New York Mental Health Reimbursement Rates for Therapists: The Definitive 2026 Guide

If you're a therapist, LCSW, LPC, LMFT, or psychiatrist practicing in New York, you already know that getting paid what you're owed is half the battle. The other half? Knowing what you're supposed to be paid in the first place.

Reimbursement rates in New York shifted meaningfully heading into 2026, with CMS finalizing its Physician Fee Schedule updates, New York Medicaid continuing its managed care restructuring, and major commercial payers adjusting their fee schedules in response. If you're still operating on 2024 assumptions, you may be leaving real money on the table — or worse, getting underpaid without realizing it.

This guide breaks down what you need to know: Medicare rates, New York Medicaid rates, commercial payer benchmarks, the CPT codes that matter most, and exactly what documentation you need to protect every dollar you bill.

Why 2026 Is a Critical Year for NY Therapist Reimbursement

A few converging factors make 2026 especially important for New York behavioral health providers:

1. CMS Conversion Factor Adjustment After years of cuts, advocacy from the AMA and mental health professional organizations pushed for stabilization of the Medicare conversion factor. The 2026 Physician Fee Schedule reflects modest adjustments to work RVUs for key psychotherapy codes, meaning a slight uptick in Medicare rates for many outpatient behavioral health visits.

2. New York Medicaid Managed Care Carve-In New York has been transitioning behavioral health services into managed care for Medicaid recipients. By 2026, virtually all outpatient mental health services for Medicaid enrollees in NYC and surrounding counties are processed through managed care organizations (MCOs) like Healthfirst, MetroPlus, and Molina — not fee-for-service Medicaid directly. This changes how you contract, credential, and get paid.

3. Mental Health Parity Enforcement Ramp-Up The federal Mental Health Parity and Addiction Equity Act (MHPAEA) enforcement has intensified. New York's Department of Financial Services (DFS) is actively auditing commercial insurers, which means some payers are quietly improving their behavioral health reimbursement to avoid scrutiny. Now is a good time to renegotiate contracts.

4. Telehealth Permanence New York permanently extended telehealth parity for mental health services. Audio-only and video-based therapy now reimburse at the same rate as in-person for most payers — but only if billed with the correct modifiers.

2026 Medicare Reimbursement Rates in New York (Outpatient Mental Health)

Medicare rates are set nationally and then adjusted by geographic locality. New York has several locality codes — NYC (locality 01) tends to have higher rates than upstate New York (localities 14, 18, etc.) due to the Geographic Practice Cost Index (GPCI).

Below are approximate 2026 Medicare reimbursement rates for New York City (Locality 01). These are non-facility rates (i.e., private practice or outpatient clinic billed on a CMS-1500).

| CPT Code | Service Description | Approx. 2026 NYC Rate | |----------|--------------------|-----------------------| | 90837 | Individual psychotherapy, 60 min | $136 – $142 | | 90834 | Individual psychotherapy, 45 min | $103 – $108 | | 90832 | Individual psychotherapy, 30 min | $69 – $73 | | 90847 | Family therapy with patient, 50 min | $108 – $114 | | 90846 | Family therapy without patient, 50 min | $105 – $111 | | 90853 | Group psychotherapy | $35 – $38 | | 90791 | Psychiatric diagnostic evaluation | $165 – $172 | | 90792 | Psych diagnostic eval with medical services | $185 – $196 | | 99213 + 90833 | E/M + psychotherapy add-on, 30 min | $155 – $168 | | 99214 + 90833 | E/M + psychotherapy add-on, 30 min | $195 – $210 | | 96130 | Psychological testing eval, first hour | $178 – $188 |

Note: These figures are estimates based on 2025 final rule data and projected 2026 conversion factor adjustments. Always verify rates against the CMS Medicare Physician Fee Schedule Lookup Tool before submitting claims.

Telehealth modifiers for Medicare: Use Place of Service (POS) 02 for video visits billed to Medicare. For audio-only, POS 02 with modifier 93. Failure to use the correct POS can result in claim denial or incorrect reimbursement.

New York Medicaid (OMH) Reimbursement Rates 2026

New York's Office of Mental Health (OMH) sets rates for licensed outpatient mental health programs (Article 31 clinics) under the Medicaid program. If you're a solo practitioner billing Medicaid directly (not through an MCO), you're likely billing under the OMH outpatient fee schedule.

