Psychiatry & psychotherapy

90838 - RVUs & Medicare payment (2026)

Psychotherapy 60 minutes, add-on to an E/M visit.

Component	Non-facility	Facility
Work RVU	2.86	2.86
Practice expense RVU	1.11	0.32
Malpractice RVU	0.12	0.12
Total RVUs	4.09	3.30
National payment (CF $33.4009)	$136.61	$110.22
Qualifying APM payment (CF $33.5675)	$137.29	$110.77

How 90838 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 90838 ranges from $129.44 in Arkansas (AR) to $184.98 in Alaska (AK); calculate 90838 for your locality.

Alaska (AK) $184.98 San Jose-Sunnyvale-Santa Clara (CA) $161.64 San Jose-Sunnyvale-Santa Clara (CA) $161.09 San Francisco-Oakland-Berkeley (CA) $158.72 San Francisco-Oakland-Berkeley (CA) $158.58 NYC Suburbs/Long Island (NY) $153.17 Napa (CA) $152.45 Vallejo (CA) $152.25 National average $136.61 … 97 more localities between … Iowa (IA) $131.04 Mississippi (MS) $130.41 Alabama (AL) $130.24 Arkansas (AR) $129.44

Non-facility payment for 90838 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: ZZZ

Add-on code: billed with a primary service and covered by the primary service’s global period.

Related codes - psychiatry & psychotherapy

90791 · psychiatric diagnostic evaluation, no medical services
90792 · psychiatric diagnostic evaluation with medical services
90832 · psychotherapy, 30 minutes
90833 · psychotherapy 30 minutes, add-on to an e/m visit
90834 · psychotherapy, 45 minutes
90836 · psychotherapy 45 minutes, add-on to an e/m visit
90837 · psychotherapy, 60 minutes
90839 · psychotherapy for crisis, first 60 minutes
90846 · family psychotherapy without the patient present, 50 minutes
90847 · family psychotherapy with the patient present, 50 minutes
90853 · group psychotherapy
96130 · psychological test evaluation, first hour
96131 · psychological test evaluation, each additional hour
96136 · psychological/neuropsychological test administration, first 30 minutes
96156 · health behavior assessment or re-assessment
96158 · health behavior intervention, individual, first 30 minutes

Frequently asked questions

How much does Medicare pay for 90838 in 2026?

The national non-facility payment is $136.61 and the facility payment is $110.22, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.

What is the work RVU for 90838?

The 2026 work RVU for 90838 is 2.86. Total RVUs are 4.09 in the non-facility setting and 3.30 in the facility setting.

Why are the facility and non-facility amounts different?

Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.