Medicare Reimbursement Rates: A Guide for Therapists (2025)
Getting paid fairly for your therapy services begins with understanding Medicare reimbursement rates. If you've ever struggled to find this information or felt lost trying to figure out your exact pay, you're not alone. Unlike commercial insurers, Medicare posts these rates online, and knowing how to locate them makes your job that much simpler.
Let’s break down where to find the numbers, how to use them, and what steps to take next so you can feel confident billing Medicare. If you'd like to see the process on-screen, I also have a short video that shows how to use the CMS Fee Schedule Tool step by step. Watch How to Find Your Medicare Reimbursement Rate here.
What Are Medicare Reimbursement Rates?
Before you can bill confidently, you need to know precisely what you'll get paid for each therapy session.
Medicare reimbursement rates are the official prices Medicare sets for every service, including therapy. What you receive depends on your credentials, service area, and the services you provide. Every region, referred to as a MAC (Medicare Administrative Contractor), has its own fee schedule, so your location is a factor.
Use this resource to find your Regional MAC.
When you look up your numbers, always make sure you're viewing your local rates, not just a national average.
Plus, your credential level counts!
Masters-level therapists usually see about 75 percent of the full listed rate. These rates are intended to reflect the total allowable charge, which includes the patient's coinsurance and your portion.
How Rates Work for Therapy Services
If you provide therapy, your pay depends on the billing codes you use, your region, and whether you're working in private practice or another setting. The service codes, known as CPT codes, describe the services provided during a session. For example, a standard code is 90834, which is used for a 45-minute therapy session.
You get paid per "unit" or per visit, depending on the code. Always check your own local fee schedule, since it can vary even within a single state.
The PFS Look-Up Tool from CMS is one way (more on the MAC tools below) to enter the CPT code and your location to view your exact payment for each service. Just enter your CPT code, pick your locality, and review participating (par) and non-facility rates.
Quick Medicare Billing Tips
Create a list of your most frequently used CPT codes for quick reference.
Use your MAC’s website or the CMS tool to look up local prices.
Remember, your client’s 20% coinsurance is included in the rate.
Getting these rates right means fewer surprises for you and your clients. If the process still feels confusing, my Introduction to Medicare billing course walks you through CPT codes, fee schedules, and every critical detail. You'll know what every session is worth, every time you bill.
How to Find Medicare Reimbursement Rates
Once you know the basics, it's time to see your real numbers. Medicare makes this step easier than most insurance companies. You don't need to call anyone or dig through manuals; you just need the right tools.
Using the Regional MAC Lookup Tools
This is by far the simplest method to quickly find your reimbursement rates.
Choose your regional MAC from the jurisdictions map here.
Enter your service/CPT code, state, and/or locality (as applicable).
Once you enter this information, focus on the two key elements:
Allowed Amount: This is the total Medicare-approved payment for the service (it includes what both Medicare and the client pay, not just your cut).
Non-Facility Rate: Most therapists in private practice should look here because this reflects what you’ll earn if you’re not working in a hospital or clinic owned by someone else.
I go further into percentage calculations, specific codes and rates, and provider scenarios in my on-screen guided walk-through. Watch the exact process here on how to use regional MAC sites to find Medicare reimbursement rates.
Using the CMS Fee Schedule Tool
This is another (less-direct) option to find reimbursement rates. Start by going to the PFS Look-Up Tool, and follow these steps:
Enter your ZIP code: This narrows results to your region, which is essential because rates change from place to place.
Select your service/CPT code: For example, search for “90834” to find a standard 45-minute therapy session.
Search: The tool generates a table detailing payment information.
Knowing how to quickly check the fee schedule makes your billing as predictable as possible. You can take the guesswork out of Medicare billing when you learn how these tools work and what every number means for you.
Factors That Affect Your Medicare Reimbursement Rates
Several moving parts influence your Medicare reimbursement rates, and understanding each one helps you avoid unexpected payment reductions.
