesotaSTATEWIDE$193.1298.80%
WI - WisconsinSTATEWIDE$189.6297.01%
AR - ArkansasSTATEWIDE$186.0495.18%
LA - LouisianaNEW ORLEANS (JEFFERSON, ORLEANS, PLAQUEMINES AND ST. BERNARD)$194.5299.52%
LA - LouisianaREST OF STATE$191.0097.72%
MS - MississippiSTATEWIDE$186.7495.54%
IN - IndianaSTATEWIDE$188.4696.42%
MI - MichiganDETROIT (MACOMB, OAKLAND, WASHTENAW AND WAYNE)$198.15101.38%
MI - MichiganREST OF STATE$191.3097.87%
FL - FloridaMIAMI (DADE AND MONROE COUNTY)$203.91104.32%
FL - FloridaFORT LAUDERDALE (BROWARD, COLLIER, INDIAN RIVER, LEE, MARTIN, PALM BEACH, AND ST. LUCIE)$199.41102.02%
FL - FloridaREST OF STATE$194.6599.59%
PR - Puerto RicoPUERTO RICO$195.77100.16%
VI - Virgin IslandsVIRGIN ISLANDS$195.77100.16%
AL - AlabamaSTATEWIDE$189.9897.20%
GA - GeorgiaATLANTA (BUTTS, CHEROKEE, CLAYTON, COBB, DEKALB, DOUGLAS, FAYETTE, FORSYTH, FULTON, GWINNETT, NEWTON, ROCKDALE AND WALTON)$194.9499.73%
GA - GeorgiaREST OF STATE$189.4596.93%
TN - TennesseeSTATEWIDE$188.2296.30%
SC - South CarolinaSTATEWIDE$189.6497.02%
VA - VirginiaSTATEWIDE$194.7799.65%
WV - West VirginiaSTATEWIDE$189.8797.14%
NC - North CarolinaSTATEWIDE$191.3597.90%
DE - DelawareSTATEWIDE$196.87100.72%
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)$215.43110.22%
MD - MarylandBALTIMORE/SURROUNDING COUNTIES$205.34105.05%
MD - MarylandREST OF STATE$199.07101.85%
NJ - New JerseyNORTHERN NEW JERSEY (BERGEN, ESSEX, HUDSON, HUNTERDON, MIDDLESEX, MORRIS, PASSAIC, SOMERSET, SUSSEX, UNION AND WARREN)$211.50108.21%
NJ - New JerseyREST OF STATE$207.10105.96%
PA - PennsylvaniaMETROPOLITAN PHILADELPHIA (BUCKS, CHESTER, DELAWARE, MONTGOMERY AND PHILADELPHIA)$203.36104.04%
PA - PennsylvaniaREST OF STATE$192.1798.32%
CT - ConnecticutSTATEWIDE$205.75105.26%
NY - New YorkNYC SUBURBS/LONG ISLAND (BRONX, KINGS, NASSAU, RICHMOND, ROCKLAND, SUFFOLK AND WESTCHESTER)$220.07112.59%
NY - New YorkMANHATTAN$217.56111.31%
NY - New YorkPOUGHKPSIE/N NYC SUBURBS (COLUMBIA, DELAWARE, DUTCHESS, GREENE, ORANGE, PUTNAM, SULLIVAN AND ULSTER)$207.12105.97%
NY - New YorkREST OF STATE$192.2898.37%
NY - New YorkQUEENS$221.56113.35%
ME - MaineSOUTHERN MAINE (CUMBERLAND AND YORK COUNTY)$193.7599.13%
ME - MaineREST OF STATE$189.2296.81%
MA - MassachusettsMETROPOLITAN BOSTON (MIDDLESEX, NORFOLK AND SUFFOLK)$211.15108.03%
MA - MassachusettsREST OF STATE$201.31102.99%
NH - New HampshireSTATEWIDE$196.83100.70%
RI - Rhode IslandSTATEWIDE$200.62102.64%
VT - VermontSTATEWIDE$193.5599.02%
KY - KentuckySTATEWIDE$188.6996.54%
OH - OhioSTATEWIDE$191.9198.18%

(Source)

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