Therapist Reimbursement Rates in 2026 and 2027: Medicare, Medicaid, Private Insurance, and Private Pay for Social Workers and Counselors

Whether you’re a Social Worker, Counselor, or Therapist thinking about private practice, joining an insurance panel, or just trying to understand your paycheck, it helps to know how therapy gets paid. Reimbursement depends on who’s paying (Medicare, Medicaid, a private insurer, or the client), your license, the service you provide, and even where you practice.

This guide covers Medicare rates for 2026 and 2027, who gets what share of the fee schedule, how locality and telehealth affect payment, how Medicaid, private insurance, and private pay compare, getting credentialed, coding basics, the ethics of fees, and continuing education. For Medicare figures, we draw heavily on OnlineTherapy.me’s detailed guide to Medicare reimbursement rates for psychotherapy, which includes code-by-code tables, a state and locality lookup, and its CMS sources.

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Jump to: Medicare Rates · Who Gets What Share · Locality · Telehealth · Medicaid, Insurance, and Private Pay · Credentialing · Coding Basics · Ethics of Fees · Private Practice CEUs · FAQs

1) Medicare Rates for LCSWs, LPCs, and LMFTs in 2026 and 2027

Medicare pays for outpatient therapy under Part B using the Physician Fee Schedule, which CMS updates every year. According to OnlineTherapy.me’s analysis of CMS data (figures checked November 5, 2026), these are the 2026 national rates for clinical Social Workers, Counselors, and Marriage and Family Therapists, which are paid at 75% of the full fee schedule amount:

Source: OnlineTherapy.me, Medicare Reimbursement Rates for Psychotherapy, based on CMS Physician Fee Schedule files. Office (non-facility) national rates, before locality adjustment. See the source for psychologist, psychiatric nurse practitioner, and facility rates.

What changes in 2027

CMS released the 2027 Physician Fee Schedule final rule on November 4, 2026. Even though the conversion factor that turns relative values into dollars goes down, psychotherapy codes go up because of updated values for behavioral health services. Based on the full fee schedule amounts reported by OnlineTherapy.me:

The 75% column is our calculation from the full rates. Medical visit codes used by prescribers go down in 2027. See the source for the full 2027 comparison.

2) Who Can Bill Medicare and What Share They Get

A few key points:

• Counselors and MFTs are new to Medicare. Since January 1, 2024, Marriage and Family Therapists and mental health Counselors can enroll and bill Medicare directly. Addiction Counselors who meet all the mental health Counselor requirements can also enroll. LCSWs have been able to bill Medicare for much longer.
• Experience requirements apply. CMS requires at least 2 years or 3,000 hours of post-master’s supervised clinical experience, plus a state license, for Counselors and MFTs.
• Assignment. LCSWs, Counselors, and MFTs who bill Medicare must accept the Medicare-approved amount as full payment.
• Client cost-sharing. After the Part B deductible, Medicare generally pays 80% of the approved amount and the client pays 20%, unless supplemental coverage picks it up.

If you’re on the Social Work licensure path, see how to get your Social Work license. Counselors can review how to become an LMHC or LPC.

3) Why Your Rate Depends on Where You Practice

Medicare adjusts every rate by location using Geographic Practice Cost Indices (GPCIs), which account for differences in the cost of work, office expenses, and malpractice insurance. As a result, the same session pays different amounts in different areas. For example, OnlineTherapy.me reports that the full 2026 rate for 90837 ranges from $161.03 in Arkansas to $232.44 in Alaska. At the 75% rate, that’s roughly $121 to $174 for an LCSW, LPC, or LMFT.

To find your exact rate, use the state and locality lookup in the OnlineTherapy.me guide or your Medicare Administrative Contractor’s fee schedule.

4) Medicare Telehealth Billing

For more on the ethics of virtual care, see our course on Ethics of AI, Tech, Telehealth, and Social Media.

5) Beyond Medicare: Medicaid, Private Insurance, and Private Pay

Medicare is the most transparent payer because its rates are public. Other payers work differently:

Good Faith Estimates for self-pay clients

Under the No Surprises Act, clients who are uninsured or not using insurance are entitled to a written Good Faith Estimate of expected charges. If the final bill is at least $400 more than the estimate, the client can dispute it. Build Good Faith Estimates into your intake process if you see private-pay clients.

