Behavioral Health Medicaid Rates in Montana (2026)

Behavioral health Medicaid rates in Montana combine a mid-market residential rate with some of the highest therapy rates in the country. Montana Medicaid pays $525.10 a day for psychiatric residential treatment, which ranks 8th of 15 states and is exactly the national median, a 0.0% gap. Skills training sits just under the median too.

Office therapy is a different story. The hour-long session, code 90837, pays $234.75 and ranks 4th of 48 states, and Montana's crisis therapy add-on is one of the highest hourly behavioral health figures we track for the state. For a licensed clinician, Montana is among the best-paying Medicaid markets in the country; for residential and community programs, it pays the going rate.

Two of Montana's rates are ranked against other states in this comparison, and both land in the middle. Skills training on H2014 is 4.1% below the $51.20 national median. Residential treatment matches the $525.10 median. The session codes, covered below, are where Montana separates from the pack.

The hour-long individual session, code 90837, pays $234.75, effective July 1, 2026. That ranks 4th of 48 states against a $132.38 national median. The 30 and 45-minute session codes, the diagnostic evaluation 90791 and the family therapy codes sit in the same top-five band nationally.

For an outpatient practice, that is the most important number in Montana's schedule. Psychotherapy fills most of a clinician's billable hours, and a session rate this far above the median changes the economics of the whole practice. It also comes with an open coverage picture: none of the psychotherapy codes we track carries a prior-authorization rule. Montana pays its practitioner services well generally, which is consistent with the therapy result.

Montana Healthcare Programs publishes rates in a set of fee schedules by provider type: an RBRVS workbook for physician-related services, a Mid-Level Fee Schedule for non-physician practitioners and a Psychiatrist Fee Schedule, each updated for July 2026. Behavioral health community services are set through the Administrative Rules of Montana (ARM) and published fee schedules.

A therapist's rate in Montana can depend on which schedule applies to the clinician's license. Practices employing both independent and mid-level practitioners should check each clinician's schedule, since the same code can carry different amounts on the mid-level and physician schedules. Montana's behavioral health line holds 1,361 current rates in our records.

Montana's psychiatric residential treatment rate of $525.10 a day, effective July 1, 2025, is the clearest example of the state paying a mid-market price. The top of this range is far higher: Minnesota pays $1,244.07 a day, Ohio $1,092.60, Oregon $1,003.95 and New York $995.49. At the bottom, Louisiana pays $448.73, Wyoming $443.78 and Nebraska $283.19.

For a residential provider, a median rate means the economics depend on occupancy and staffing ratios rather than on any rate advantage. Montana also attaches two prior-authorization rules to code 124 in its coverage data, so admissions should be authorized before the stay begins. Code 220 carries one prior-authorization rule.

Montana's comparison figure for outpatient psychotherapy is code 90840, a crisis therapy add-on paid at $97.60 per 30 minutes, effective July 1, 2026. On an hourly basis that is $195.20. Because the unit and service differ from the session codes most states use, Montana is not ranked on this measure, and the hourly figure should not be read against per-session rates elsewhere.

The economics on this code are strong. Against a Montana median wage of $28.36 an hour for a mental health counselor, wages take 20.7% of the hourly rate, leaving a margin of $154.89 an hour after loaded wages. That figure applies to crisis add-on time specifically; routine sessions are paid separately on the session codes.

The psychoeducation rate on H2027 is $30.94 per 15 minutes, or $123.76 an hour, effective May 9, 2026. It is Montana's comparison rate for non-physician mental health assessment, though it is not ranked against other states' H0031 rates because the service and unit differ.

Skills training is where Montana's margins are thinnest. At $49.08 an hour and a median psychiatric technician wage of $18.84, wages take 54.6% of the rate and the margin after loaded wages is $22.30 an hour. That is workable but leaves little room for travel, supervision or no-shows, and travel is a real cost in a large rural state.

