90876 Medicaid reimbursement rate by state (2026)

• Order. States are listed from the highest published rate to the lowest. No single unit is shared by 8 or more states for 90876, so the order is by published amount and is not a like-for-like rank.
• Medicaid rate. The most the state's fee-for-service program pays for one unit, as published. 12 of the 15 states list more than one rate for 90876, by modifier, provider type or setting; the table shows the one that matches the provider level and setting used across states, without add-ons.
• Unit. Of the 15 states, 1 publish 90876 per 45 min, and 14 schedules print no unit at all (a flat amount per service).
• Per hour. 90876 is not billed in time units in these states, so no hourly figure is shown.
• Managed-care plans. The rule the state sets for its plans on this rate. What each rule means is explained below.
• % of Medicare. No Medicare physician fee schedule amount is on file for 90876, so there is no percentage.
• Source and date. Each Source link opens the state's own document; “since” is the date the rate took effect.

Published rates for 90876 run from $46.22 in Illinois to $117.15 in North Dakota, a 2.5x gap in the same unit. Half the states pay more than the median of $84.98 and half pay less. The usual reasons for a spread like this in behavioral health rates:

• Behavioral health is frequently run through a separate state agency, a carve-out or a specialty plan, with its own rate-setting cycle.
• Community mental health and substance use services are often billed under H and T codes that each state defines for itself, so the same code can describe a different service in two states.
• Many states pay behavioral health services differently by the practitioner's credential, from psychiatrist and psychologist to licensed clinical social worker, counselor and peer specialist.

Timing matters too. 8 states set the current rate for 90876 in 2026 or later, while 6 states still pay a rate that took effect in 2022 or earlier. A state that has not updated its rate in years will drift down the ranking as others raise theirs.

Most Medicaid members are in managed-care plans, and plans don't publish their provider fee schedules. For 90876, the public signal is the rule each state sets for its plans, recorded on each rate above.

In 4 states, the published rate binds plans: a floor, a pass-through or a state-set rate. In 8 states, plans negotiate and the published rate is a benchmark or out-of-network default. The rule for the remaining 3 states is not classified yet.

• Plans negotiate; the published rate applies out of network (8 states). In-network rates can be above or below the published rate. The published rate is the benchmark both sides know, and the fallback if no contract is signed.
• Plans must pay at least the published rate (4 states). The published rate is your floor. Negotiate up from it, and if a plan pays less, the contract provision is the basis for a payment dispute.

Plan-negotiated rates are never estimated here. To see the rule and its citation for a particular state, open that state's managed-care page, for example North Dakota managed care.

90876 is a CPT medicine code in the behavioral health line, billed mostly by psychiatrists, psychologists, licensed clinicians and community mental health agencies. The medicine section runs from vaccines and psychiatry to dialysis, cardiology and therapy. Some of its codes are timed in 15-minute units, others are billed once per session or per test, so the unit matters more here than in most sections.

Psychotherapy codes are defined by session length, so one unit is one session of the stated duration; H codes are billed in whatever unit the state defines, often 15 minutes, an hour or a day. Modifiers such as HO (master's level), HN (bachelor's level) and HP (doctoral level) identify the practitioner, and many states publish a different rate for each.

Before billing, confirm the rate, unit and any modifier with the state's current schedule or the plan: the amounts here are as published, not a guarantee of payment.