NYS Medicaid Rates for Mental Health Providers: What Your License Type Actually Gets Paid

One of the most common reasons therapists in New York avoid Medicaid is the assumption that the rates are not worth it. For most license types, that assumption is now wrong.

This post is written for masters-level and doctoral-level mental health clinicians in private practice in New York State - LCSWs, LMHCs, LMFTs, psychologists (PhD/PsyD), and PMHNPs. The rates you receive from New York Medicaid are not the same across all of these licenses. They come from separate fee schedules, and the differences are meaningful. Here is exactly what each credential earns under the current eMedNY fee schedules, alongside what major commercial insurers pay.

The Rate Comparison, by License Type

New York Medicaid uses separate fee schedules for different provider categories. The numbers below are sourced directly from current eMedNY published documents.

CPT 90837 — Individual Psychotherapy, 60 minutes

Credential	NYS Medicaid FFS	BCBS (NY)	UnitedHealthcare (NY)	Aetna (NY)
Psychologist (PhD/PsyD)	$153.07	$130–$200	$133–$160	$151–$175
LCSW	$145.02	$100–$165	$110–$145	$120–$155
LMHC / LMFT	$136.91	$90–$145	$95–$130	$100–$140

CPT 90834 — Individual Psychotherapy, 45 minutes

Credential	NYS Medicaid FFS	BCBS (NY)	UnitedHealthcare (NY)	Aetna (NY)
Psychologist (PhD/PsyD)	$104.59	$87–$130	$98–$120	$114–$135
LCSW	$99.08	$75–$120	$85–$110	$95–$120
LMHC / LMFT	$93.58	$70–$105	$75–$100	$80–$110

CPT 90791 — Psychiatric Diagnostic Evaluation

Credential	NYS Medicaid FFS
Psychologist (PhD/PsyD)	$168.79
LCSW	$159.90
LMHC / LMFT	Not on LMHP schedule

Additional LMHC/LMFT codes from the current eMedNY LMHP fee schedule:

Code	Service	NYS Medicaid FFS
90785	Interactive complexity add-on	$10.70
90839	Crisis psychotherapy, first 60 min	$120.68
90846	Family therapy without patient	$88.68
90847	Family therapy with patient	$91.99
90853	Group psychotherapy	$24.84

What This Actually Means by Credential

If you are a psychologist, New York Medicaid is a clear premium payer. At $153.07 for a 60-minute session, you earn more than most regional BCBS and UHC contracts in New York. The financial case for credentialing is straightforward.

If you are an LCSW, Medicaid is competitive with or ahead of most commercial contracts. At $145.02 for a 60-minute session, you are above mid-range BCBS and UHC rates across most of New York outside Manhattan's highest-negotiated contracts.

If you are an LMHC or LMFT, the picture is stronger than most people assume. At $136.91 for a 60-minute session, New York Medicaid now beats UnitedHealthcare outright ($95–$130 range) and is competitive with mid-tier BCBS contracts. Whether it beats your specific BCBS or Aetna contract depends on your market and what you negotiated, but the gap has closed significantly. Combined with the zero-bad-debt billing model and guaranteed patient pipeline, the rate alone makes a credible case for enrollment.

For context on how your current commercial rates compare, this 2026 insurance reimbursement breakdown by CPT code is worth reviewing alongside these numbers. And if you are currently weighing whether to stay in-network at all, the in-network vs. out-of-network decision guide walks through how to think about that strategically.

More Rate Increases Are Coming for Pediatric Providers

If you work with children and adolescents, there is additional upside on the way

regardless of credential.

Two active bills in the New York legislature (Senate Bill S8427 and Assembly Bill A8600) would direct $200 million into children's outpatient behavioral health services. If passed, they would trigger a 35% rate increase for therapy provided to clients under 21, plus a permanent annual inflation adjustment of 3.2% going forward.

A 35% increase on the current LMHC/LMFT 90837 rate pushes it above $184. For psychologists and LCSWs, the same bump moves those rates above $200. Providers already enrolled in eMedNY when the legislation takes effect receive those increases automatically on clean claims. Those still mid-enrollment will be waiting.

