Look up the published national Medicare PFS rate for common SUD and behavioral-health billing codes. Source and as-of date on every number. Not a quote, not commercial pricing.
Published Medicare rates only. These are public national non-facility PFS reference amounts, not what commercial insurers pay, not what Medicaid pays, and not what your contract pays. No PHI: don't enter patient info.
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Evaluation & psychotherapy
Group / IOP / PHP
SUD counseling
MAT / medication mgmt
Screening & brief intervention
Care management
What shifts the actual paid amount
Local geographic adjustment (Medicare locality / GPCI). Place of service (facility vs. non-facility). Modifiers like -25, -59, HQ (group), HF (SUD), or HE (mental health). Provider type adjustments (e.g. non-physician practitioner percentages). Bundled-vs-component billing rules. Managed-care plan contracts that price independently from Medicare. Authorization status, place-of-service edits, and NCCI bundling.
About the data
Medicare rates are the published national non-facility PFS amount. Your locality may differ. Verify at the CMS PFS Look-up Tool.
CPT descriptions here are paraphrased; the official AMA CPT long descriptors are copyrighted and not redistributed.
Every result shows the source URL and the date that row was captured.
Reference, not a quote. This tool shows published national Medicare PFS reference amounts only. It does not show, predict, or imply Medicaid, commercial-payer, or contract rates. Actual payment can differ from the published amount based on locality, place of service, modifiers, managed-care contract terms, authorization, and bundling rules. This is general billing reference information, not legal, coding, billing, or financial advice. Always verify against the CMS PFS Look-up Tool before relying on a number for a claim, appeal, or SCA request.