How to Use the Medicare Physician Fee Schedule Lookup for Psychotherapy Codes: Find Your Locality and Check the Math

Last verified: November 9, 2026.

General information, not financial or legal advice. This guide explains CMS's public tools and files as of November 9, 2026. For official payment amounts, CMS directs providers to their Medicare Administrative Contractor (MAC).

What the Medicare Physician Fee Schedule is

The Medicare Physician Fee Schedule (PFS) is the list Medicare uses to pay physicians and other practitioners, including psychologists, clinical social workers, marriage and family therapists and mental health counselors, for professional services. Each service has relative value units (RVUs) in three parts:

• Work: the clinician's time, skill and effort.

• Practice expense (PE): office overhead. It has two values: non-facility (your office) and facility (hospital or similar setting).

• Malpractice (MP): liability insurance cost.

CMS's documentation page gives the formula:

Non-facility amount = [(Work RVU × Work GPCI) + (Non-facility PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × conversion factor

The GPCIs (geographic practice cost indices) adjust each part for your Medicare locality. The conversion factor turns RVUs into dollars. For 2026 there are two conversion factors: $33.4009 for clinicians who are not qualifying APM participants (most private practices) and $33.5675 for qualifying APM participants. The CMS fact sheet rounds these to $33.40 and $33.57; the exact values are in the RVU files.

Step 1: Find your Medicare locality

Your locality depends on where you provide the service, not where you live. There are two primary ways to find it:

1. The locality-to-county file. Every quarterly RVU release on cms.gov includes a file listing the counties in each locality (for 2026, 26LOCCO). For example, it lists New York County as locality 01, Manhattan, and Alabama as a single statewide locality 00.

2. Your MAC's website. Each MAC publishes its own fee schedule pages, and several have their own lookup tools. Search results for "medicare fee schedule lookup" show MAC tools from Palmetto GBA, First Coast, Novitas and Noridian next to CMS's. They draw on the same CMS fee schedule, but the CMS tool covers every locality in one place.

For telehealth from home, use the location your MAC's billing instructions point you to. Locality and place-of-service rules for telehealth have changed several times, so check the current MLN telehealth guidance instead of assuming.

Step 2: Look up your codes in the CMS PFS Look-up Tool

CMS describes the tool as giving "Medicare payment information on more than 10,000 services," including pricing, RVUs and payment policies. You can:

• Search by a single procedure code, a range of codes, or a list of codes. A list works well for therapy practices: 90791, 90832, 90834, 90837, 90847.

• Choose the geography: the national payment amount, a specific MAC, or a specific MAC locality.

• Choose the year. Pick 2026 for current-year claims. Earlier years are useful when you reconcile old EOBs.

You may be asked to accept a license agreement before results appear, because CPT codes and descriptors belong to the AMA. The tool doesn't show MAC-priced codes or codes Medicare Part B doesn't pay.

The CMS overview page also points to a "PFS Quick Reference Search Guide" and "Sample PFS Searches." Read those if the screens look different from this description. CMS updates the interface from time to time.

Step 3: Read the result correctly

Each row gives several prices. Psychotherapy practices most often misread these four.

Non-facility vs. facility price. Use the non-facility price when you see the patient in your own office. The facility price is lower and applies when the service is in a hospital or similar facility that bills Medicare separately for overhead. For 90837 at the 2026 national non-QP rate, that is $167.00 non-facility vs. $135.27 facility.

Participating vs. non-participating amount. CMS's documentation says the law sets the payment for non-participating physicians at 95% of the fee schedule amount. Nationally for 90837, that is $158.65.

Limiting charge. For a non-participating physician billing on an unassigned claim, the most the patient can be charged is the limiting charge: 115% of the non-participating amount. CMS gives the shortcut: multiply the fee schedule amount by 1.0925. For 90837 nationally that is $182.45. The limiting charge rarely applies in therapy practices. CMS's Medicare & Mental Health Coverage booklet (MLN1986542, March 2026) says clinical psychologists, clinical social workers, MFTs, mental health counselors, NPs and clinical nurse specialists must accept assignment.

Your license's percentage. The tool shows the full fee schedule amount. According to the same booklet, Medicare pays clinical social workers, MFTs and mental health counselors 75% of the clinical psychologist amount, and NPs and CNSs 85% of the physician amount. Apply your percentage to the tool's figure.

Step 4: Check the math yourself

Doing the calculation once makes later EOB errors easier to catch. Here it is for 90837 in Manhattan (locality 01), 2026, non-facility, non-QP, using the RVU26D October release and GPCI2026:

5.44804 × $33.4009 = $181.97.

Nationally, with every GPCI at 1.000, 90837 has 5.00 total RVUs: 5.00 × $33.4009 = $167.00.

The same method for 90834 (work 2.56, non-facility PE 0.83, MP 0.02) gives $113.90 nationally and $124.25 in Manhattan. If your MAC's figure differs from your math by more than a cent or two, check that you used the same release (CMS publishes quarterly corrections A through D), the right conversion factor, and the right setting.

Step 5: For many codes, download the files instead

If you bill a dozen codes across several localities, or you are an agency or billing company serving several practices, the files are faster than the tool.

1. Open PFS Relative Value Files on cms.gov and choose the latest 2026 release. On November 9, 2026 that was RVU26D, labeled updated 08-26-2026.

2. The zip contains the national RVU file in two versions (PPRRVU2026_Oct_nonQPP and PPRRVU2026_Oct_QPP), the GPCI file (GPCI2026) and the locality-to-county file (26LOCCO), each in CSV, TXT and Excel formats.

3. Filter the RVU file to your codes. Read the work RVU, the non-facility and facility PE RVUs, the MP RVU, the totals and the conversion factor column.

4. Apply the GPCIs for each locality with the formula above.

The RVU file also has a status code column. Most psychotherapy codes show "A" (active). 90846, family psychotherapy without the patient, shows "R," a restricted-coverage status, so read your MAC's policy before relying on it.

Common mistakes when reading the fee schedule

• Using last year's numbers. The 2026 conversion factors replaced the single 2025 factor of $32.35. A 2025 table understates 2026 rates.

• Using the QP factor by default. Unless your practice qualifies through an Advanced APM, use $33.4009.

• Using the facility column for office visits. That understates what you should receive.

• Treating Medicare as your commercial rate. Commercial and Medicaid payers set their own fee schedules. See state Medicaid behavioral health fee schedules and how carriers set allowed amounts.

• Forgetting the patient's share. Medicare generally pays 80% of the allowed amount after the Part B deductible. The patient or a secondary plan pays the rest.

A national table for common therapy codes, with locality comparisons and payment by clinician type, is in what Medicare pays for therapy in 2026.

Using these numbers on your website

The fee schedule tells you what Medicare pays. It doesn't tell new patients what you charge. If your site names the plans you accept and states self-pay fees, fewer callers have to ask. The free ClinicStats audit checks for this ("Insurance or self-pay prices stated," explained on our methodology page). It also checks whether your clinicians' names match their NPI records, using the public sources described in our public provider data guide. Scan your site free.