Kentucky Medicaid might pay a different amount for a therapist or provider for providing the same service, with the same code number, and providing the same length of time–sixty minutes–in two different locations. This is because Kentucky does not have a single rate for each code number that applies equally to all professionals regardless of the location of treatment. Rather, there may be six different payment rates for the same service, and these rates vary only based on whether the provider is a psychiatrist, a trained nurse practitioner, a licensed counselor, a supervised auxiliary professional, a certified peer support specialist, or another approved category.
The “Kentucky Medicaid Behavioral Health Fee Schedule” tells providers how much Medicaid will pay for a specific service, what code number to use when submitting a request for payment, how the service will be billed — for example, per service provided or every 15 minutes — and what types of services providers are permitted to request reimbursement or payment from Medicaid for each specific service.
The current schedule went into effect on April 1, 2026. It was revised as of July 15, 2026, and now includes mental health as well as substance use disorder (SUD) services.
This document details the amounts that Kentucky Medicaid pays eligible providers for behavioral and mental health services covered by the Fee-for-Service (FFS) payment method.
Common Terms Used in Kentucky Medicaid Behavioral Health Billing
| ABA | Applied Behavior Analysis | Behavioral treatment services, often used for autism-related care |
| ACT | Assertive Community Treatment | Community-based mental health treatment delivered by a multidisciplinary team |
| AH | Allied Health | Provider/practitioner category |
| AMA | American Medical Association | Organization that owns the CPT code copyright |
| APRN | Advanced Practice Registered Nurse | Healthcare practitioner category |
| ASAM | American Society of Addiction Medicine | Used for levels of care in substance use treatment programs |
| BHSO | Behavioral Health Services Organization | Kentucky Medicaid behavioral health provider organization/type |
| CADC | Certified Alcohol and Drug Counselor | Substance-use-disorder counseling credential |
| CDTC | Chemical Dependency Treatment Center | Residential treatment facility/program for substance use disorders |
| CPsy | Clinical Psychologist | Provider/practitioner designation |
| DMS | Department for Medicaid Services | Kentucky Medicaid agency/department referenced for certification |
| DO | Doctor of Osteopathic Medicine | Physician credential |
| HF | HF modifier | Kentucky Medicaid billing modifier used for SUD-related services |
| HQ | HQ modifier | Modifier used to identify group services, such as group peer support |
| LABA | Licensed Assistant Behavior Analyst | Behavioral-health/ABA practitioner credential |
| LBA | Licensed Behavior Analyst | Behavioral-health/ABA practitioner credential |
| LCADC | Licensed Clinical Alcohol and Drug Counselor | Substance-use-disorder professional credential |
| LCSW | Licensed Clinical Social Worker | Mental-health professional credential |
| LMFT | Licensed Marriage and Family Therapist | Mental-health professional credential |
| LP | Licensed Psychologist | Mental-health professional credential |
| LPA | Licensed Psychological Associate | Psychology practitioner credential |
| LPP | Licensed Psychological Practitioner | Psychology practitioner credential |
| MAT | Medication-Assisted Treatment | Treatment for substance use disorders involving medication |
| MD | Doctor of Medicine | Physician credential |
| NTP | Narcotic Treatment Program | Program providing treatment for opioid/substance use disorders |
| PA | Physician Assistant | Healthcare practitioner |
| PSS | Peer Support Specialist | Provider/practitioner category for peer-support services |
| RBT | Registered Behavior Technician | ABA practitioner working under supervision |
| RCSU | Residential Crisis Stabilization Unit | Residential facility/service for crisis stabilization |
| SBIRT | Screening, Brief Intervention, and Referral to Treatment | Screening and brief counseling approach for alcohol/drug use |
| SED | Serious Emotional Disturbance | Modifier/category used for certain members receiving targeted case management |
| SMI | Serious Mental Illness | Member category used for targeted case management |
| SUD | Substance Use Disorder | Conditions involving problematic use of alcohol or drugs |
| TG | TG modifier | Kentucky Medicaid billing modifier for certain complex/co-occurring conditions |
| UA | UA modifier | Modifier used for members with SED |
| U1 | U1 modifier | Kentucky Medicaid modifier identifying the applicable PA/provider billing category |
| U4 | U4 modifier | Modifier associated with LPA/CPsy billing in the testing section |
| U7 | U7 modifier | Modifier associated with PSS/peer-support services |
| U8 | U8 modifier | Provider modifier used for specified psychological/neuropsychological testing services |
| UB | UB modifier | Modifier used to identify the 10-professional-team ACT service |
| NTP | Narcotic Treatment Program | Also appears in the NTP-specific billing section |
Kentucky Medicaid Reimbursement Rates for Behavioral Health (by Practitioner Type)
There is no single fixed amount for each procedure code number in the payment for services provided under Kentucky Medicaid. For a single code number, there can be up to six different rates of payment, depending on the type of professional providing the service.
This is because Medicaid pays different types of professionals at different rates. Physicians or specialists who are formally licensed to practice independently, such as therapists or psychologists, are paid more. Compared to this, individuals who are working under someone’s supervision, who only have the relevant certification rather than independent professional authorization, or who are serving as support professionals are paid less.
So before looking at the payment amount listed against a procedure in any of the tables below, be sure to look at this info. This will show what kind of professionals and what additional code symbols each column represents.
| Column | Modifier | Practitioner Type | Provider Type Code |
| Col 1 | AF | Psychiatrist | 64 |
| Col 1 | AM | MD/DO (Physician) | 64 |
| Col 2 | SA | APRN (Advanced Practice Registered Nurse) | 78 |
| Col 2 | AH | Licensed Clinical Psychologist | 89 |
| Col 2 | U1 | Physician Assistant | 95 |
| Col 3 | U8 | LPP (Licensed Psychological Practitioner) or CPsy with Autonomous Functioning, working with a supervisor | 84 |
| Col 3 | AJ | LCSW (Licensed Clinical Social Worker), working with a supervisor | 82 |
| Col 3 | HO | LPCC (Licensed Professional Clinical Counselor) | 81 |
| Col 3 | HO | LMFT (Licensed Marriage and Family Therapist) | 83 |
| Col 3 | HO | LPAT (Licensed Professional Art Therapist) | 62 |
| Col 3 | HO | LBA (Licensed Behavior Analyst) | 63 |
| Col 3 | HO | LCADC (Licensed Clinical Alcohol and Drug Counselor) | 67 |
| Col 4 | U4 | Associate-level practitioners who require supervision: LPA, CPsy/CSW, LPCA, MFTA, LPATA, LABA, LCADCA | — |
| Col 5 | U6 | CADC (Certified Alcohol and Drug Counselor) | — |
| Col 6 | U7 | PSS (Peer Support Specialist) | — |
| Col 6 | UC | CSA and RBT (Registered Behavior Technician) and other non-bachelor’s staff | — |
Practitioner Reimbursement Levels and Rate Calculation: Example Using CPT 90837
| Practitioner Column & Provider Types | Code Rate & Unit | Calculation / Rate Relationship |
| Column 1 — Psychiatrist, MD/DO | $121.88 per 60 minutes | Base rate = $121.88 |
| Column 2 — APRN, Licensed Clinical Psychologist, PA | $103.59 per 60 minutes | $121.88 × 85% ≈ $103.59 |
| Column 3 — Licensed Master’s-Level Providers | $97.50 per 60 minutes | $121.88 × 80% ≈ $97.50 |
| Column 4 — Associate-Level Providers Under Supervision | $85.31 per 60 minutes | $121.88 × 70% ≈ $85.31 |
| Column 5 — CADC | $60.94 per 60 minutes | $121.88 × 50% = $60.94 |
Note: The percentage rates listed here are general levels of payment. However some code numbers are also specified to be used only by certain types of service providers. Professional qualifications, additional code symbols, supervised work requirements and other relevant requirements may also apply in deciding whether a person is eligible for a particular rate.
Kentucky Medicaid behavioral health rate index
Rates differ by practitioner level, so pick your tier below and every figure updates to what you can actually bill.
Show rates for — flat-rate codes stay visible for every tier
Office Visits (E&M)7 codes
Standard medical visits used for psychiatric medication management. Also billable at identical rates under the Narcotic Treatment Program.
- These same codes are billable under an enrolled Narcotic Treatment Program at identical rates.
- Only Physician and APRN/PA columns apply — not available to Master's, Associate, or CADC-level practitioners.