For 2026, New York Medicaid outpatient mental health rates (fee-for-service, non-clinic) include:

| CPT Code | Service | Approx. NY Medicaid Rate | |----------|---------|---------------------------| | 90837 | Individual therapy, 60 min | $88 – $95 | | 90834 | Individual therapy, 45 min | $72 – $78 | | 90832 | Individual therapy, 30 min | $48 – $54 | | 90847 | Family therapy with patient | $82 – $89 | | 90791 | Psychiatric diagnostic eval | $120 – $130 | | 90853 | Group therapy | $28 – $32 |

Important Medicaid caveat for NYC providers: If your patients are enrolled in a Medicaid Managed Care plan (Healthfirst, MetroPlus, Fidelis, Molina, WellCare, etc.), your rates are governed by your contract with the MCO, not the state fee-for-service schedule. MCO rates vary significantly — some pay at or near Medicare, others pay 15–25% below. Review every MCO contract carefully.

Article 31 Clinics: If you practice within an OMH-licensed Article 31 clinic, reimbursement shifts to the Clinic Treatment Program (CTP) rate structure, which bundles services differently. These clinics typically receive higher per-visit rates but have stricter documentation and supervision requirements.

Commercial Payer Benchmarks: What NY Therapists Are Getting Paid in 2026

Commercial rates are negotiated, not published — but benchmarking matters. Here's what we're seeing across major payers in New York for outpatient behavioral health in 2026:

| Payer | 90837 (60 min) | 90791 (Intake) | Notes | |-------|----------------|----------------|-------| | UnitedHealthcare | $115 – $145 | $160 – $185 | Varies heavily by network tier | | Aetna | $120 – $150 | $165 – $190 | LCSW/LPC rates lower than PhD/MD | | Cigna | $110 – $140 | $155 – $180 | Telehealth parity confirmed | | Emblem Health (GHI/HIP) | $105 – $130 | $150 – $170 | Common in NYC; slow to update rates | | Empire BlueCross BlueShield | $118 – $148 | $162 – $188 | Rates differ by downstate vs. upstate | | Oscar Health | $100 – $125 | $140 – $165 | Growing ACA marketplace presence in NY | | Healthfirst (Medicaid MCO) | $88 – $100 | $118 – $130 | Medicaid MCO; near state fee schedule | | Oxford Health (UHC subsidiary) | $118 – $145 | $162 – $185 | Large NY employer plan presence |

Pro tip: If you haven't renegotiated your commercial contracts in the last two years, contact your payer relations representative directly. Parity enforcement pressure means some payers are more open to rate increases than they were in 2022–2023.

Credential Type Matters: How Your License Affects Your Rate

In New York, reimbursement rates are not equal across license types — even for the same CPT code.

Psychiatrists (MD/DO): Generally highest rates, especially for 90792, medication management (99213/99214), and add-on psychotherapy codes.
Psychologists (PhD/PsyD): Typically reimburse at 85–100% of psychiatrist rates for therapy codes. Medicare reimburses psychologists at 100% of the physician fee schedule for mental health services.
LCSWs: Medicare covers LCSWs at 75% of the physician fee schedule. Many commercial payers pay LCSWs at or near psychologist rates, but some still have a credential-based tier.
LPCs and LMFTs: Medicare does not currently cover LPCs or LMFTs independently (though federal legislation to change this has been repeatedly introduced). New York Medicaid and most commercial payers do cover LPCs and LMFTs — check your contracts for credential-specific rates.

This distinction has major billing implications. If you're an LCSW billing Medicare 90837, your rate is approximately $102–$107 in NYC — about 25% less than a psychologist or psychiatrist billing the same code.

The Documentation-Reimbursement Connection

Here's something most billing guides won't tell you plainly: your documentation directly determines whether you get paid, how much, and whether you survive an audit.

In New York, both Medicaid and commercial payers are increasing post-payment audits of behavioral health claims. Common triggers include:

Billing 90837 (60-min therapy) without documentation showing 53+ minutes of face-to-face time
Missing or vague treatment plan goals that don't support medical necessity
Inconsistent session notes that don't match the billed CPT code duration
Group therapy notes (90853) that fail to document the number of participants and group process
Intake evaluations (90791) that lack a DSM-5 diagnosis, risk assessment, and treatment plan

New York Medicaid, in particular, has clawed back significant dollars from providers whose documentation didn't support the billed service — even when the service was legitimately provided.

This is where platforms like Mozu Health change the equation. AI-assisted documentation that's built around behavioral health billing standards — not generic medical documentation — means your notes are structured to support the CPT code from the moment you start writing.

Telehealth Billing in New York: 2026 Updates

New York's telehealth parity law (amended in 2023 and confirmed through 2026) requires commercial insurers to reimburse telehealth mental health services at the same rate as in-person services. Key billing rules:

Modifier GT or 95: Use modifier 95 for synchronous audio-video telehealth. Modifier GT is largely deprecated but still accepted by some legacy payers.
POS 10 vs. POS 02: POS 10 (patient's home) is now standard for telehealth when the patient is at home. POS 02 is used when the patient is at another telehealth originating site.
Audio-only: New York Medicaid permits audio-only for mental health when video is unavailable. Bill with POS 02 and modifier 93. Medicare also allows audio-only with modifier 93 through the end of 2026 under extended telehealth flexibilities.
Out-of-state patients: Be careful — if your patient is physically located in New Jersey or Connecticut during a telehealth session, New York law doesn't apply. You need licensure in the patient's state.

