Behavioral Health Medicaid Billing: A State-by-State Overview

Behavioral health codes are some of the most-tracked in Medicaid fee schedules, and also some of the most variable state to state. Two codes in particular — 90791 (initial psychiatric diagnostic evaluation) and 90837 (individual psychotherapy, approximately 60 minutes) — are published widely enough to make direct state comparison possible.

What the published rates actually show

Pulling current published rates for 90791 and 90837 across states with available data shows a wide spread — not a small rounding difference, but multiples apart:

State	90791 (initial eval)	90837 (60-min therapy)
Alaska	$618.02	$140.77
Nebraska	$193.49	$196.19
New York	$177.67	$161.13
Hawaii	$148.43	$134.02
Louisiana	$142.09	$125.86
Kentucky	$129.53	$109.47
Ohio	$130.72	$120.36
Michigan	$128.58	$64.48
Mississippi	$125.93	$118.63
Illinois	$122.11	$91.58
Pennsylvania	$26.25	$52.00

(Figures are current published FFS rates as tracked by MedicaidBench; see each state’s page for source documents and effective dates.)

Why the spread is this wide

A few real factors drive this, beyond simple state generosity:

• Cost-of-living and provider-market differences feed into how each state sets its rate-setting methodology.
• Bundling differences — some states’ published rate may assume additional services are billed separately, while another state’s number reflects a more inclusive bundle.
• Provider-type differentials — a rate published without a provider-type breakdown may reflect a blended or base rate rather than what a specific credential level actually receives.
• Effective date lag — some of these figures reflect a 2024 effective date, others more recent; a state that hasn’t updated in a while will look lower purely because it hasn’t been rebased, not necessarily because its methodology values the service less.

Why this matters for multi-state operators

If you operate behavioral health billing across several of these states, working from a single “expected reimbursement” assumption is a mistake — the spread above isn’t noise, it’s the actual published rate structure. Contracting, staffing, and margin decisions that assume a national-average rate will be meaningfully wrong in either direction depending on which states you’re actually billing in.

Keeping this current

Every one of these numbers changes independently, on each state’s own schedule, with no shared notification. The comparison above is a snapshot — for current figures, cross-state comparison, and instant alerts when any of these states updates a behavioral health rate, MedicaidBench tracks all of them continuously against the official source.