99202New patient visit, 15–29 minper visit$44.83–$52.74$52.74$44.83
- Physician / Psychiatrist (MD, DO)$52.74per visit
- APRN / Physician Assistant$44.83per visitAPRN must use modifier SA; PA must use modifier U1
99203New patient visit, 30–44 minper visit$70.50–$82.94$82.94$70.50
- Physician / Psychiatrist (MD, DO)$82.94per visit
- APRN / Physician Assistant$70.50per visitAPRN must use modifier SA; PA must use modifier U1
99204New patient visit, 45–59 minper visit$106.79–$125.64$125.64$106.79
- Physician / Psychiatrist (MD, DO)$125.64per visit
- APRN / Physician Assistant$106.79per visitAPRN must use modifier SA; PA must use modifier U1
99205New patient visit, 60–74 minper visit$142.69–$167.87$167.87$142.69
- Physician / Psychiatrist (MD, DO)$167.87per visit
- APRN / Physician Assistant$142.69per visitAPRN must use modifier SA; PA must use modifier U1
99213Established patient visit, 20–29 minper visit$57.07–$67.14$67.14$57.07
- Physician / Psychiatrist (MD, DO)$67.14per visit
- APRN / Physician Assistant$57.07per visitAPRN must use modifier SA; PA must use modifier U1
99214Established patient visit, 30–39 minper visit$81.47–$95.85$95.85$81.47
- Physician / Psychiatrist (MD, DO)$95.85per visit
- APRN / Physician Assistant$81.47per visitAPRN must use modifier SA; PA must use modifier U1
99215Established patient visit, 40–54 minper visit$115.77–$136.20$136.20$115.77
- Physician / Psychiatrist (MD, DO)$136.20per visit
- APRN / Physician Assistant$115.77per visitAPRN must use modifier SA; PA must use modifier U1
Tobacco Cessation & SBIRT4 codes
Short, add-on-style counseling visits for smoking cessation and alcohol/drug screening.
99406Smoking cessation counseling, 3–10 minper visit$5.47–$10.94$10.94$9.30$8.75$7.66$5.47
- Physician / Psychiatrist (MD, DO)$10.94per visit
- APRN / Physician Assistant$9.30per visit
- Master's-Level Practitioner (With Supervision)$8.75per visit
- Associate-Level Practitioner$7.66per visit
- CADC / Other Certified Provider$5.47per visit
99407Smoking cessation counseling, 10+ minper visit$10.40–$20.79$20.79$17.67$16.63$14.55$10.40
- Physician / Psychiatrist (MD, DO)$20.79per visit
- APRN / Physician Assistant$17.67per visit
- Master's-Level Practitioner (With Supervision)$16.63per visit
- Associate-Level Practitioner$14.55per visit
- CADC / Other Certified Provider$10.40per visit
99408SBIRT screening/brief intervention, 15–30 minper visit$10.97–$21.95$21.95$18.65$17.55$15.36$10.97
- Physician / Psychiatrist (MD, DO)$21.95per visit
- APRN / Physician Assistant$18.65per visit
- Master's-Level Practitioner (With Supervision)$17.55per visit
- Associate-Level Practitioner$15.36per visit
- CADC / Other Certified Provider$10.97per visit
99409SBIRT screening/brief intervention, 30+ minper visit$20.92–$55.65$55.65$47.30$44.52$38.95$20.92
- Physician / Psychiatrist (MD, DO)$55.65per visit
- APRN / Physician Assistant$47.30per visit
- Master's-Level Practitioner (With Supervision)$44.52per visit
- Associate-Level Practitioner$38.95per visit
- CADC / Other Certified Provider$20.92per visit
Psychiatric Diagnostic Evaluation2 codes
The intake visit where a provider works out the client's diagnosis.
90791Diagnostic evaluation, no medical componentper visit$90.67–$129.53$129.53$110.10$103.63$90.67
- Physician / Psychiatrist (MD, DO)$129.53per visit
- APRN / Physician Assistant$110.10per visit
- Master's-Level Practitioner (With Supervision)$103.63per visit
- Associate-Level Practitioner$90.67per visit
- CADC / Other Certified ProviderNot billable
90792Diagnostic evaluation, with medical componentper visit$124.45–$146.42$146.42$124.45
- Physician / Psychiatrist (MD, DO)$146.42per visit
- APRN / Physician Assistant$124.45per visitAPRN must use modifier SA; PA must use modifier U1
- Master's-Level Practitioner (With Supervision)Not billable
- Associate-Level PractitionerNot billable
Individual Psychotherapy7 codes
Talk therapy — rate rises with session length. Separate codes exist for when therapy is billed together with a same-day medical visit.
- The 90833/90836/90838 add-on codes require a same-day E&M visit and are restricted to Physician, APRN, or PA.
90832Individual psychotherapy, 30 min — standaloneper visit$31.32–$62.63$62.63$53.24$50.11$43.84$31.32
- Physician / Psychiatrist (MD, DO)$62.63per visit
- APRN / Physician Assistant$53.24per visit
- Master's-Level Practitioner (With Supervision)$50.11per visit
- Associate-Level Practitioner$43.84per visit
- CADC / Other Certified Provider$31.32per visit
90833Individual psychotherapy, 30 min — with an E&M visitper visitAdd-on$50.27–$59.14$59.14$50.27
- Physician / Psychiatrist (MD, DO)$59.14per visit
- APRN / Physician Assistant$50.27per visitAPRN must use modifier SA; PA must use modifier U1
- Must be billed alongside an allowable E&M code (99202–99205 or 99213–99215).
- Only Physician, APRN, or PA may render this code.
90834Individual psychotherapy, 45 min — standaloneper visit$41.54–$83.07$83.07$70.61$66.46$58.15$41.54
- Physician / Psychiatrist (MD, DO)$83.07per visit
- APRN / Physician Assistant$70.61per visit
- Master's-Level Practitioner (With Supervision)$66.46per visit
- Associate-Level Practitioner$58.15per visit
- CADC / Other Certified Provider$41.54per visit
90836Individual psychotherapy, 45 min — with an E&M visitper visitAdd-on$63.67–$74.90$74.90$63.67
- Physician / Psychiatrist (MD, DO)$74.90per visit
- APRN / Physician Assistant$63.67per visitAPRN must use modifier SA; PA must use modifier U1
- Must be billed alongside an allowable E&M code (99202–99205 or 99213–99215).
- Only Physician, APRN, or PA may render this code.
90837Individual psychotherapy, 60 min — standaloneper visit$60.94–$121.88$121.88$103.59$97.50$85.31$60.94
- Physician / Psychiatrist (MD, DO)$121.88per visit
- APRN / Physician Assistant$103.59per visit
- Master's-Level Practitioner (With Supervision)$97.50per visit
- Associate-Level Practitioner$85.31per visit
- CADC / Other Certified Provider$60.94per visit
90838Individual psychotherapy, 60 min — with an E&M visitper visitAdd-on$84.25–$99.11$99.11$84.25
- Physician / Psychiatrist (MD, DO)$99.11per visit
- APRN / Physician Assistant$84.25per visitAPRN must use modifier SA; PA must use modifier U1
- Must be billed alongside an allowable E&M code (99202–99205 or 99213–99215).
- Only Physician, APRN, or PA may render this code.
H0004Behavioral health counseling and therapy (pairs with 90837)15-minute units$14.50–$28.99$28.99$24.64$23.19$20.30$14.50
- Physician / Psychiatrist (MD, DO)$28.9915-minute units
- APRN / Physician Assistant$24.6415-minute units
- Master's-Level Practitioner (With Supervision)$23.1915-minute units
- Associate-Level Practitioner$20.3015-minute units
- CADC / Other Certified Provider$14.5015-minute units
- Must be billed on the same date of service as 90837.
- Limited to 8 units maximum per client, per date of service.
Crisis Therapy, Psychoanalysis & Add-On4 codes
Urgent mental-health-emergency therapy, psychoanalysis, and the interactive-complexity add-on.
