The Rates plan
$29/mo7-day free trialThe table on this page is a common-procedure sample. The full Pennsylvania behavioral health schedule has 26 codes.
- Every code on all 51 published schedules
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Published codes
26
Behavioral Health procedures on the 2026 schedule
Median % of Medicare
24.7%
vs national Medicare, GPCI-neutral
Effective vintage
2026
latest effective year on the schedule
Common behavioral health procedures and what Pennsylvania Medicaid pays
A curated sample of recognizable procedures from the 26-code schedule. Rates are the state's published fee-for-service amounts; the percentage compares each rate with the national Medicare amount for the same code.
| Code | Procedure | Pennsylvania rate | % of Medicare |
|---|---|---|---|
| 90791 | Psychiatric diagnostic evaluation, no medical services | $26.25 | 15.1% |
| 90792 | Psychiatric diagnostic evaluation with medical services | $75.00 | 37.1% |
| 90832 | Psychotherapy, 30 minutes | $26.00 | 30.3% |
| 90834 | Psychotherapy, 45 minutes | $39.00 | 34.2% |
| 90837 | Psychotherapy, 60 minutes | $52.00 | 31.1% |
| 90846 | Family psychotherapy without the patient, 50 minutes | $13.00* | 12.3% |
| 90847 | Family psychotherapy with the patient, 50 minutes | $13.00* | 11.9% |
| 90853 | Group psychotherapy | $3.50* | 11.5% |
| 90867 | Transcranial magnetic stimulation (TMS), initial treatment | $101.58 | -- |
| 90868 | Transcranial magnetic stimulation (TMS), subsequent treatment | $104.87 | -- |
| 90870 | Electroconvulsive therapy (ECT) | $45.00 | 24.7% |
| H0031 | Mental health assessment, by non-physician | $26.25* | -- |
| H0038 | Self-help/peer services, per 15 minutes | $10.00 | -- |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Rows marked * show the schedule's representative published variant.
More Pennsylvania Medicaid fee schedules
- Pennsylvania physician fee schedule · 4,676 codes
- Pennsylvania lab & imaging fee schedule · 1,500 codes
- Pennsylvania dme & supplies fee schedule · 1,408 codes
- Pennsylvania other services fee schedule · 62 codes
- Pennsylvania vision fee schedule · 40 codes
- Pennsylvania hearing fee schedule · 24 codes
Behavioral Health rates in neighboring states
Frequently asked questions
What does Pennsylvania Medicaid pay for behavioral health services?
Pennsylvania Medicaid publishes 26 behavioral health procedure rates effective 2026, paying a median 24.7% of the national Medicare amount for the same services. The schedule covers psychotherapy, psychiatric evaluations, substance-use treatment, and community mental health services. The table on this page shows published rates for common procedures; the complete all-codes schedule is available as a CSV download with a ProviderSignal Rates subscription.
How do Pennsylvania's behavioral health rates compare with Medicare?
Across behavioral health codes with a national Medicare comparator, Pennsylvania Medicaid pays a median 24.7% of the Medicare amount (GPCI-neutral national comparison). Individual codes vary widely, so check the per-code percentage in the table.
Do behavioral health services need prior authorization in Pennsylvania?
Pennsylvania does not publish prior-authorization indicators on this fee schedule, so PA requirements must be confirmed through the state's provider manual or portal. Absence of a flag here means "not published", never "no PA required".
Where do these rates come from?
Directly from Pennsylvania's published Medicaid fee-for-service schedule (effective 2026), collected and normalized by ProviderSignal across all 50 states + DC. Rates are re-collected on a rolling schedule and this page updates automatically. Procedure descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.
Get an email the next time Pennsylvania changes these rates.