90837

Psychotherapy, 1 hour

Code 90837. Medicare covered 6,863,646 of these. Here is what providers billed and what Medicare allowed, state by state.

$209.11Billed, national avg
$124.73Medicare allowed
1.7xBilled vs allowed
1.9xHighest vs lowest state

Providers in Alaska billed the most for this, at $295.68. In Puerto Rico the average was $152.48. Same procedure code, same programme.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

By state

StateBilledMedicare allowedGapServices
Alaska$295.68$164.301.8x16,109
North Dakota$271.31$119.392.3x14,198
Wisconsin$264.81$117.082.3x91,936
Minnesota$252.82$119.012.1x164,590
Unknown$244.11$110.822.2x545
Oregon$239.58$121.722.0x81,514
Nebraska$236.12$114.612.1x35,287
Virgin Islands$228.64$142.291.6x596
Colorado$228.01$123.971.8x136,184
California$223.86$141.671.6x815,604
West Virginia$220.83$118.921.9x20,416
New Jersey$217.09$128.141.7x293,187
Hawaii$217.05$131.551.6x20,782
Arkansas$216.89$111.431.9x57,009
Washington$216.72$127.631.7x122,281
Arizona$215.35$125.081.7x102,424
Utah$214.10$116.901.8x43,756
Mississippi$213.54$113.291.9x23,767
Florida$213.12$126.241.7x542,368
Illinois$212.78$123.711.7x369,514
North Carolina$212.24$115.991.8x195,748
Rhode Island$209.80$122.171.7x27,121
New York$208.72$130.061.6x528,817
Michigan$208.34$119.661.7x278,410
Texas$207.36$121.371.7x266,171
South Dakota$207.12$116.541.8x24,942
Massachusetts$206.41$123.411.7x355,732
District of Columbia$204.57$134.831.5x18,646
Ohio$204.32$118.581.7x190,715
Indiana$204.27$114.631.8x72,798
Guam$203.94$130.021.6x62
Iowa$203.60$113.021.8x48,212
Nevada$203.32$122.301.7x55,668
Wyoming$201.77$115.091.8x25,567
Armed Forces Europe$200.92$133.831.5x184
Foreign Country$196.89$128.771.5x531
Kentucky$196.63$111.391.8x54,649
Delaware$196.57$117.921.7x39,958
Pennsylvania$196.38$128.571.5x348,518
New Mexico$195.64$117.511.7x52,925
Idaho$195.10$113.601.7x24,881
Alabama$194.50$116.091.7x26,351
Tennessee$193.18$119.371.6x57,478
Georgia$193.03$119.341.6x139,045
South Carolina$191.86$116.711.6x67,917
Connecticut$189.21$122.331.5x117,258
Maryland$188.48$124.321.5x214,663
Virginia$188.42$118.751.6x155,594
Kansas$186.31$114.701.6x68,847
New Hampshire$184.16$124.041.5x62,464
Montana$184.13$115.481.6x58,114
Louisiana$180.05$113.411.6x43,062
Oklahoma$177.23$113.261.6x64,445
Maine$176.70$112.651.6x68,753
Missouri$176.51$117.271.5x85,986
Armed Forces Pacific$167.22$110.431.5x370
Vermont$159.24$116.941.4x68,616
Puerto Rico$152.48$136.341.1x2,274

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume across places of service.

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