What your 90834 actually pays: Medicare's 2026 rate for the 45-minute hour

The 45-minute session is the workhorse of outpatient therapy, the code behind what most patients think of as their weekly hour. Medicare raised it 9.4% for 2026, and commercial payers show one of the widest spreads in this code family.

The code, and why it is the default

CPT code 90834 is individual psychotherapy with a patient, 38 to 52 minutes of face-to-face therapy time, what most clinicians and patients call the 45-minute hour. It is the single most commonly billed psychotherapy code in outpatient behavioral health. A therapist seeing a full caseload of weekly patients for standard sessions is billing 90834 for the overwhelming majority of them.

What Medicare pays in 2026

Medicare pays $113.90 nationally for 90834 in 2026, up from $104.16 in 2025, an increase of 9.4%. The number underneath that move is the Medicare conversion factor, a single dollar multiplier that CMS applies to every code on the physician fee schedule. It fell for five straight years, from a peak of $36.09 in 2020 to $32.35 in 2025, before this year's rule reversed course: $33.40 for 2026, a 3.26% increase. Time-based psychotherapy codes were explicitly exempted from a separate 2.5% efficiency cut CMS applied elsewhere in the same rule, part of why a code like 90834 gained more than the conversion factor alone would produce.

What commercial payers pay

PayerPrice shows national average commercial rates for 90834 from $94.81 (UnitedHealthcare) to $134.81 (Cigna) as of August 2026, a spread of $40.00 per session. Because this is the single highest-volume code most therapy-heavy practices bill, that spread compounds faster than almost any other code in this series: a therapist running a 25-patient weekly caseload sees the difference on every session, every week, all year.

The so-what

Because 90834 is the default, it is also the code most likely to be billed on autopilot, including in situations where the session actually ran long enough to support 90837 instead. A therapist whose sessions consistently run past 53 minutes but who documents time loosely, or whose EHR template defaults to 90834 regardless of actual session length, is giving away the gap between the two codes on every long session.

• Document actual minutes, not assumed minutes. The code should follow the clock, not a template default set once and never revisited.
• Know your payer mix's weighted average. A practice heavy in UnitedHealthcare contracts collects meaningfully less per 90834 than one weighted toward Cigna, a fact worth knowing before negotiating a new contract.