90839Crisis therapy, first 60 minper visit$58.44–$116.87$116.87$99.34$93.50$81.81$58.44
- Physician / Psychiatrist (MD, DO)$116.87per visit
- APRN / Physician Assistant$99.34per visit
- Master's-Level Practitioner (With Supervision)$93.50per visit
- Associate-Level Practitioner$81.81per visit
- CADC / Other Certified Provider$58.44per visit
90840Crisis therapy, each additional 30 minper unitAdd-on$28.11–$56.21$56.21$47.78$44.97$39.35$28.11
- Physician / Psychiatrist (MD, DO)$56.21per unit
- APRN / Physician Assistant$47.78per unit
- Master's-Level Practitioner (With Supervision)$44.97per unit
- Associate-Level Practitioner$39.35per unit
- CADC / Other Certified Provider$28.11per unit
- Must be billed together with 90839.
90845Psychoanalysisper visit$55.67–$79.52$79.52$67.59$63.62$55.67
- Physician / Psychiatrist (MD, DO)$79.52per visit
- APRN / Physician Assistant$67.59per visit
- Master's-Level Practitioner (With Supervision)$63.62per visit
- Associate-Level Practitioner$55.67per visit
- CADC / Other Certified ProviderNot billable
90785Psychiatric services complicated by a communication factorper visitAdd-on$5.42–$10.83$10.83$9.21$8.66$7.58$5.42
- Physician / Psychiatrist (MD, DO)$10.83per visit
- APRN / Physician Assistant$9.21per visit
- Master's-Level Practitioner (With Supervision)$8.66per visit
- Associate-Level Practitioner$7.58per visit
- CADC / Other Certified Provider$5.42per visit
- Add-on code — must be billed with a diagnostic evaluation (90791/90792), standard psychotherapy (90832, 90834, 90837), psychotherapy with an E&M visit (90833, 90836, 90838, 99202–99205, 99213–99215), or group psychotherapy (90853).
Family and Group Therapy4 codes
Sessions involving family members or multiple clients at once.
90846Family psychotherapy, without patient presentper visit$39.12–$78.23$78.23$66.50$62.59$54.76$39.12
- Physician / Psychiatrist (MD, DO)$78.23per visit
- APRN / Physician Assistant$66.50per visit
- Master's-Level Practitioner (With Supervision)$62.59per visit
- Associate-Level Practitioner$54.76per visit
- CADC / Other Certified Provider$39.12per visit
90847Family psychotherapy, with patient presentper visit$40.51–$81.02$81.02$68.86$64.81$56.71$40.51
- Physician / Psychiatrist (MD, DO)$81.02per visit
- APRN / Physician Assistant$68.86per visit
- Master's-Level Practitioner (With Supervision)$64.81per visit
- Associate-Level Practitioner$56.71per visit
- CADC / Other Certified Provider$40.51per visit
90849Multiple-family group psychotherapyper visit$14.41–$28.82$28.82$24.50$23.06$20.18$14.41
- Physician / Psychiatrist (MD, DO)$28.82per visit
- APRN / Physician Assistant$24.50per visit
- Master's-Level Practitioner (With Supervision)$23.06per visit
- Associate-Level Practitioner$20.18per visit
- CADC / Other Certified Provider$14.41per visit
90853Group psychotherapy (not multiple-family)per visit$11.07–$22.13$22.13$18.81$17.71$15.49$11.07
- Physician / Psychiatrist (MD, DO)$22.13per visit
- APRN / Physician Assistant$18.81per visit
- Master's-Level Practitioner (With Supervision)$17.71per visit
- Associate-Level Practitioner$15.49per visit
- CADC / Other Certified Provider$11.07per visit
Other Psychiatric Services6 codes
Narcosynthesis, ECT, biofeedback, collateral therapy, and unlisted services.
90865Narcosynthesis (psychiatric diagnostic/therapeutic)per visit$103.52–$121.79$121.79$103.52
- Physician / Psychiatrist (MD, DO)$121.79per visit
- APRN / Physician Assistant$103.52per visitAPRN must use modifier SA; PA must use modifier U1
- Master's-Level Practitioner (With Supervision)Not billable
- Associate-Level PractitionerNot billable
90870Electroconvulsive therapy (includes monitoring)per treatment$128.39$128.39
- Physician / Psychiatrist (MD, DO)$128.39per treatment
- APRN / Physician AssistantNot billable
90875Individual psychophysiological therapy with biofeedback, 30 minper visit$23.19–$33.13$33.13$28.16$26.51$23.19
- Physician / Psychiatrist (MD, DO)$33.13per visit
- APRN / Physician Assistant$28.16per visit
- Master's-Level Practitioner (With Supervision)$26.51per visit
- Associate-Level Practitioner$23.19per visit
90876Individual psychophysiological therapy with biofeedback, 45 minper visit$36.09–$51.55$51.55$43.82$41.24$36.09
- Physician / Psychiatrist (MD, DO)$51.55per visit
- APRN / Physician Assistant$43.82per visit
- Master's-Level Practitioner (With Supervision)$41.24per visit
- Associate-Level Practitioner$36.09per visit
90887Collateral therapyper visit$33.16–$66.32$66.32$56.37$53.05$46.42$33.16
- Physician / Psychiatrist (MD, DO)$66.32per visit
- APRN / Physician Assistant$56.37per visit
- Master's-Level Practitioner (With Supervision)$53.05per visit
- Associate-Level Practitioner$46.42per visitListed with an additional CADC-tier reference in the source schedule — verify current listing before billing.
- CADC / Other Certified Provider$33.16per visit
90899Unlisted psychiatric service or procedureper visit$15.76–$22.52$22.52$19.14$18.01$15.76
- Physician / Psychiatrist (MD, DO)$22.52per visit
- APRN / Physician Assistant$19.14per visit
- Master's-Level Practitioner (With Supervision)$18.01per visit
- Associate-Level Practitioner$15.76per visit
Psychological & Neuropsychological Testing18 codes
Formal testing — IQ, memory, developmental, and cognitive assessments. No CADC-tier billing on any code in this group.
- Some codes are limited to MD/DO, Licensed Psychologist, Licensed Psychological Practitioner, Certified Psychologist with Autonomous Functioning, Licensed Psychological Associate, or Certified Psychologist.
- Some codes are limited to MD/DO, Licensed Psychologist, Licensed Psychological Practitioner, or Certified Psychologist with Autonomous Functioning.
- Some codes are limited to Physician, Licensed Behavior Analyst, Licensed Assistant Behavior Analyst, Technician, or another qualified healthcare professional as listed.
- Check each code above for its own provider-type and modifier restrictions — they vary code to code.
96105Assessment of aphasiaper hour$49.72–$71.03$71.03$60.37$56.82$49.72
- Physician / Psychiatrist (MD, DO)$71.03per hour
- APRN / Physician Assistant$60.37per hour
- Master's-Level Practitioner (With Supervision)$56.82per hour
- Associate-Level Practitioner$49.72per hour
96110Developmental screening (scoring & documentation)per event$23.57–$33.67$33.67$28.62$29.93$23.57
- Physician / Psychiatrist (MD, DO)$33.67per event
- APRN / Physician Assistant$28.62per event
- Master's-Level Practitioner (With Supervision)$29.93per event
- Associate-Level Practitioner$23.57per event
96112Developmental test administration, first hour60 min$64.89–$92.70$92.70$78.80$74.16$64.89
- Physician / Psychiatrist (MD, DO)$92.7060 min
- APRN / Physician Assistant$78.8060 min
- Master's-Level Practitioner (With Supervision)$74.1660 min
- Associate-Level Practitioner$64.8960 min
96113Developmental test administration, additional30 minAdd-on$30.50–$43.57$43.57$37.03$34.85$30.50
- Physician / Psychiatrist (MD, DO)$43.5730 min
- APRN / Physician Assistant$37.0330 min
- Master's-Level Practitioner (With Supervision)$34.8530 min
- Associate-Level Practitioner$30.5030 min
- Add-on to 96112.
96116Neurobehavioral status exam, first hour60 min$54.96–$68.70$68.70$58.40$54.96
- Physician / Psychiatrist (MD, DO)$68.7060 min
- APRN / Physician Assistant$58.4060 min
- Master's-Level Practitioner (With Supervision)$54.9660 minRequires modifier U8
- Associate-Level PractitionerNot billable
96121Neurobehavioral status exam, additional hour60 minAdd-on$46.26–$57.83$57.83$49.15$46.26
- Physician / Psychiatrist (MD, DO)$57.8360 min
- APRN / Physician Assistant$49.1560 min
- Master's-Level Practitioner (With Supervision)$46.2660 minRequires modifier U8
- Associate-Level PractitionerNot billable
- Add-on to 96116.
