Current fee-for-service (FFS) rates published by PA Department of Human Services (DHS) — Office of Medical Assistance Programs 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. | — | $12.73 / 15 min | 2023-10-01 | Auto-extracted |
| U8 | $15.76 / 15 min | 2023-10-01 | Auto-extracted | ||
| 90791 | Initial psychiatric diagnostic evaluation without medical services. | — | $26.25 / encounter | 2023-10-01 | Auto-extracted |
| 90837 | Individual psychotherapy, approximately 60 minutes. | — | $52.00 / session (60 min) | 2025-11-12 | Auto-extracted |
Source: PA Department of Human Services (DHS) — Office of Medical Assistance Programs
No. These are fee-for-service (FFS) benchmark rates published directly by Pennsylvania'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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