Behavioral Health Rate Intelligence

Know what payers pay —
before you negotiate

Benchmark negotiated rates for mental health, SUD, and ABA services across all 50 states, 300+ health plans, and 8 credential types. Built on CMS Transparency in Coverage data.

50 States
300+ Health Plans
23 CPT & HCPCS Codes
8 Credential Types
⚠  Prescriber-only codes: E/M codes (99213–99215) and 90792 are billed by MD/DO & PMHNP only. Other credentials show N/A for these codes.
ⓘ  ABA codes (97151, 97153, 97155, 97156) apply to BCBA credential only and are billed in 15-minute units. Rates shown are per unit. ABA fee schedules are negotiated separately — treat as estimates.
ⓘ  H0001 & H0004 are HCPCS Level II codes (not CPT). Commercial payer coverage varies significantly. H0004 is billed per 15-min unit. CADC/LADC panel acceptance also varies by plan.
Code Description Category Health Plan Credential Est. Rate
Select a state, code, or credential to view estimated rates

Click any state to filter all views to that market.

Payer comparison for selected code & credential (defaults to 90837 / PhD/PsyD). Select a state to see state-specific plans.

Rate comparison across all credential types for the selected code and state.

Methodology
How rates are estimated

Anchor Rate

Each plan's anchor rate for CPT 90837 (Psychotherapy 60 min, PhD/PsyD) is sourced from CMS Transparency in Coverage machine-readable files — the actual negotiated rates payers are legally required to publish.

Relative Value

Each CPT/HCPCS code carries a relative value benchmarked against 90837. Medicare-covered codes use CMS RVU ratios. HCPCS H-codes (no Medicare reference) use commercial market averages from published MRF data.

Geographic Adjustment

Rates are adjusted by CMS Geographic Practice Cost Index (GPCI) per state, reflecting regional differences in cost of living, malpractice premiums, and practice expenses across all 50 markets.

Credential Factor

Each credential type commands a different rate multiplier relative to PhD/PsyD anchor. MD/DO typically bills at 104–105%; master's-level clinicians at 79–85%; BCBA at parity. Factors are derived from MRF benchmarks.

Data Sources
CMS Transparency in Coverage MRFs Medicare Physician Fee Schedule (MPFS) CMS Geographic Practice Cost Index Sapphire MRF Hub (BCBS plans) Commercial ABA market benchmarks