96125Standardized cognitive performance testing60 min$52.29–$75.70$75.70$63.50$59.76$52.29
- Physician / Psychiatrist (MD, DO)$75.7060 min
- APRN / Physician Assistant$63.5060 min
- Master's-Level Practitioner (With Supervision)$59.7660 min
- Associate-Level Practitioner$52.2960 min
96127Brief emotional/behavioral assessmentper event$2.34–$3.35$3.35$2.84$2.68$2.34
- Physician / Psychiatrist (MD, DO)$3.35per event
- APRN / Physician Assistant$2.84per event
- Master's-Level Practitioner (With Supervision)$2.68per event
- Associate-Level Practitioner$2.34per event
96130Psychological testing evaluation, first hour60 min$62.86–$89.80$89.80$76.33$71.84$62.86
- Physician / Psychiatrist (MD, DO)$89.8060 min
- APRN / Physician Assistant$76.3360 min
- Master's-Level Practitioner (With Supervision)$71.8460 minRequires modifier U8
- Associate-Level Practitioner$62.8660 minLicensed Psychological Associate / Certified Psychologist only — requires modifier U4
96131Psychological testing evaluation, additional hour60 minAdd-on$45.80–$65.43$65.43$55.62$52.34$45.80
- Physician / Psychiatrist (MD, DO)$65.4360 min
- APRN / Physician Assistant$55.6260 min
- Master's-Level Practitioner (With Supervision)$52.3460 minRequires modifier U8
- Associate-Level Practitioner$45.8060 minLicensed Psychological Associate / Certified Psychologist only — requires modifier U4
- Add-on to 96130.
96132Neuropsychological testing evaluation, first hour60 min$75.97–$94.97$94.97$80.72$75.97
- Physician / Psychiatrist (MD, DO)$94.9760 min
- APRN / Physician Assistant$80.7260 min
- Master's-Level Practitioner (With Supervision)$75.9760 minRequires modifier U8
- Associate-Level PractitionerNot billable
96133Neuropsychological testing evaluation, additional30 minAdd-on$58.85–$73.57$73.57$62.53$58.85
- Physician / Psychiatrist (MD, DO)$73.5730 min
- APRN / Physician Assistant$62.5330 min
- Master's-Level Practitioner (With Supervision)$58.8530 minRequires modifier U8
- Associate-Level PractitionerNot billable
96136Test administration & scoring, first 30 min30 min$21.80–$31.15$31.15$26.48$24.92$21.80
- Physician / Psychiatrist (MD, DO)$31.1530 min
- APRN / Physician Assistant$26.4830 min
- Master's-Level Practitioner (With Supervision)$24.9230 minRequires modifier U8
- Associate-Level Practitioner$21.8030 minLicensed Psychological Associate / Certified Psychologist only — requires modifier U4
- May be billed with 96130–96133, same day or different day.
96137Test administration & scoring, additional 30 min30 minAdd-on$19.55–$27.93$27.93$23.74$22.34$19.55
- Physician / Psychiatrist (MD, DO)$27.9330 min
- APRN / Physician Assistant$23.7430 min
- Master's-Level Practitioner (With Supervision)$22.3430 minRequires modifier U8
- Associate-Level Practitioner$19.5530 minLicensed Psychological Associate / Certified Psychologist only — requires modifier U4
- Add-on to 96136.
96138Test administration by technician, first 30 min30 min$17.62–$25.17$25.17$21.39$20.14$17.62
- Physician / Psychiatrist (MD, DO)$25.1730 min
- APRN / Physician Assistant$21.3930 min
- Master's-Level Practitioner (With Supervision)$20.1430 minRequires modifier U8
- Associate-Level Practitioner$17.6230 minLicensed Psychological Associate / Certified Psychologist only — requires modifier U4
- May be billed with 96138/96139 same or different day as related testing codes.
96139Test administration by technician, additional 30 min30 minAdd-on$16.53–$23.61$23.61$20.07$18.89$16.53
- Physician / Psychiatrist (MD, DO)$23.6130 min
- APRN / Physician Assistant$20.0730 min
- Master's-Level Practitioner (With Supervision)$18.8930 minRequires modifier U8
- Associate-Level Practitioner$16.5330 minLicensed Psychological Associate / Certified Psychologist only — requires modifier U4
- Add-on to 96138.
96146Automated single-instrument testing, electronic platformper event$1.10–$1.57$1.57$1.33$1.25$1.10
- Physician / Psychiatrist (MD, DO)$1.57per event
- APRN / Physician Assistant$1.33per event
- Master's-Level Practitioner (With Supervision)$1.25per eventRequires modifier U8
- Associate-Level Practitioner$1.10per eventLicensed Psychological Associate / Certified Psychologist only — requires modifier U4
96156Health behavior assessment or re-assessment (primary care/hospital settings)per event$66.64–$78.40$78.40$66.64
- Physician / Psychiatrist (MD, DO)$78.40per event
- APRN / Physician Assistant$66.64per eventAPRN=SA, PA=U1, and Allied Health
Applied Behavior Analysis (ABA)8 codes
Behavior identification assessments and adaptive behavior treatment, most often used for autism-related services.
- 97152, 97153, and 97154 are billable only by a Registered Behavior Technician (RBT), regardless of tier.
97151Behavior identification assessment15 min$19.25–$27.50$27.50$23.37$21.99$19.25
- Physician / Psychiatrist (MD, DO)$27.5015 min
- APRN / Physician Assistant$23.3715 min
- Master's-Level Practitioner (With Supervision)$21.9915 min
- Associate-Level Practitioner$19.2515 min
97152Behavior identification supporting assessment15 minAdd-on$12.18$12.18
- Associate-Level Practitioner$12.1815 minRegistered Behavior Technician (RBT) only
- Registered Behavior Technician (RBT)$12.1815 minRBT only
97153Adaptive behavior treatment by protocol, individual15 min$12.18$12.18
- Associate-Level Practitioner$12.1815 minRegistered Behavior Technician (RBT) only
- Registered Behavior Technician (RBT)$12.1815 minRBT only
97154Group adaptive behavior treatment by protocol15 min$12.18$12.18
- Associate-Level Practitioner$12.1815 minRegistered Behavior Technician (RBT) only
- Registered Behavior Technician (RBT)$12.1815 minRBT only
97155Adaptive behavior treatment with protocol modification15 min$19.25–$27.50$27.50$23.37$21.99$19.25
- Physician / Psychiatrist (MD, DO)$27.5015 min
- APRN / Physician Assistant$23.3715 min
- Master's-Level Practitioner (With Supervision)$21.9915 min
- Associate-Level Practitioner$19.2515 min
97156Family adaptive behavior treatment guidance15 min$14.94–$21.35$21.35$18.13$17.09$14.94
- Physician / Psychiatrist (MD, DO)$21.3515 min
- APRN / Physician Assistant$18.1315 min
- Master's-Level Practitioner (With Supervision)$17.0915 min
- Associate-Level Practitioner$14.9415 min
97157Multiple-family group adaptive behavior treatment guidance15 min$7.57–$10.81$10.81$9.18$8.65$7.57
- Physician / Psychiatrist (MD, DO)$10.8115 min
- APRN / Physician Assistant$9.1815 min
- Master's-Level Practitioner (With Supervision)$8.6515 min
- Associate-Level Practitioner$7.5715 min
97158Group adaptive behavior treatment with protocol modification15 min$7.57–$10.81$10.81$9.18$8.65$7.57
- Physician / Psychiatrist (MD, DO)$10.8115 min
- APRN / Physician Assistant$9.1815 min
- Master's-Level Practitioner (With Supervision)$8.6515 min
- Associate-Level Practitioner$7.5715 min
Community-Based & Crisis Services21 codes
HCPCS "H" codes for assessments, screenings, day treatment, case management, and crisis response delivered in the community.
- H0001, H0031, H0032, T1007, H0038, and H0038 HQ also appear in the Narcotic Treatment Program group at identical rates — they're shared codes both general community providers and enrolled NTPs may bill.
