What your 90836 actually pays: Medicare's 2026 rate for the 45-minute add-on

The middle add-on code covers a full standard therapy block layered onto a medication management visit. Medicare raised it 11.6% for 2026, and it demands the same thing every add-on code demands: two clearly separated blocks of time in one note.

The code, and what it actually requires

CPT code 90836 is psychotherapy, 45 minutes, billed as an add-on to an evaluation and management (E/M) visit. Like its shorter and longer siblings (90833 and 90838), it cannot stand alone: it attaches to a primary E/M code such as 99214 and auto-denies without one. It represents a longer, standard-length psychotherapy block, the kind a psychiatrist or psychiatric mental health nurse practitioner (PMHNP) delivers when a visit genuinely combines medication management with a substantial piece of talk therapy, not a brief check-in.

The requirement that makes or breaks this code is time documentation. Current procedural terminology (CPT) rules require the medical decision-making time and the psychotherapy time to be separately identifiable, meaning a note that describes one continuous 60-minute conversation without marking where the medication discussion ended and the therapy began does not support the add-on, even if the total time and the clinical content were both genuinely there.

What Medicare pays in 2026

Medicare pays $103.21 nationally for 90836 in 2026, up from $92.51 in 2025, an increase of 11.6%. 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. Behavioral health and time-based codes were explicitly exempted from a separate 2.5% efficiency cut applied elsewhere in the same rule. Stacked onto a 2026 99214, a 90836 add-on brings the combined visit to $238.82.

What commercial payers pay

PayerPrice shows national average commercial rates for 90836 from $92.08 (BCBS/Anthem) to $123.07 (Cigna) as of August 2026. Aetna and UnitedHealthcare both pay slightly above the Medicare rate for this particular code, a reversal of the pattern seen on several other codes in this family where UnitedHealthcare pays the least.

The so-what

• Mark the boundary in the note. A simple, explicit line, where the medication review ends and the therapy block begins, is the difference between a defensible add-on claim and one that folds back into the E/M code alone.
• Do not round up from 90833. If the therapy portion runs closer to 20 minutes than 45, the shorter add-on code is the correct one even though it pays less.