If you've ever noticed a difference in your pay for the same CPT code, there's a good chance it's tied to factors such as where you practice or the billing modifiers you use. Here’s what you need to look out for in your day-to-day billing.
Location Impact
Location matters - a lot. Medicare sets different pay rates for each region, right down to specific zip codes.
To get your exact rate, use your CPT code and zip code in the CMS Fee Schedule Tool. Always select your correct locality, since some states are divided into multiple payment areas.
Tips to Maximize Your Reimbursement
Getting paid every dollar you deserve starts with smart, consistent habits in your billing process.
When you use the right techniques and stay organized, you avoid common mistakes that lead to claim denials or underpayments. Here's what therapists and providers can do to maintain the highest Medicare reimbursement rates.
Double-Check Your Fee Schedule and Locality
Medicare Payment rates change based on where you work. Your local region (MAC) and even your zip code can affect the compensation you receive for the same service. Each year, check the updated fee schedules to ensure you’re not charging incorrectly.
If you practice in more than one area, keep a list of rates for each zip code you serve.
Use Accurate CPT Codes and Modifiers
Using the right CPT code for every session is key. If you choose the wrong code or skip a modifier, Medicare may pay less or reject the claim. Check and double-check before you submit. For therapy, remember to:
List all CPT codes you use regularly, such as 90791, 90834, and 90837.
Attach the GP modifier (if needed) to indicate services under Medicare therapy, such as audio-only services.
When performing separate billable services during the same visit, use modifier 59 to prevent bundling and ensure full payment.
If you're unsure, online resources and billing support tools help clarify the best choices. Consider using guides published by CMS or reputable breakdown guides.
Stay Organized With Documentation and Timelines
Solid documentation isn’t just a compliance issue; it protects your income!
Be sure to complete progress notes and billing records right after each session. If you miss deadlines or fail to include all required details, reimbursement gets delayed or denied. Establish a system to submit claims regularly and conduct monthly audits to identify missed sessions.
Key reminders for documentation and timeliness:
Keep session notes and billing details clear, concise, and compliant.
Submit claims within Medicare’s timely filing window (generally 12 months from date of service).
Check for common billing errors before finalizing, such as missing signatures or incomplete information.
For more ideas on compliant documentation practices, check out my webinar on compliant therapy documentation.
Monitor Changes and Advocate for Yourself
Medicare adjustments are standard, and payment rates may be adjusted due to policy changes. By staying proactive, you avoid getting caught off guard by lower reimbursements. Subscribe to email updates, follow your MAC’s announcements, and join professional groups to share insights with other providers.
Invest in Training and Support
Medicare billing isn’t something you have to tackle alone or from scratch. Providers who invest in their education bill more confidently, avoid underpayments, and spend less time fixing mistakes.
If you want step-by-step training from someone who’s handled Medicare billing for an entire private group practice of 15 clinicians, check out my Medicare billing course. It gives you everything you need to get organized and stay paid at the highest Medicare reimbursement rates.
A little time invested up front can lead to more accurate income every month!
Ready to Take Control of Medicare Billing?
There you have the essentials for understanding Medicare reimbursement rates: where to find them, how they work, and what factors actually change your pay. With these tools, billing Medicare doesn’t have to feel like guesswork every time you hit “submit.”
Want to see the process? Watch me walk through the CMS Fee Schedule Tool in this quick video.
If you want step-by-step guidance to keep your billing clean, check out my Introduction to Medicare Billing course. You’ll get lifetime access, unlimited replays, and real-world examples so you can bill confidently every single time.
Gabrielle Juliano-Villani, LCSW, helps healthcare organizations, online platforms, and mental health providers navigate Medicare & Medicaid with confidence. With over a decade of experience supporting mental health providers in navigating billing, compliance, and documentation, she now offers consulting and training to help others grow sustainable, compliant practices.