H0001Alcohol and/or drug assessmentper event$46.76–$93.50$93.50$79.48$74.79$65.45$46.76
- Physician / Psychiatrist (MD, DO)$93.50per event
- APRN / Physician Assistant$79.48per event
- Master's-Level Practitioner (With Supervision)$74.79per event
- Associate-Level Practitioner$65.45per event
- CADC / Other Certified Provider$46.76per event
H0002Behavioral health screening (treatment admission eligibility)per event$65.45–$93.50$93.50$79.48$74.79$65.45
- Physician / Psychiatrist (MD, DO)$93.50per event
- APRN / Physician Assistant$79.48per event
- Master's-Level Practitioner (With Supervision)$74.79per event
- Associate-Level Practitioner$65.45per event
H0015Alcohol/drug services, Intensive Outpatient Programper diem$135.72
- Flat rate — all practitioner types$135.72per diem
H0025Behavioral health prevention education serviceper event$13.26–$26.54$26.54$22.55$21.22$18.58$13.26
- Physician / Psychiatrist (MD, DO)$26.54per event
- APRN / Physician Assistant$22.55per event
- Master's-Level Practitioner (With Supervision)$21.22per event
- Associate-Level Practitioner$18.58per event
- CADC / Other Certified Provider$13.26per event
H0031Mental health assessment by a non-physicianper event$65.45–$79.48$79.48$74.79$65.45
- APRN / Physician Assistant$79.48per event
- Master's-Level Practitioner (With Supervision)$74.79per event
- Associate-Level Practitioner$65.45per event
H0032Mental health service plan development by a non-physicianper event$65.45–$79.48$79.48$74.79$65.45
- APRN / Physician Assistant$79.48per event
- Master's-Level Practitioner (With Supervision)$74.79per event
- Associate-Level Practitioner$65.45per event
H0035Partial hospitalization (under 24 hrs)per diem$203.03
- Flat rate — all practitioner types$203.03per diem
H0038Self-help/peer services, individual15 min$9.35
- Peer Support Specialist (PSS)$9.3515 minRequires modifier U7
H0038 HQSelf-help/peer services, group15 min$3.87
- Peer Support Specialist (PSS)$3.8715 minRequires modifier U7 and HQ (group)
H0040Assertive Community Treatment (ACT), 4-professional teamper month$814.31
- Flat rate$814.31per month
H0040 UBAssertive Community Treatment (ACT), 10-professional teamper month$1,085.75
- Flat rate$1,085.75per monthRequires modifier UB
H0049Alcohol/drug screening & brief intervention, under 15 min1–14 min$10.02–$26.12$26.12$22.21$20.90$19.60$10.02
- Physician / Psychiatrist (MD, DO)$26.121–14 min
- APRN / Physician Assistant$22.211–14 min
- Master's-Level Practitioner (With Supervision)$20.901–14 min
- Associate-Level Practitioner$19.601–14 min
- CADC / Other Certified Provider$10.021–14 min
H2011Crisis intervention service15 min$11.69–$23.38$23.38$19.87$18.69$16.36$11.69
- Physician / Psychiatrist (MD, DO)$23.3815 min
- APRN / Physician Assistant$19.8715 min
- Master's-Level Practitioner (With Supervision)$18.6915 min
- Associate-Level Practitioner$16.3615 min
- CADC / Other Certified Provider$11.6915 min
H2012Behavioral health day treatmentper hour$46.75–$93.50$93.50$79.48$74.79$65.45$46.75
- Physician / Psychiatrist (MD, DO)$93.50per hour
- APRN / Physician Assistant$79.48per hour
- Master's-Level Practitioner (With Supervision)$74.79per hour
- Associate-Level Practitioner$65.45per hour
- CADC / Other Certified Provider$46.75per hour
H2015Comprehensive community support services15 min$9.35–$23.38$23.38$19.87$18.69$16.36
- Physician / Psychiatrist (MD, DO)$23.3815 min
- APRN / Physician Assistant$19.8715 min
- Master's-Level Practitioner (With Supervision)$18.6915 min
- Associate-Level Practitioner$16.3615 min
- Additional certified provider category$9.3515 min
H2019Therapeutic rehabilitation15 min$13.58
- Flat rate — Physician through Associate tiers$13.5815 min
- Limited to 12 units per day, per individual.
H2020Therapeutic rehabilitation, more than 3 hrs/dayper diem$244.29
- Flat rate — all practitioner types$244.29per diem
S9480Intensive outpatient psychiatric servicesper diem$135.72
- Flat rate — all practitioner types$135.72per diem
S9484Mobile crisis serviceper 60 min$46.81–$93.61$93.61$79.48$74.81$65.45$46.81
- Physician / Psychiatrist (MD, DO)$93.61per 60 min
- APRN / Physician Assistant$79.48per 60 min
- Master's-Level Practitioner (With Supervision)$74.81per 60 min
- Associate-Level Practitioner$65.45per 60 min
- CADC / Other Certified Provider$46.81per 60 min
T1007Alcohol/substance abuse services — treatment plan development or modificationper event$46.81–$93.61$93.61$79.48$74.81$65.45$46.81
- Physician / Psychiatrist (MD, DO)$93.61per event
- APRN / Physician Assistant$79.48per event
- Master's-Level Practitioner (With Supervision)$74.81per event
- Associate-Level Practitioner$65.45per event
- CADC / Other Certified Provider$46.81per event
T2023Targeted Case Managementper month$362.64–$587.39
- Standard rate — SED members$362.64per monthUse modifier UA
- Standard rate — SMI members$362.64per monthUse modifier HE
- Co-occurring mental health/SUD + complex physical health$587.39per monthUse modifier TG; BHSO Tier II providers must also add modifier HF
- Substance use disorder members$362.64per monthUse modifier HF
Narcotic Treatment Program (NTP)7 codes
Billable only by enrolled Narcotic Treatment Programs, under Provider Type 03 (BHSO) or Tier II NTP. Standard office-visit codes (99202–99215) are also billable here at the rates shown in Office Visits.
- Only the codes listed here (plus 99202–99215) are billable by an enrolled NTP.
- H0020 and H0047 are weekly bundled codes. The following are already included in that weekly rate and cannot be billed separately on top of it: 80305, 80306, 90785, 90832, 90834, 90837, 90839, 90840, 90853, H0015, and H0004.
- H0020, H0016, and H0047 are exclusive to NTPs and don't appear elsewhere on the fee schedule.
H0020Methadone MAT bundleweekly$114.00
- NTP-enrolled provider$114.00weeklyRequires modifier HF
H0016Buprenorphine or methadone inductionper event$217.15$217.15$217.15
- Physician / Psychiatrist (MD, DO)$217.15per eventRequires modifier HF
- APRN / Physician Assistant$217.15per eventAPRN must use modifier SA; PA must use modifier U1. Also requires modifier HF
- Limited to 4 events per year, per client.
H0038Self-help/peer services, individual (NTP)15 min$9.35
- Peer Support Specialist (PSS)$9.3515 min
H0038 HQGroup peer support services (NTP)15 min$3.87
- Peer Support Specialist (PSS)$3.8715 minRequires modifier HQ to designate group service
H0047Buprenorphine MAT bundleweekly$124.86
- NTP-enrolled provider$124.86weeklyRequires modifier HF
T1007Alcohol/substance abuse services — treatment plan development or modification (NTP)per event$46.81–$93.61$93.61$79.48$74.81$65.45$46.81
- Physician / Psychiatrist (MD, DO)$93.61per event
- APRN / Physician Assistant$79.48per event
- Master's-Level Practitioner (With Supervision)$74.81per event
- Associate-Level Practitioner$65.45per event
- CADC / Other Certified Provider$46.81per event
T2023Targeted case management, SUD (NTP)per month$362.64
- NTP-enrolled provider$362.64per monthRequires modifier HF
Residential SUD Treatment Programs2 codes
Per-diem codes billable only by Provider Type 03 (BHSO Tier III) licensed residential programs.
H0011Residential treatment program (SUD)per diem$320.30
- Licensed residential SUD program$320.30per diem
- For programs with Provisional Certification by DMS/CARF at ASAM Level of Care 3.5 (excludes room and board).
H2034Residential treatment program (SUD)per diem$271.44
- Licensed residential SUD program$271.44per diem
- For programs with Provisional Certification by DMS/CARF at ASAM Level of Care 3.1 (excludes room and board).
Residential Crisis Stabilization & CDTC3 codes
Codes for Residential Crisis Stabilization Units (RCSU, Provider Type 26) and Chemical Dependency Treatment Centers (CDTC, Provider Type 06).
