Current fee-for-service (FFS) rates published by Michigan Dept of Health and Human Services (MDHHS) 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 |
|---|---|---|---|---|---|
| 90791 | Initial psychiatric diagnostic evaluation without medical services. | child · Non-Facility | $128.58 / encounter | — | Auto-extracted |
| child · Facility | $112.14 / encounter | — | Auto-extracted | ||
| adult · Non-Facility | $76.66 / encounter | — | Auto-extracted | ||
| adult · Facility | $66.12 / encounter | — | Auto-extracted | ||
| 90837 | Individual psychotherapy, approximately 60 minutes. | child · Non-Facility | $68.23 / session (60 min) | — | Auto-extracted |
| child · Facility | $60.65 / session (60 min) | — | Auto-extracted | ||
| adult · Non-Facility | $64.48 / session (60 min) | — | Auto-extracted | ||
| adult · Facility | $56.76 / session (60 min) | — | Auto-extracted |
No. These are fee-for-service (FFS) benchmark rates published directly by Michigan'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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