Current fee-for-service (FFS) rates published by Iowa Dept of Health and Human Services — Iowa Medicaid for behavioral health codes. ABA therapy and psychotherapy codes, plus the E/M codes CMS requires in the Medicaid-vs-Medicare comparative analysis for outpatient mental health/SUD.
FFS benchmark rates only — managed care organization (MCO) contract rates may differ. Not legal or compliance advice.
| Code | Description | Variant | Rate | Effective | Status |
|---|---|---|---|---|---|
| 97153 | Adaptive behavior treatment delivered one-on-one by a technician, per 15 minutes. | HN | $17.16 / 15 min | 2024-07-01 | Auto-extracted |
| HO | $28.59 / 15 min | 2024-07-01 | Auto-extracted | ||
| HP | $28.59 / 15 min | 2024-07-01 | Auto-extracted | ||
| HN FC9 | $17.16 / 15 min | 2024-07-01 | Auto-extracted | ||
| HO FC9 | $28.59 / 15 min | 2024-07-01 | Auto-extracted | ||
| HP FC9 | $28.59 / 15 min | 2024-07-01 | Auto-extracted | ||
| 90791 | Initial psychiatric diagnostic evaluation without medical services. | HO | $149.71 / encounter | 2023-07-01 | Auto-extracted |
| U1 | $149.71 / encounter | 2023-07-01 | Auto-extracted | ||
| U2 | $149.71 / encounter | 2023-07-01 | Auto-extracted | ||
| U3 | $149.71 / encounter | 2023-07-01 | Auto-extracted | ||
| SA | $159.08 / encounter | 2023-07-01 | Auto-extracted | ||
| HP | $168.42 / encounter | 2023-07-01 | Auto-extracted | ||
| AF | $187.13 / encounter | 2023-07-01 | Auto-extracted | ||
| HO FCX | $149.71 / encounter | 2023-07-01 | Auto-extracted | ||
| U1 FCX | $149.71 / encounter | 2023-07-01 | Auto-extracted | ||
| U2 FCX | $149.71 / encounter | 2023-07-01 | Auto-extracted | ||
| U3 FCX | $149.71 / encounter | 2023-07-01 | Auto-extracted | ||
| SA FCX | $159.08 / encounter | 2023-07-01 | Auto-extracted | ||
| HP FCX | $168.42 / encounter | 2023-07-01 | Auto-extracted | ||
| AF FCX | $187.13 / encounter | 2023-07-01 | Auto-extracted | ||
| HO FC9 | $159.00 / encounter | 2023-07-01 | Auto-extracted | ||
| U1 FC9 | $159.00 / encounter | 2023-07-01 | Auto-extracted | ||
| U2 FC9 | $159.00 / encounter | 2023-07-01 | Auto-extracted | ||
| U3 FC9 | $159.00 / encounter | 2023-07-01 | Auto-extracted | ||
| SA FC9 | $168.94 / encounter | 2023-07-01 | Auto-extracted | ||
| HP FC9 | $178.87 / encounter | 2023-07-01 | Auto-extracted | ||
| AF FC9 | $198.75 / encounter | 2023-07-01 | Auto-extracted | ||
| 90837 | Individual psychotherapy, approximately 60 minutes. | HO | $114.63 / session (60 min) | 2023-07-01 | Auto-extracted |
| U1 | $114.63 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| U2 | $114.63 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| SA | $121.81 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| HP | $128.98 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| AF | $143.31 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| HO FCX | $114.63 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| U1 FCX | $114.63 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| U2 FCX | $114.63 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| SA FCX | $121.81 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| HP FCX | $128.98 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| AF FCX | $143.31 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| HO FC9 | $118.97 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| U1 FC9 | $118.97 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| U2 FC9 | $118.97 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| SA FC9 | $126.42 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| HP FC9 | $133.86 / session (60 min) | 2023-07-01 | Auto-extracted | ||
| AF FC9 | $148.73 / session (60 min) | 2023-07-01 | Auto-extracted |
Source: Iowa Dept of Health and Human Services — Iowa Medicaid
No. These are fee-for-service (FFS) benchmark rates published directly by Iowa's Medicaid agency. Managed care organizations (MCOs) negotiate their own contract rates separately, and those aren't published publicly — FFS rates are commonly used as a reference point, not a guarantee of what an MCO will pay.
It varies by state and code — some update annually, others quarterly or on an as-needed basis. MedicaidBench checks official sources continuously and logs the effective date and source document for every rate change.
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