H0011Residential treatment (within a CDTC)per diem$320.30
- Chemical Dependency Treatment Center (Provider Type 06)$320.30per diem
- For CDTC SUD programs with Provisional Certification at ASAM Level of Care 3.5 (excludes room and board).
H2036Alcohol and/or drug treatment programper diem$408.24
- RCSU or CDTC$408.24per diem
- For RCSUs treating SUD, or CDTCs, at ASAM Level of Care 3.7.
- Must be billed by Provider Type 26 (RCSU) or, in the CDTC context, Provider Type 06.
S9485Crisis intervention mental health serviceper diem$408.24
- Residential Crisis Stabilization Unit (Provider Type 26)$408.24per diem
- Primary mental health diagnosis treatment service.
- Must be billed by Provider Type 26 (RCSU).
No codes match. Try the code on its own, or switch back to all practitioners.
Rates are Kentucky Medicaid fee-for-service maximums for behavioral health services and may differ from managed care organisation rates. Modifier requirements shown against a rate are required for that practitioner type. Confirm current rates with DMS before billing.
KY Medicaid Rates for Office Visits (Evaluation & Management)
The table shows standard KY Medicaid rates for medical office visits used for psychiatric medication management and evaluation. New patient visits (99202–99205) pay more than visits for returning, established patients (99213–99215). Also, col 1 pays more than col 2.
| Code | Service | MD/DO, Psychiatrist (col 1) | APRN / PA (col 2) |
| 99202 | New patient visit, 15–29 min | $52.74 | $44.83 (APRN=SA & PA=U1 only) |
| 99203 | New patient visit, 30–44 min | $82.94 | $70.50 (APRN=SA & PA=U1 only) |
| 99204 | New patient visit, 45–59 min | $125.64 | $106.79 (APRN=SA & PA=U1 only) |
| 99205 | New patient visit, 60–74 min | $167.87 | $142.69 (APRN=SA & PA=U1 only) |
| 99213 | Established patient visit, 20–29 min | $67.14 | $57.07 (APRN=SA & PA=U1 only) |
| 99214 | Established patient visit, 30–39 min | $95.85 | $81.47 (APRN=SA & PA=U1 only) |
| 99215 | Established patient visit, 40–54 min | $136.20 | $115.77 (APRN=SA & PA=U1 only) |
These same office visit codes are also billable under the Narcotic Treatment Program (NTP) at the same rates.
Tobacco Cessation and Screening/Brief Intervention (SBIRT) Codes Rates
These are shorter, add-on-style counseling visits. Smoking cessation codes pay more for longer sessions, and SBIRT (Screening, Brief Intervention, and Referral to Treatment) is used for alcohol/drug screening and brief counseling.
| Code | Service | Col 1 (Psych/MD) | Col 2 (APRN/AH/PA) | Col 3 (Masters w/ Supv) | Col 4 (Associate) | Col 5 (CADC) |
| 99406 | Smoking cessation, 3–10 min | $10.94 | $9.30 | $8.75 | $7.66 | $5.47 |
| 99407 | Smoking cessation, 10+ min | $20.79 | $17.67 | $16.63 | $14.55 | $10.40 |
| 99408 | SBIRT, 15–30 min | $21.95 | $18.65 | $17.55 | $15.36 | $10.97 |
| 99409 | SBIRT, 30+ min | $55.65 | $47.30 | $44.52 | $38.95 | $20.92 |
Psychiatric Diagnostic Evaluation Rates
This is the first visit, when a provider determines the client’s diagnosis. CPT 90791 is the evaluation without a medical component, while 90792 includes a medical component and is limited to APRN/PA (Advanced Practice Registered Nurse/Physician Assistant) rendering under column 2.
| Code | Service | Col 1 | Col 2 | Col 3 (Masters w/ Supv) | Col 4 (Associate) |
| 90791 | Diagnostic eval, no medical part | $129.53 | $110.10 | $103.63 | $90.67 |
| 90792 | Diagnostic eval, with medical part | $146.42 | $124.45 (APRN=SA & PA=U1 only) | — | — |
Individual Psychotherapy (Talk Therapy) Reimbursement Rates
KY reimbursement rates increase with session length e.g, 30, 45, or 60 minutes. Kentucky also has separate codes (90833, 90836, 90838) for when psychotherapy is billed with a medical office visit on the same day, and those are restricted to physicians, APRNs, or PAs only.
| Code | Length/Service | Col 1 | Col 2 | Col 3 | Col 4 | Col 5 |
| 90832 | 30 min, standalone | $62.63 | $53.24 | $50.11 | $43.84 | $31.32 |
| 90833 | 30 min, with E&M visit | $59.14 | $50.27 | — | — | — |
| 90834 | 45 min, standalone | $83.07 | $70.61 | $66.46 | $58.15 | $41.54 |
| 90836 | 45 min, with E&M visit | $74.90 | $63.67 | — | — | — |
| 90837 | 60 min, standalone | $121.88 | $103.59 | $97.50 | $85.31 | $60.94 |
| 90838 | 60 min, with E&M visit | $99.11 | $84.25 | — | — | — |
| H0004 | Behavioral Health Counseling and Therapy, 15 min | $28.99 | $24.64 | $23.19 | $20.30 | $14.50 |
H0004 must be billed on the same day as 90837 and is limited to 8 units (15 min per unit) per patient per date of service.
The 90833/90836/90838 add-on codes must be billed alongside an allowable E&M code (99201–99205 or 99213–99215) and can only be rendered by a Physician, APRN, or PA.
Crisis Therapy, Psychoanalysis, and Add-On Interactive Complexity
Crisis therapy (90839/90840) is for an urgent mental health emergency and pays more than routine therapy of the same length.
| Code | Service | Col 1 | Col 2 | Col 3 | Col 4 | Col 5 |
| 90839 | Crisis therapy, first 60 min | $116.87 | $99.34 | $93.50 | $81.81 | $58.44 |
| 90840 | Crisis therapy, each extra 30 min (use with 90839) | $56.21 | $47.78 | $44.97 | $39.35 | $28.11 |
| 90845 | Psychoanalysis | $79.52 | $67.59 | $63.62 | $55.67 | — |
| +90785 | Psychiatric services complicated by communication factor | $10.83 | $9.21 | $8.66 | $7.58 | $5.42 |
+90785 is an add-on code. It’s used alongside a diagnostic evaluation (90791/90792), standard psychotherapy (90832, 90834, 90837), psychotherapy performed with an E&M service (90833, 90836, 90838, 99201–99205, 99213–99215), or group psychotherapy (90853).
Family and Group Therapy KY Reimbursement Rates
Family and group therapy services are reimbursed at different rates based on the practitioner type represented by each rate column. The schedule includes family psychotherapy with or without the patient present, multiple-family group psychotherapy, and standard group psychotherapy.
| Code | Service | Col 1 | Col 2 | Col 3 | Col 4 | Col 5 |
| 90846 | Family psychotherapy, without patient present | $78.23 | $66.50 | $62.59 | $54.76 | $39.12 |
| 90847 | Family psychotherapy, with patient present | $81.02 | $68.86 | $64.81 | $56.71 | $40.51 |
| 90849 | Multiple-family group psychotherapy | $28.82 | $24.50 | $23.06 | $20.18 | $14.41 |
| 90853 | Group psychotherapy (not multiple-family) | $22.13 | $18.81 | $17.71 | $15.49 | $11.07 |
Other Psychiatric Services Rates
This category covers additional psychiatric services, including narcosynthesis, electroconvulsive therapy, biofeedback therapy, collateral therapy, and unlisted psychiatric procedures. Reimbursement varies by practitioner type, and some services are limited to specific provider categories.
| Code | Service | Unit | Col 1 | Col 2 | Col 3 | Col 4 | Col 5 |
| 90865 | Narcosynthesis | Event | $121.79 | $103.52 | — | — | — |
| 90870 | Electroconvulsive therapy | Event | $128.39 | — | — | — | — |
| 90875 | Psychophysiological therapy with biofeedback, 30 min | 30 min | $33.13 | $28.16 | $26.51 | $23.19 | — |
| 90876 | Psychophysiological therapy with biofeedback, 45 min | 45 min | $51.55 | $43.82 | $41.24 | $36.09 | — |
| 90887 | Collateral therapy | Event | $66.32 | $56.37 | $53.05 | $46.42 | $33.16 |
| 90899 | Unlisted psychiatric service/procedure | Event | $22.53 | $19.14 | $18.01 | $15.76 | — |
Psychological and Neuropsychological Testing
These codes cover formal testing including IQ, memory, developmental, and cognitive assessments. Several events have “base” codes for the first block of time and add-on “+” codes for additional time. Testing codes carry special provider limits.
