What insurance pays a California therapist. Every number that is actually published.

You are trying to price an hour, and the market will not tell you

Somebody asks what you charge, or a panel sends you a contract, or you are deciding whether to take insurance at all — and you go looking for the number. There is no page anywhere that gives it to you, and the reason is not laziness on anyone’s part. Most of what a California therapist is paid is a contracted amount between two private parties, and both of them treat it as confidential.

So before any figures, it is worth being precise about the three different things people mean when they say “the rate”, because they are not equally knowable:

• A published rate. A government fee schedule. Medicare and Medi-Cal both publish theirs, down to the cent, and you can reproduce the arithmetic yourself. This is fact.
• An advertised range. What a company puts on a marketing page or a sign-up calculator. It is real in the sense that the company published it, and it is not a rate anyone is contractually owed.
• A contracted rate. What Aetna has agreed to pay you, or what Headway has agreed to pay you. This is the number you actually want and the one nobody publishes. You usually cannot see it until after you are credentialed.

Everything on this page is labeled as one of those three, or as arithmetic derived from them with the steps shown. Where the honest answer is that a figure is not published, that is what it says, and that sentence is worth more to you than a confident guess would be. Every dollar amount below is either lifted from a primary source or computed from one in front of you.

Medicare is the only rate you can actually look up

Start here, not because most California therapists bill Medicare, but because Medicare is the benchmark every other rate is quoted against. Health economists express commercial reimbursement as a percentage of Medicare. Payers negotiate off it internally. If you know the Medicare number for your locality, you have the yardstick.

Two things changed for this audience recently, and both matter. LMFTs and LPCCs became independently billable to Medicare on 1 January 2024 — before that date you simply could not enroll.^[4] The federal regulation that defines the benefit requires a master’s or doctoral degree, state licensure, and at least two years or 3,000 hours of post-master’s supervised clinical experience,^[5] which is the same 3,000 hours the BBS already made you do.

The second thing is the one that decides your income. Medicare does not pay you the physician fee schedule amount. It pays you 75% of it. The statute is short and worth reading once: for marriage and family therapist and mental health counselor services, “the amounts paid shall be 80 percent of the lesser of the actual charge for the services or 75 percent of the amount determined for payment of a psychologist”.^[3] CMS says the same thing in plain English on its own provider page: “Medicare Part B pays MFTs and MHCs for these services at 75% of what a clinical psychologist is paid under the Medicare Physician Fee Schedule.”^[4] The same 75% has applied to clinical social workers for years.

Here is the whole calculation, so you can check it. Every payment under the physician fee schedule is three relative value units multiplied by three geographic indices, added together, and multiplied by one national conversion factor. For CY 2026 the conversion factor is $33.4009 for clinicians not qualifying as advanced alternative payment model participants — which is nearly every solo practice — and $33.5675 for those who do. Both are up from a single $32.3465 in 2025.^[2]

Take CPT 90837, the 53-minute individual session, in the Los Angeles locality. The 2026 relative value file gives it 3.78 work RVUs, 1.20 non-facility practice expense RVUs and 0.02 malpractice RVUs. The Los Angeles geographic practice cost indices are 1.041, 1.183 and 0.664.^[1]

• (3.78 × 1.041) + (1.20 × 1.183) + (0.02 × 0.664) = 5.3679 total RVUs
• 5.3679 × $33.4009 = $179.29 — what a psychologist or a physician is paid
• $179.29 × 0.75 = $134.47 — what an LMFT, LCSW or LPCC is paid

That $134.47 is the allowed amount, not the check. Medicare pays 80% of it, $107.58, and the remaining $26.89 is the patient’s coinsurance — billed to a supplement if they have one, and to the person otherwise. Over a full year of 90837s at 20 a week, roughly $24,739 of your Medicare revenue arrives from patients rather than from Medicare.

Run the same arithmetic across the six codes most solo practices use, in three California localities. These are the amounts payable to an LMFT, LCSW or LPCC in 2026, non-facility — the setting that covers both an office and telehealth from home.

Two cautions on that table. The first is that 90846 is not really on the fee schedule. CMS gives it status indicator R — restricted coverage, and “if covered, the service is contractor priced”.^[1] The figures above are what the published RVUs come to, but the actual payment is set by the Medicare administrative contractor, not by the national schedule. Treat that row as an estimate and confirm it with the contractor before you plan around it.