Questions to ask before joining a panel

• What is the rate for each code I bill most, and how does it compare to my private-pay fee?
• How long does credentialing take, and how quickly are claims paid?
• What are the documentation, authorization, and audit requirements?
• How many of my current or likely clients use this payer?

6) Getting Credentialed

Need help staying current? Use our free CE tracker and check the Social Work CE requirements or Counselor CE requirements for your state.

7) Coding Basics for Psychotherapy

Psychotherapy codes are based on time spent face-to-face with the client (in person or by telehealth):

Document start and stop times, the medical necessity of the service, and how the session connects to the treatment plan. Person-centered, collaborative documentation can make notes more useful for clients and more defensible in an audit. Billing rules vary by payer, so check with each payer or a billing professional when you’re unsure.

8) The Ethics of Fees and Billing

Both professions address fees in their codes of ethics:

• NASW Code of Ethics (1.13, Payment for Services): fees should be fair, reasonable, and in line with the services provided, with attention to the client’s ability to pay. Bartering is generally discouraged.
• ACA Code of Ethics (A.10, Fees and Business Practices): Counselors should consider clients’ financial situations, explain fees in advance, and avoid fees that exploit clients.

Billing integrity matters too. Bill only for services you provided, choose the code that matches the time and service, and never misrepresent a diagnosis or service to get paid. Clear, consistent fee policies also protect the therapeutic relationship. Learn more about conflicts of interest and dual relationships.

9) Continuing Education for Private Practice

Agents of Change Continuing Education offers self-paced courses and live CE events with ASWB and NBCC approval and certificates of completion for your license renewal. Related courses include:

Explore more in the course library or start with 7.5 free CEUs.

10) FAQs: Therapist Reimbursement Rates

How much does Medicare pay an LCSW for a 60-minute therapy session?

In 2026, the national rate for 90837 is $125.25 for LCSWs, LPCs, and LMFTs (75% of the $167.00 full rate), before locality adjustment. In 2027, the full rate rises to $183.37, or about $137.53 at 75%. Find your local rate with the OnlineTherapy.me rate lookup.

Can LPCs and LMFTs bill Medicare?

Yes. Since January 1, 2024, licensed mental health Counselors (including LPCs, LMHCs, and LCPCs) and Marriage and Family Therapists who meet CMS requirements can enroll in Medicare and bill for their services at 75% of the fee schedule.

Why do LCSWs and Counselors get paid less than psychologists by Medicare?

Medicare law sets payment for clinical Social Workers, Counselors, and MFTs at 75% of the fee schedule amount, while psychologists and physicians receive 100%. Private insurers set their own rates, which may or may not follow the same pattern.

Do private insurers pay more than Medicare?

It depends on the insurer, plan, region, and your license. Some pay more and some pay less. Compare rates for the codes you bill most before joining a panel.

Do I need to give clients a Good Faith Estimate?

If you see clients who are uninsured or paying out of pocket instead of using insurance, the No Surprises Act generally requires a written Good Faith Estimate of expected charges.

11) Conclusion

Reimbursement shapes where Social Workers, Counselors, and Therapists can practice and who they can serve. Medicare rates for therapy are rising in 2027, and Counselors and MFTs can now bill Medicare alongside LCSWs. Knowing how Medicare, Medicaid, private insurance, and private pay compare, coding accurately, and setting fair, consistent fees can help you build a sustainable practice. For the complete Medicare rate tables and a locality lookup, see OnlineTherapy.me’s Medicare reimbursement rates guide.

Learn more about Agents of Change Continuing Education. We’ve helped more than 100,000 Social Workers, Counselors, and Mental Health Professionals with exam prep and Continuing Education and want to help you next!

► Learn more about Agents of Change Continuing Education here: https://agentsofchangeprep.com/continuing-education/

About the Lead Instructor, Dr. Meagan Mitchell: Meagan is a Licensed Clinical Social Worker and has been providing Continuing Education for Social Workers, Counselors, and Mental Health Professionals for more than 10 years. From all of this experience helping others, she created Agents of Change Continuing Education to help Social Workers, Counselors, and Mental Health Professionals stay up-to-date on the latest trends, research, and techniques.

Disclaimer: This content has been made available for informational and educational purposes only. It is not intended to be a substitute for professional medical, clinical, legal, or billing advice. Rates and rules change, so verify current information with CMS, your Medicare Administrative Contractor, state Medicaid program, or payer.