| Code | Service | Unit | Col 1 | Col 2 | Col 3 | Col 4 | Provider limit |
| 96105 | Assessment of aphasia | Per hour | $71.03 | $60.37 | $56.82 | $49.72 | — |
| 96110 | Developmental screening | Event | $33.67 | $28.62 | $29.93 | $23.57 | — |
| 96112 | Developmental test administration, first hour | 60 min | $92.70 | $78.80 | $74.16 | $64.89 | — |
| +96113 | Developmental test administration, additional | 30 min | $43.57 | $37.03 | $34.85 | $30.50 | Use with 96112 |
| 96116 | Neurobehavioral status exam, first hour | 60 min | $68.70 | $58.40 | $54.96 (U8 only) | — | ** |
| +96121 | Neurobehavioral status exam, additional hour | 60 min | $57.83 | $49.15 | $46.26 (U8 only) | — | **, use with 96116 |
| 96125 | Standardized cognitive performance testing | 60 min | $75.70 | $63.50 | $59.76 | $52.29 | * |
| 96127 | Brief emotional/behavioral assessment | Event | $3.35 | $2.84 | $2.68 | $2.34 | — |
| 96130 | Psychological testing evaluation, first hour | 60 min | $89.80 | $76.33 | $71.84 (U8 only) | $62.86 (LPA/CPsy=U4 only) | * |
| +96131 | Psychological testing evaluation, additional hour | 60 min | $65.43 | $55.62 | $52.34 (U8 only) | $45.80 (LPA/CPsy=U4 only) | *, use with 96130 |
| 96132 | Neuropsychological testing evaluation, first hour | 60 min | $94.97 | $80.72 | $75.97 (U8 only) | — | ** |
| 96133 | Neuropsychological testing evaluation | 30 min | $73.57 | $62.53 | $58.85 (U8 only) | — | ** |
| 96136 | Test administration & scoring, first 30 min | 30 min | $31.15 | $26.48 | $24.92 (U8 only) | $21.80 (LPA/CPsy=U4 only) | * |
| +96137 | Test administration & scoring, additional 30 min | 30 min | $27.93 | $23.74 | $22.34 (U8 only) | $19.55 (LPA/CPsy=U4 only) | *, may bill with 96130–96133 same/different day |
| 96138 | Test administration by technician, first 30 min | 30 min | $25.17 | $21.39 | $20.14 (U8 only) | $17.62 (LPA/CPsy=U4 only) | * |
| +96139 | Test administration by technician, additional 30 min | 30 min | $23.61 | $20.07 | $18.89 (U8 only) | $16.53 (LPA/CPsy=U4 only) | *, may bill with 96130–96133 same/different day |
| 96146 | Automated single-instrument testing | Event | $1.57 | $1.33 | $1.25 (U8 only) | $1.10 (LPA/CPsy=U4 only) | * |
| 96156 | Health behavior assessment/re-assessment | Event | $78.40 | $66.64 (APRN=SA, PA=U1 & AH) | — | — | — |
Provider-type limit key:
- * Limited to MD/DO, LP, LPP, CPsy w/ Autonomous Functioning, LPA, or CPsy.
- ** Limited to MD/DO, LP, LPP, or CPsy w/ Autonomous Functioning (narrower than * — excludes plain LPA/CPsy).
Applied Behavior Analysis (ABA) Codes
Applied Behavior Analysis (ABA) codes cover behavior identification assessments and adaptive behavior treatment, most often used for autism-related services. Several are restricted to Registered Behavior Technicians (RBT) under supervision.
| Code | Service | Unit | Col 1 | Col 2 | Col 3 | Col 4 | Col 6 |
| 97151 | Behavior identification assessment | 15 min | $27.50 | $23.37 | $21.99 | $19.25 | |
| 97152 | Behavior identification supporting assessment | 15 min | — | — | — | $12.18 (RBT only) | $12.18 (RBT only) |
| 97153 | Adaptive behavior treatment by protocol, individual | 15 min | — | — | — | $12.18 (RBT only) | $12.18 (RBT only) |
| 97154 | Group adaptive behavior treatment by protocol | 15 min | — | — | — | $12.18 (RBT only) | $12.18 (RBT only) |
| 97155 | Adaptive behavior treatment with protocol modification | 15 min | $27.50 | $23.37 | $21.99 | $19.25 | |
| 97156 | Family adaptive behavior treatment guidance | 15 min | $21.35 | $18.13 | $17.09 | $14.94 | |
| 97157 | Multiple-family group adaptive behavior treatment guidance | 15 min | $10.81 | $9.18 | $8.65 | $7.57 | |
| 97158 | Group adaptive behavior treatment with protocol modification | 15 min | $10.81 | $9.18 | $8.65 | $7.57 |
Community-Based and Crisis Services (HCPCS “H” Codes)
These HCPCS Level II codes cover assessments, screenings, day treatment, case management, and crisis response delivered in the community.
| Code | Service | Unit | Col 1 | Col 2 | Col 3 | Col 4 | Col 5 | Col 6 |
| H0001 | Alcohol and/or drug assessment | Event | $93.50 | $79.48 | $74.79 | $65.45 | $46.76 | |
| H0002 | Behavioral health screening (for treatment admission eligibility) | Event | $93.50 | $79.48 | $74.79 | $65.45 | — | |
| H0015 | Alcohol/drug services, Intensive Outpatient Program | Per diem | $135.72 (flat rate) | |||||
| H0025 | Behavioral health prevention education service | Event | $26.54 | $22.55 | $21.22 | $18.58 | $13.26 | |
| H0031 | Mental health assessment by non-physician | Event | — | $79.48 | $74.79 | $65.45 | — | |
| H0032 | Mental health service plan development by non-physician | Event | — | $79.48 | $74.79 | $65.45 | — | |
| H0035 | Partial hospitalization (under 24 hrs) | Per diem | $203.03 (flat rate) | |||||
| H0038 | Self-help/peer services, individual | 15 min | $9.35 (PSS=U7 only) | |||||
| H0038 HQ | Self-help/peer services, group | 15 min | $3.87 (PSS=U7 only) | |||||
| H0040 | Assertive Community Treatment (ACT), 4-professional team | 1 month | $814.31 (flat rate) | |||||
| H0040 UB | Assertive Community Treatment (ACT), 10-professional team | 1 month | $1,085.75 use UB modifier | |||||
| H0049 | Alcohol/drug screening & brief intervention, under 15 min | 1–14 min | $26.12 | $22.21 | $20.90 | $19.60 | $10.02 | |
| H2011 | Crisis intervention service | 15 min | $23.38 | $19.87 | $18.69 | $16.36 | $11.69 | |
| H2012 | Behavioral health day treatment | Per hour | $93.50 | $79.48 | $74.79 | $65.45 | $46.75 | |
| H2015 | Comprehensive community support services | 15 min | $23.38 | $19.87 | $18.69 | $16.36 | $9.35 | |
| H2019 | Therapeutic rehabilitation (limit 12 units/day/individual) | 15 min | $13.58 (same across Cols 1–4) | |||||
| H2020 | Therapeutic rehabilitation, more than 3 hrs/day | Per day | $244.29 (flat rate) | |||||
| S9480 | Intensive outpatient psychiatric services | Per diem | $135.72 (flat rate) | |||||
| S9484 | Mobile crisis service | Per 60 min | $93.61 | $79.48 | $74.81 | $65.45 | $46.81 | |
| T1007 | Alcohol/substance abuse services — treatment plan development/modification | Event | $93.61 | $79.48 | $74.81 | $65.45 | $46.81 |
T2023 (Targeted Case Management) (per month) has three billing paths:
Standard rate $362.64: modifier UA for members with Serious Emotional Disturbance (SED), or modifier HE for members with Serious Mental Illness (SMI).
$587.39: modifier TG, used for members with co-occurring mental health or substance use disorders and chronic/complex physical health issues. BHSO (Behavioral Health Services Organization) Tier II providers must also include the HF modifier alongside TG.
$362.64: modifier HF, used specifically for members with substance use disorders.