Why Insurance Plans Are Actively Trying to Add You

Right Now

A new state regulation (DFS 11 NYCRR 38) took effect July 1, 2025, requiring Medicaid

insurance plans to offer new patients an appointment within 10 business days. If a patient cannot get an appointment and files a complaint, the plan has three days to fix it or pay for an out-of-network provider at significantly higher rates.

New York already has a documented shortage of mental health providers - rural counties sit at roughly one provider per 590 residents. Many plans are regularly failing to meet the 10-day rule, which means they are actively looking for licensed clinicians at every credential level to bring into their networks.

Applications that used to take six to nine months are moving faster right now. Panels that were closed are opening. That changes once network gaps fill in. Providers who credential now will hold positions that will be harder to access 12 to 18 months from now.

For a realistic look at the full credentialing timeline, this payer-by-payer breakdown is worth reading before you start the process.

Who Can Enroll and Who Cannot

To receive reimbursement from any New York Medicaid Managed Care plan, you must first enroll directly with the state through eMedNY FFS. This has been a hard requirement since April 2023. Without it, all managed care Medicaid claims deny automatically regardless of any contracts you hold.

Fully licensed clinicians who can enroll independently: LCSWs, LMHCs, LMFTs, licensed psychologists, and PMHNPs.

Who cannot enroll independently: LMSWs, limited permit holders in counseling or marriage and family therapy, and pre-licensed clinicians of any type. Their services can be billed under the NPI of a supervising fully licensed clinician. For group practice owners, this supervised billing model is what makes Medicaid financially viable at scale.

The setup sequence - NPI, eMedNY enrollment, CAQH synchronization - has a specific order that matters. This post on what comes first walks through it clearly. A federal directive from April 2026 also requires that your CAQH ProView profile stay current within a 120-day attestation window, so this is ongoing maintenance, not a one-time task.

The Billing Simplicity Argument

Beyond the rate comparison, there is an operational case for adding Medicaid to your payer mix that applies across all credential types.

Medicaid clients have no copays, no coinsurance, and no deductibles for outpatient mental health services. There is no patient balance to collect. New York also enacted two patient billing laws in October 2024 that changed how providers can store credit cards and obtain payment consent from commercial and private-pay clients - adding compliance overhead that Medicaid billing completely sidesteps. Clean claims submitted through ePACES pay via direct deposit within about two to three weeks, with no merchant processing fees and no bad debt.

If your current billing setup has more friction than it should, this guide to building a lower-stress billing system covers the foundations.

What the Numbers Look Like in Practice

LMHC or LMFT, solo practice: At 25 sessions per week for 48 weeks at the current 90837 Medicaid rate, gross annual billings come to approximately $164,000. No marketing spend to fill the schedule, zero patient bad debt.

LCSW, solo practice: Same model at $145.02 produces approximately $174,000 annually.

Psychologist, solo practice: Same model at $153.07 produces approximately $183,000 annually.

Group practice with supervised clinicians: Pre-licensed staff billed under a supervising LCSW or psychologist at 30 sessions per week generates roughly $195,000 per clinician per year at current Medicaid rates. For a realistic look at how solo and group models actually net out after overhead, this private practice vs. group practice income comparison is a useful reference.

The Short Version

New York Medicaid is now a serious payer for every master's-level and doctoral-level mental health license type in private practice. LMHCs and LMFTs sit at $136.91 for a 60-minute session - above UnitedHealthcare and competitive with mid-tier BCBS contracts. LCSWs and psychologists earn even more. The patient demand is documented and durable. The regulatory environment is pushing MCOs to fast-track applications right now. And pending legislation could raise pediatric rates by 35%.

If you have been putting off the eMedNY enrollment process, the cost of waiting is real and growing.

Not Sure Where to Start?

The eMedNY enrollment process has different forms and sequences depending on your license type, practice structure, and whether you are enrolling solo or as part of a group. Getting the setup right the first time prevents the claim denials and CAQH revalidation issues that push timelines back by months.

A strategy session is the right starting point to map out your specific credentialing pathway and timeline before you submit anything.

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Upstate Healthcare Administration LLC provides billing and credentialing consulting services for therapy and mental health practices across New York State. This content is for informational purposes and does not constitute legal or financial advice. Fee schedule rates are sourced from current eMedNY published documents and are subject to change. Verify current rates at emedny.org before making financial projections.