Montana wages for May 2025 compare with the national medians as follows:

• Mental health counselor: $28.36, against $28.53 nationally
• Mental health social worker: $21.71, against $28.98
• Clinical psychologist: $32.77, against $48.36
• Nurse practitioner: $65.97, against $63.61
• Psychiatric technician: $18.84, against $21.70

Counselor wages are close to the national median, social worker and psychologist wages are well below it, and nurse practitioner wages are above it. For a Montana agency, that makes licensed social workers comparatively affordable, while psychiatric prescribing capacity through nurse practitioners costs more than the national norm. Paired with top-five session rates, the low social worker and psychologist wages give Montana therapy practices unusually wide margins.

Montana's listed Medicaid programs, including Montana Medicaid and HMK Plus, the HCBS waiver for adults with severe disabling mental illness and the HEART section 1115 demonstration services, are all identified as fee-for-service. The state also funds the Montana Mental Health Services Plan, which is state-funded and not Medicaid. Montana's data names 17 plans and care arrangements, such as primary care medical home tracks and a third-party administrator for HMK; see the Montana managed care page for the full list.

Fee-for-service payment means there is no plan-by-plan negotiation. Every enrolled provider is paid the published rate, and a schedule update reaches all providers on the same date. For behavioral health practices, revenue planning starts and ends with the fee schedule edition in effect.

Montana has an active year of rate and benefit changes:

• July 1, 2026 Fee Schedule Updates took effect July 1, 2026, and the state's 90840 and 90837 rates carry that effective date.
• MAR Notice No. 2026-127.1 proposed amending rules on Medicaid and non-Medicaid provider rates, fee schedules and effective dates, with a 3.39% change effective July 1, 2026.
• MT SPA 26-0001 was approved by CMS on August 5, 2026, effective May 9, 2026. It adds Home Support Services group services to the EPSDT state plan.
• A set of state plan amendments posted for comment on February 27, 2026 includes Comprehensive School and Community Treatment (CSCT) under EPSDT, effective May 9, 2026, the same date as the H2027 rate.
• MAR Notice No. 2026-525.2, adopted August 21, 2026 and effective August 22, 2026, covers the CSCT and HSS rate restructure and service provision.
• MT SPA 26-0003, approved by CMS, expands the HEART Initiative populations from January 1, 2026.

For providers serving children, the CSCT and Home Support Services changes are the ones to read in full, since both sit inside the EPSDT state plan and the August 2026 rule restructures their rates.

Montana sits in the middle of the national range on residential care and skills training, and near the top on therapy sessions. States such as Wyoming and Washington pay far more for therapeutic behavioral services, and Rhode Island leads skills training at $139.64 an hour. At the low end, Idaho pays $8.60 an hour for skills training. Neighboring Idaho offers a useful contrast, with very different community rates.

The split inside Montana's schedule is what a provider should plan around. A group practice of licensed therapists will find Montana one of the strongest Medicaid markets in the country, with session rates in the national top five and no fee-schedule authorization barrier. A residential treatment center will find a median daily rate and authorization requirements on admission. A community agency delivering skills training will find a rate just below the median and a modest margin that rural travel can erase. The same state can look generous or ordinary depending on which of those businesses a provider runs, so budgets should be built service line by service line rather than from a single statewide impression.

• Build around therapy. Session codes rank in the top five nationally and need no prior authorization.
• Check the clinician's schedule. Mid-level and physician schedules can price the same code differently.
• Plan residential on occupancy. At a median daily rate, margins come from beds filled and staffing efficiency.
• Read the CSCT and HSS rules. The August 2026 restructure changes rates for children's school and home services.

Rates on this page are compiled from official Montana Medicaid publications, and each rate on our site links to its source document. Montana sources include the Montana Healthcare Programs RBRVS July 2026 workbook, the July 2026 Mid-Level Fee Schedule and the July 2026 Psychiatrist Fee Schedule. Units and rankings follow our methodology.

All 141,671 current Montana Medicaid rates, across 134 service categories and history back to 2007, are on the Montana Medicaid rates page. National medians are on the behavioral health Medicaid rates by state page.