Narcotic Treatment Program (NTP) Codes
These codes apply only to enrolled Narcotic Treatment Programs — billed under Provider Type 03 (BHSO) or Tier II NTP. Only the codes listed here are billable by an enrolled NTP. The standard office visit codes (99202–99215) are billable at the same rates listed in the Office Visits table above.
| Code | Service | Unit | Rate | Notes |
| H0020 | Methadone MAT bundle | Weekly | $114.00 | NTP only; requires HF modifier |
| H0016 | Buprenorphine or methadone induction | Event | $217.15 (Col 1) / $217.15 (Col 2, APRN=SA & PA=U1 only) | Requires HF modifier; limited to 4 events per year per client |
| H0038 | Self-help/peer services, individual | 15 min | $9.35 | NTP |
| H0038 HQ | Group peer support services | 15 min | $3.87 | NTP; must use HQ modifier to designate group service |
| H0047 | Buprenorphine MAT bundle | Weekly | $124.86 | NTP only; requires HF modifier |
| T1007 | Alcohol/substance abuse services — treatment plan dev/mod | Event | $93.61 / $79.48 / $74.81 / $65.45 / $46.81 (Cols 1–5) | NTP |
| T2023 | Targeted case management, SUD | 1 month | $362.64 | NTP; requires HF modifier |
Important bundling rule:
H0020 and H0047 are code numbers. They are reimbursed under the weekly lump sum rate. All of the below code numbers have been added to the same weekly rate so cannot be charged separately: 80305, 80306, 90785, 90832, 90834, 90837, 90839, 90840, 90853, H0015, H0004, and H0038.
The following code numbers are also included in the “Community Based and Crisis Service” table above with the same fixed amount: H0038, H0038 HQ, T1007 and T2023. They have been intentionally added in both places; it is not a case of re-entering the same service by mistake.
Look, the point here is that these are commonly used code numbers. They can also be used by mental health service providers at the community level in general and NTPs as well, and in both cases the same published rate applies.
Licensed Residential SUD Treatment Programs
These per day codes are only billable by Provider Type 03 (BHSO Tier III).
| Code | Service | Rate | Notes |
| H0011 | Residential Treatment Program | $320.30 per day | For residential SUD programs with Provisional Certification by DMS/CARF at ASAM Level of Care 3.5 (without room and board) |
| H2034 | Residential Treatment Program | $271.44 per day | For residential SUD programs with Provisional Certification by DMS/CARF at ASAM Level of Care 3.1 (without room and board) |
Residential Crisis Stabilization Units (RCSU) and Chemical Dependency Treatment Centers (CDTC)
Provider Type 26 (RCSU) or Provider Type 06 (CDTC) may bill H2036, depending on the applicable program and level of care.
- Provider Type 26 (RCSU) bills S9485.
- Provider Type 06 (CDTC) bills H0011.
| Code | Service | Rate | Notes |
| H0011 | Residential Treatment (within CDTC) | $320.30 per diem | For CDTC SUD programs with Provisional Certification at ASAM Level of Care 3.5, without room and board |
| H2036 | Alcohol and/or Drug Treatment Program | $408.24 per diem | For RCSUs treating SUD, or CDTCs, at ASAM Level of Care 3.7 |
| S9485 | Crisis Intervention Mental Health Service (RCSU) | $408.24 per diem | For Residential Crisis Stabilization Units; primary mental health diagnosis treatment service |
What is Changed in KY Medicaid Behavioral Fee Schedule 2026
Comparing the two documents (KY Medicaid Behavioral Fee Schedule 2026 and KY Medicaid Behavioral Fee Schedule 2025) side by side turns up few real changes worth knowing about, beyond the rate numbers themselves.
1). Most standard CPT codes got a rate increase.
The bulk of the schedule’s CPT-based codes including office visits, psychotherapy, diagnostic evaluations, psychological/neuropsychological testing, and ABA codes, increased from 2025 to 2026, typically by somewhere in the 3–9% range. A few examples:
| Code | Service | 2025 Rate (Col 1) | 2026 Rate (Col 1) |
| 90837 | Psychotherapy, 60 min | $112.39 | $121.88 |
| 90791 | — | unchanged | unchanged |
| 90792 | Diagnostic eval, with medical part | $144.55 | $146.42 |
| 99202 | New patient office visit, 15–29 min | $51.33 | $52.74 |
| H0004 | Behavioral health counseling and therapy | $28.01 | $28.99 |
| 97151 | Behavior identification assessment | $26.57 | $27.50 |
2). The HCPCS “H” community-service codes mostly held flat
Unlike the CPT-based codes above, most H-codes e.g., H0001, H0002, H0015, H0025, H0031, H0032, H0035, H0038, H0040, H0049, H2011, H2012, H2015, H2019, H2020, S9480 — did not change rate at all between 2025 and 2026. A couple (S9484, T1007) moved by only a few cents in one or two columns. Community-based and crisis service reimbursement was essentially untouched in this revision, while clinical/testing CPT codes rates were raised.
3). Psychoeducational Service codes were removed
H2027 and H2027 HQ (“Psychoeducational Service,” billed in 15-minute units at $49.08 / $41.16 / $39.26 / $34.36 / $21.87 for individual and $36.81 / $30.87 / $29.44 / $25.87 / $16.40 for the HQ group variant) appeared on the 2025 schedule but do not appear anywhere on the current 2026 schedule.
4). Two codes were renamed
H2019 and H2020 were labeled “Therapeutic Behavioral Health Services” in 2025. On the current schedule, they’re labeled “Therapeutic Rehabilitation.” The billing codes, units, and rates are identical — only the service description changed.
5). The weekly MAT bundling rule was updated
H0020 and H0047 (the methadone and buprenorphine weekly MAT bundles) each come with a list of codes that are already included in the weekly rate and can’t be billed separately. That list changed:
- Dropped from the bundle list: 99354 and 99355 (prolonged service codes)
- Added to the bundle list: H0004 (Behavioral Health Counseling and Therapy)
If your NTP (Narcotic Treatment Program) was previously billing 99354/99355 separately from the weekly bundle, or was billing H0004 alongside it, double check against the current list before submitting claims.
Kentucky Medicaid Behavioral Health Billing Requirements
It’s not enough to know how much a service costs to get paid for mental and behavioral health services under Kentucky Medicaid. In order to have a request for payment approved, providers must follow all of the billing and payment rules established for the service in question. Providers of such services in Kentucky should be aware of additional codes, the type of service provider, the principle of combining several services into a single lump-sum payment, and the regulations regarding beneficiary eligibility.
➔ Use the Required HF Modifier for SUD Services
Providers must include the HF Additional Code Symbol to track substance use disorder (SUD) services. If more additional symbols are also applied to a service, HF will be used with them.
➔ Be sure to check your professional category rules before submitting a payment request.
Just because a service is listed on the Kentucky Medicaid payment rates table, it doesn’t necessarily mean you’re allowed to provide that service and ask for its money. Each provider should check their specific professional category rules to see if they are authorized to provide that service and claim payment for it.
➔ Correctly identify lump sum and fixed-rate payments.
Some services are paid at a fixed rate, e.g., per day, while some services are paid as a lump sum by combining several related services. Therefore, mental and behavioral health providers in Kentucky are not required to claim payment for such services by time. Some services are included in a lump-sum payment and cannot be charged separately.
➔ Submit additional codes with any applicable primary service.
Codes with a plus (+) sign are considered additional codes. They cannot be submitted as a separate payment request. They must be associated with a valid and applicable basic service completed on the same date.
➔ Also verify beneficiary eligibility when submitting a payment request.
According to Kentucky Medicaid regulations, it is the responsibility of the service provider to verify that the individual is eligible for the service under Medicaid before submitting a payment request. This check should be done at the time of preparing and submitting the payment request for processing.
➔ Laboratory testing within the facility must be ordered only by a physician, advanced practice registered nurse, or physician assistant.
If a mental or behavioral health service includes laboratory testing, the testing must be ordered by a physician, advanced practice registered nurse (APRN), or physician assistant (PA) working within the same institution or organization, according to the instructions in the payment rate table.
➔ Rates and payment application rules may change with each new revision.
Kentucky Medicaid may make changes to the rates and payment request submission requirements through each new revision to its payment rate table. Therefore, providers should refer to the most recent version of this table each time they submit a payment application.