The second is geography, which moves the number more than most people expect. The same 53-minute session, done by the same clinician, is worth $129.52 in the Rest of California locality and $148.66 in Santa Clara County, which carries the state’s highest indices at 1.110 and 1.442.^[1] That is $19.14 a session for identical work, or $17,609 across a 920-session year. If you are comparing an offer in Fresno with one in San Jose, that spread is real and it is published.

Medi-Cal publishes a number, and it may not be your number

Medi-Cal is two systems wearing one name, and which one you are in decides whether the published rate means anything to you.

If you are a private practitioner seeing mild-to-moderate presentations, you are in non-specialty mental health services, billed fee-for-service or through a managed care plan. Those rates are published in the Medi-Cal provider manual as maximum allowances — reimbursement is “the provider’s usual charge to the general public, not to exceed” the figure listed, under Title 22 CCR §51505.3.^[6] The manual splits every code into two columns, and the split is the story:

Read the last column again. Medi-Cal’s published maximum allowance pays a licensed therapist $38.01 for a 60-minute session and $67.16 for a 45-minute one. The longer code pays 43% less than the shorter code. Nothing about that is clinically coherent, and no explanation for it appears anywhere in the manual. It may be a transcription error that has sat uncorrected since the psychotherapy page was last updated in December 2022. It is nonetheless the published figure, and it is the figure a claims system will pay. If you take Medi-Cal fee-for-service, know before you write your first note that the schedule as published rewards billing 90834.

Elsewhere on this site the Medi-Cal 90837 rate is given as $98 — the rate gap page carries that figure. That is the MD, NP and PA column. For an LMFT the manual says $38.01, and this page is the correction.

The other Medi-Cal is specialty mental health services, for serious mental illness, and it does not run through a fee schedule you can bill against at all. It runs through county mental health plans. DHCS publishes an outpatient rate schedule for each fiscal year,^[7] but those are the rates DHCS pays the county, not the rates a county pays a subcontracted clinician. DHCS is explicit that they are fully loaded county rates covering “staff time spent on direct patient care; staff time not spent on direct patient care (e.g., time spent on documentation, travel, and paid time off); total staff compensation… and any direct and indirect overhead and operating costs”, and that counties decide their own subcontractor arrangements.^[8]

So: the county rate is published, your rate under that county is a contract term, and there is no public source for it. If somebody quotes you a Medi-Cal specialty rate as though it were a fee schedule, they are quoting the county’s revenue, not your pay.

Commercial rates are confidential. Here is everything that is not.

No commercial insurer in California publishes what it pays a therapist. Neither does any of the networks, and it is worth being blunt about that, because they are often described as though they do.

Headway says only that it keeps “a small percentage of session payments” and that “the amount we’re able to keep depends on the strength of the rates we’re able to negotiate”.^[12] No percentage is given. Its help center confirms that rates are per payer and per CPT code and are visible after credentialing.^[13] Its one resource page titled for California salaries contains Bureau of Labor Statistics wage figures — $83,960 for Los Angeles, $77,190 for San Francisco — and not a single Headway payout figure.^[12] There is more detail in the full Headway breakdown.

Alma publishes exactly two dollar figures: a membership of $95 a month, billed at $1,140 a year, and a sign-up calculator whose “average payout per one hour session” slider runs from $50 to $250.^[14] That slider is an input, not a claim. It is not an Alma rate and not a California rate.

Grow Therapy tells providers that rates “are determined based on a variety of factors, which may include payor, state, CPT code, license type, and credentialing date” and directs them to the provider portal to see their own.^[15] Nothing is published.

That is the whole of it. None of the three publishes a California rate. Anyone showing you a Headway or Alma or Grow California rate table is showing you one clinician’s portal screen, or an invention.

What does exist is peer-reviewed and regulatory work that measures commercial rates in aggregate. The most useful is an RTI International study of Merative MarketScan commercial claims, published April 2024, which indexed every claim to what Medicare would have paid for the same code, in the same MAC locality, in the same facility or non-facility setting. Crucially for us, RTI used the 75% benchmark for therapists, “because this is what Medicare reimburses clinical social workers” — so its ratio is directly comparable to the LMFT column above.^[9]

For California in 2021, across 1,051,678 covered lives, the study found:

• Therapists — social workers, counselors and marriage and family counselors — reimbursed in-network at 102.9% of the Medicare benchmark. Physician assistants, over the same claims, got 105.2%.
• Psychologists at 107.9% of Medicare, against 136.5% for medical and surgical specialist physicians — a 26.5-point gap.
• All behavioral health clinicians at 116.7% of Medicare against 129.0% for all medical and surgical clinicians.

