April 17, 2022

How New York Medicaid's psychotherapy rates measure up

Mental health care providers say insurance rates are abysmal. But just how bad are they?

In New York City, there are just 47 child and adolescent psychologists who accept Medicaid. They must serve more than 1.3 million children who rely on the state's health insurance.

Barbara Kapetanakes, the president of the New York Psychological Association, says reimbursement rates play a large role in deterring psychologists from working with Medicaid or other health insurers.

New York Medicaid pays about $70 for a typical session of psychotherapy*, about $12 below the national median. However, Kapetanakes says the market rate for psychotherapy is significantly higher where she practices in Westchester and there is little incentive to take a pay cut and enroll with Medicaid.

An analysis of more than 1,300 NYC-area child therapist listings on Psychology Today shows just how big this gap could be.

Cost per 45-minute psychotherapy session

All

Therapists

Psychologists

Medicaid

$155

$100

$200

$300

$400

$500

Medicaid

$100

All

Therapists

$155

$200

Psychologists

$300

$400

$500

Among the 1,375 child therapists, the average cost for a session ranged from roughly $50 to $500.

New York Medicaid pays providers $70.39 for a 45-minute session of psychotherapy.

Among all therapists the median charge for a therapy session was $175

For just psychologists, that median increased to $225

Leaving the difference between what a provider can get by billing Medicaid versus charging their own rates:

$155 per session

While New York Medicaid reimburses significantly less than what most providers are charging, it actually is paying psychologists more than what it pays for a comparable 30-40-minute specialist visit. Specialists, like gastroenterologists or orthopedic doctors, make $56 when they bill one of the most common codes, a level four office visit.

The last time psychotherapy saw a raise from New York Medicaid was a little over seven years ago, when rates jumped up $20 to the current price. Specialists visits, however, have remained at the same price for at least the past 15 years.

Methodology

I scraped PsychologyToday.com by searching for therapists that treat children 6-10 in the following areas: New York, Brooklyn, Bronx, Staten Island, and multiple neighborhoods in Queens. I used the "Cost Per Session" section of the profile to get a price for that provider. If they listed a range, I took the average. If they listed a maximum ("Up to {number}"), I used the maximum. If they used a base rate ("{number}+"), I used the base.

* Psychologists typically bill 90834, a 45-minute psychotherapy session, according to New York Psychological Association President Barbara Kapetanakes.

To determine the Medicaid reimbursement rates of the psychotherapy session (90834) and one of the most commonly billed specialist visit codes (99214), I referenced New York State's Medicaid Physician Fee Schedules from 2006-2022

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