5 Billing Mistakes That Cost NY Therapists Money in 2026

Billing 90837 when you delivered 45 minutes — Medicare and most payers require 53+ minutes for 90837. If your session ran 48 minutes, bill 90834. Overbilling by code is an audit risk.
Forgetting the add-on code for E/M + therapy — Psychiatrists doing both a med check and psychotherapy in the same session should bill 99213/99214 + 90833 (add-on). Billing only 90837 leaves money on the table.
Not updating your NPI taxonomy code — If your specialty taxonomy doesn't match your billing code set, you'll hit claim denials with Medicaid MCOs.
Missing the authorization for ongoing sessions — Several NYC-area managed care plans require authorization after session 8–12. Billing without auth = denied claim + potential clawback.
Using the wrong modifiers for telehealth — POS code errors are one of the most common reasons telehealth claims are reprocessed at the wrong rate.

FAQ: New York Mental Health Reimbursement 2026

Q1: What is the 2026 Medicare rate for a 60-minute therapy session (90837) in New York City? The approximate non-facility rate for CPT 90837 in NYC locality for 2026 is $136–$142 for psychologists and psychiatrists. LCSWs receive 75% of this rate, approximately $102–$107. Always confirm using the CMS MPFS Look-Up Tool with the applicable locality code.

Q2: Can LPCs and LMFTs bill Medicare in New York in 2026? Not independently — Medicare does not currently recognize LPCs or LMFTs as independently billing providers. LPCs and LMFTs can provide services incident-to a supervising physician or through certain Medicare Advantage plans that have broader coverage. Federal legislation (the Mental Health Access Improvement Act) has been reintroduced but not yet passed as of early 2026.

Q3: How do I find out what a specific commercial payer is paying me versus what they should be paying? Request your current fee schedule in writing from every payer you're contracted with. Compare it to your Medicare rate. Most commercial payers set rates as a percentage of Medicare — if a payer is paying below 80% of Medicare for behavioral health codes while paying 110% for surgical codes, that's a parity issue worth raising with the payer or reporting to the NY Department of Financial Services.

Q4: My Medicaid patient is enrolled in Healthfirst. Do I bill Medicaid or Healthfirst? Bill Healthfirst directly as a managed care organization. You should have a separate contract with Healthfirst. Do not bill New York Medicaid fee-for-service for managed care enrollees — the claim will deny. If you're not contracted with the MCO, the patient may still have out-of-network emergency access, but for routine outpatient therapy you need to be in-network.

Q5: What documentation do I need to support a 90791 (psychiatric diagnostic evaluation) claim in New York? Your intake note must include: presenting problem and history of present illness, psychiatric history, medical and medication history, substance use history, family and social history, mental status examination, DSM-5 diagnosis with specifiers, risk assessment (suicidality, homicidality, self-harm), and a documented treatment plan or referral plan. Without all of these elements, the note doesn't support the code — and in an audit, that means a potential clawback.

Q6: Does New York require telehealth parity for out-of-network providers in 2026? Yes. New York's telehealth law extends parity obligations to out-of-network reimbursement as well. If your patient has out-of-network benefits, the payer cannot reimburse your telehealth session at a lower rate solely because it was delivered via telehealth.

The Bottom Line for NY Therapists in 2026

New York's reimbursement landscape is genuinely complex — more so than most states, because you're navigating Medicare, a large Medicaid managed care ecosystem, aggressive commercial payers, and some of the highest cost-of-practice environments in the country.

The therapists and practices that get paid accurately and consistently in 2026 share a few things in common: they know their rates, they document to support their codes, and they have systems that catch errors before claims go out the door.

Take Control of Your Billing and Documentation with Mozu Health

Mozu Health is an AI-powered clinical documentation platform built specifically for behavioral health providers. Whether you're a solo LCSW in Brooklyn, a psychiatrist in Albany, or running a group practice with 20 clinicians, Mozu Health helps you:

Generate HIPAA-compliant progress notes that are structured to support your billed CPT codes
Catch documentation gaps before they become audit risks
Stay current with payer-specific requirements for New York Medicaid MCOs and commercial insurers
Reduce documentation time so you can see more patients — or actually leave the office on time

Don't let poor documentation or billing uncertainty cost you thousands in underpayments or clawbacks this year.

Start your free trial at mozuhealth.com →

Your notes. Your rates. Protected.

New York Mental Health Reimbursement Rates 2026: Full Guide