Milliman found the same shape seven years earlier: in 2015 PPO data, California in-network behavioral office visits were paid 99.3% of Medicare, while primary care got 127.1% and specialists 129.4%.^[10] The gap is old and it is stable.

California’s own regulator has said the consequence out loud. The Department of Managed Health Care’s behavioral health investigation of Aetna Health of California, published 20 August 2025 and covering March 2022 to February 2024 across 215,860 enrollees, found thirteen Knox-Keene violations and listed inadequate provider reimbursement rates as a barrier that “create[s] a barrier to increasing the number of in-network behavioral health care providers”.^[11] That is a state regulator putting in writing that the rates are too low to build a network on.

Applying RTI’s 102.9% to the Los Angeles Medicare figure gives $134.47 × 1.029 = $138.37 for a 90837. Label that carefully: it is a derived estimate from a study average across a whole state and all payers, not a rate anyone will offer you. Individual clinician reports collected on the rate gap page put California 90837 between $80 and $150, clustering at $110–$123.^[17] A study mean sitting above the top of a small self-reported cluster is what you would expect: employer-sponsored claims data skews toward large plans with better contracts. Both numbers are useful; neither is your contract.

Six codes, four columns, and what each column actually is

This is the table the whole page exists to produce. Los Angeles locality, fully licensed LMFT, LCSW or LPCC, non-facility, 2026.

Now what each column is, because they are four different kinds of number and treating them as one is how people talk themselves into bad decisions:

• Medicare, LA — published fact. Computed from the CMS 2026 relative value file, the 2026 California GPCIs and the $33.4009 conversion factor, then reduced to 75% by statute. Reproducible to the cent, except 90846, which is contractor priced.^[1]
• Medi-Cal FFS — published fact, with a caveat. The maximum allowance in the non-specialty mental health services section of the provider manual, licensed-therapist column. It is what is published; the 90837 and 90832 rows are internally inconsistent and this page does not pretend otherwise.^[6]
• Commercial — derived estimate, not a rate. The Medicare column multiplied by 102.9%, RTI’s California average for therapists on 2021 commercial claims.^[9] It is a statewide mean across all payers. No individual payer has agreed to it and no one owes it to you.
• Private pay — an observed range, not a schedule. The Los Angeles range on the rate gap page, where the Bay Area runs $180–$350 and West LA and Santa Monica reach $175–$350.^[17] The same number repeats down the column because private pay is a session fee, not a code-based fee schedule — which is itself one of the real differences between the routes.

One number falls out of the first column that nobody puts in front of a therapist. A psychologist in Los Angeles is paid $179.29 for the same 90837 you are paid $134.47 for. The difference is $44.82 a session, purely from the 75% rule in the statute. Over a year at 20 sessions a week:

Twenty sessions a week, for a year, under each column

Headline rates decide nothing on their own. What decides things is what lands in the bank after the cost of collecting it. Here is the same year run five ways.

The assumptions, stated so you can change them: 20 sessions a week, 46 working weeks, 920 sessions a year, all 90837, all in the Los Angeles locality, fully licensed. Billing is charged at 7% of collections — the bottom of the 7–11% band an outside biller costs in California.^[17] Private pay carries no claims cost. These are gross practice figures, before rent, insurance, software or tax.

The fourth row is not an oversight. It is the finding. You cannot compute what a network route pays because neither the rate nor the cut is published by anybody. The one documented California data point is on the rate gap page: a case where Cigna paid Alma $151.74 for a session and the clinician received $95, a 37% cut.^[17] If that 37% held against the $138.37 derived commercial allowed amount, you would see $87.17 a session, $80,196 across the year, $79,056 after Alma’s $1,140 membership.^[14] That is one documented case, not a rate, and it is presented as such.

Three things the table does not include, because they are yours to fill in and there is no published California figure for a solo practice:

• Denials. Covered California insurers denied 21% of in-network claims in plan year 2023; nationally, HealthCare.gov issuers denied 19% in 2024, with individual insurers ranging from 3% to 36%.^[18] A denial is not automatically lost revenue — most are resubmitted and paid — but at 21%, a 920-session year generates roughly 193 denied claims you or your biller have to work. That is the real cost, and it is time, not money.
• No-shows and late cancelations. There is no published no-show benchmark for California solo private practice, so no figure is invented here. What can be given is the price of a point: at these rates, every 1% of sessions you do not collect costs $1,237 on Medicare, $1,273 on a commercial panel, $1,380 on private pay and $350 on Medi-Cal. Multiply by your own rate.
• The patient’s share. On Medicare, $26.89 of every $134.47 is coinsurance, about $24,739 across the year. On a commercial plan it is a deductible or a copay. Either way, part of an “insurance” rate is money you collect from a person, with all the friction that implies.

The conclusion is unglamorous and it is the point of running the numbers: private pay at the bottom of the published Los Angeles range beats every insurance route in this table, by $22,947 a year against Medicare and by $19,611 against a derived commercial panel rate. It also assumes you can fill 20 hours a week at $150 without a referral pipeline, which is the assumption doing all the work.

Why the rate is not the thing to decide on

Four things move the annual number more than the per-session figure does, and none of them appear in a rate comparison.

Volume. A panel with a full caseload at $110 beats an empty private-pay practice at $250. The arithmetic is not close: 920 sessions at $110 is $101,200; 400 sessions at $250 is $100,000, and the second one comes with marketing work the first does not. This is the whole reason the networks exist, and it is a legitimate reason to use one. If your gaps are the problem rather than your rate, the practice growth tool is the one to open, not this page.

Payment speed. Grow Therapy initiates payouts every Friday, with insurance claims taking 14–21 days to process, and guarantees the payout even where it cannot collect from the insurer or the client.^[16] A direct contract with a California payer is slower — Blue Shield of California quotes 45 to 60 days, and 60 to 120 is realistic depending on the payer.^[17] That difference does not change what you earn, but it changes what your first six months feel like, and it is the reason a lot of new practices start on a platform and move off it.

Rates move without you. A contract you are not a party to can be renegotiated over your head. The one publicly documented instance in this market: Optum cut rates across Headway and Alma effective 1 January 2025, one provider’s 90834 going from $144.27 to $103.00.^[20] More recently Aetna proposed consolidating 90837 into 90834 for Alma clinicians and eliminating the pay differential between master’s-level clinicians and psychologists, effective 15 August 2026 after a partial rollback.^[19] That second one is the trend to watch. Code flattening does not cut your rate; it deletes the reason to do the longer session. In Los Angeles, Medicare pays $134.47 for 90837 and $91.69 for 90834 — a 47% premium for the longer hour. A payer that flattens the two has taken that premium off you without ever announcing a rate cut.

Clawbacks. Post-payment audits can take back money you have already spent. Headway’s own help center reserves the right to adjust payment after a chart review. A direct payer will simply recoup against future claims. Budget as though a proportion of insurance revenue is provisional for eighteen months, because it is.

And a structural point worth more than any of the above: none of these routes is exclusive. The published evidence, such as it is, points at a blend — direct contracts where direct pays more, a platform where the platform’s negotiated rate is higher, private pay for the hours you can fill at your own fee. The panels guide covers how to work out which is which for a given payer.

What to do on Monday

In order, and none of it takes long.

• Find your Medicare locality and write down your three numbers. 90791, 90834 and 90837 for your locality, at 75%. The table above covers Rest of California, Los Angeles and San Francisco; for anywhere else, the CMS relative value file has your GPCIs and the arithmetic is the three lines shown earlier.^[1] This is your yardstick for every conversation that follows.
• Ask every payer for its fee schedule in writing before you sign. Ask for 90791, 90832, 90834, 90837, 90846 and 90847 separately, and ask specifically whether 90837 is paid above 90834. That last question is the one that catches code flattening, and it is the question almost nobody asks.
• Convert the answer to a percentage of Medicare. Divide their number by your 75% Medicare figure. Against RTI’s California therapist average of 102.9%, anything materially under 100% is a below-market offer and you now have a published benchmark to say so with.^[9]
• Do not take a network rate on trust. None of the three publishes one. If you want to know what Headway or Alma or Grow will pay you in California, the only way is to be credentialed and look, and the only honest thing anyone can tell you beforehand is that.
• Run both scenarios to a net figure. A gross rate is not a decision. Put the panel rate and your private-pay fee through the practice simulator with your real caseload and expenses, and compare the two bottom lines. If the gap is small, the deciding factor is referral flow and payment speed, not the rate.

One last thing, because it comes up. If your practice is stable enough to wait two to four months per payer, direct contracts keep the whole rate and nobody can renegotiate it above your head. If it is not, a platform fills hours now at a rate you do not control. Both are defensible. What is not defensible is choosing between them on a number nobody has published.