Aetna Behavioral Health Reimbursement Rates in California (2026)

Aetna publishes what its California HMO network pays therapists, psychologists and other behavioral health clinicians. This page shows those rates for a diagnostic evaluation, a 60-minute therapy session and the first hour of psychological testing.

The rates come from Aetna Health of California, the company that issues Aetna’s HMO plans in the state. It is licensed by the California Department of Managed Health Care (DMHC) under the Knox-Keene Act. Every plan in its September 2026 files is an employer group plan. Aetna’s national PPO and self-funded employer plans publish separate files and are not included here.

We read all eight of Aetna Health of California’s network files for September 2026, 88 gigabytes of pricing data once unzipped. We kept negotiated and fee schedule rates billed as professional claims. We dropped rates Aetna labels as derived, which are estimates rather than contracted prices. We also dropped reduced and discontinued testing rates, billed with modifiers 52 and 53. We matched each NPI against the federal NPPES registry and filtered for unique behavioral health clinicians whose practice location is in California.

Aetna’s Negotiated Behavioral Health Rates in California

The table covers 45,885 California clinicians with a rate for 90837, the 60-minute therapy code.

CPT Code	Description	Mean Negotiated Rate	Median Negotiated Rate	Min	Max	Unique NPI Count
90791	Psychiatric Diagnostic Evaluation	$155.26	$149.65	$55.00	$717.09	45,912
90837	Psychotherapy, 60 minutes	$143.39	$146.15	$45.00	$680.56	45,885
96130	Psychological Testing Evaluation, 1st hour	$114.14	$109.48	$69.25	$493.06	33,332

Rates extracted from Aetna’s September 2026 California machine readable files.

Over nine in ten clinicians in this file have more than one 90837 rate. Aetna lists each rate for a group of providers, and one clinician can belong to several groups. The median is the middle of all those rates. Pull the 90837 amount from your own contract and see if it sits above or below the median.

Half of Aetna’s 90837 rates are above $146.15 and half are below. The average, $143.39, is close to that, so a few very high contracts are not inflating the numbers. The full range is wide, from $45.00 to $680.56 for the same hour of therapy.

How Does Aetna Compare With Anthem Blue Cross in California?

It depends on the clinician’s license. For counselors, marriage and family therapists and social workers, Aetna’s 90837 median is a few dollars above Anthem Blue Cross’s. For psychologists, Anthem pays more. Our Anthem Blue Cross California rates page uses Anthem’s August 2026 file.

Testing needs a closer look. Aetna’s overall 96130 median is less than half of Anthem’s, but the two payers list very different groups of clinicians. Anthem’s testing rates are highest for psychiatrists, and it lists a testing rate for far fewer counselors and therapists than Aetna does. Compared psychologist to psychologist, Aetna pays less for 96130, but by about 13 percent, not half.

Do License Modifiers Change What Aetna Pays for Therapy?

Rarely, in these files. About one in five of Aetna’s 90837 rows carries a license modifier, such as AH for psychologists or AJ for clinical social workers. Those rows add up to about half of one percent of unique provider-rate pairs, and their rates sit below the median. For almost every clinician in the network, the rate has no license modifier at all. We kept these rows in the table so it stays comparable with our other behavioral health pages.

Pre-licensed associates are a separate question. Aetna’s fall 2024 provider bulletin says it allows supervisory billing for license-eligible behavioral health clinicians in its network. It was the latest Aetna guidance on this we could find as of September 2026. The claim lists the licensed supervisor as the rendering clinician. The supervisor must work for the same in-network group or facility. Confirm that your contract and your California licensing board’s rules both allow it before billing this way.

How Quickly Must Aetna HMO Patients Get a Therapy Appointment in California?

Within 10 business days of the request, for a non-urgent visit with a non-physician mental health provider. That rule comes from California’s timely access law, Health and Safety Code section 1367.03. Since July 1, 2022, follow-up visits for patients in ongoing treatment must also be offered within 10 business days of the prior appointment. The wait can run longer when the treating or referring provider notes in the record that it will not harm the patient.

Aetna checks this through California’s annual Provider Appointment Availability Survey. Aetna’s June 2026 OfficeLink Updates newsletter says Sutherland Healthcare Solutions runs the 2026 survey for Aetna. Aetna reports the results to the DMHC and the California Department of Insurance. Both in-person and telehealth visits count as appointments. If your office gets the survey call, give your real next opening.

Does Aetna Have to Pay the Same Rate for Telehealth Therapy in California?

Yes, for the HMO plans in this data. Health and Safety Code section 1374.14 requires DMHC-licensed plans to pay for telehealth on the same basis as the same service in person. Services described the same way on the claim must be paid the same rate. The plan and the provider still negotiate the rate itself. The law does not reach self-funded employer plans, which follow federal rules.

What Does SB 855 Mean for Aetna’s Behavioral Health Reviews?

It requires Aetna’s HMO to base mental health and substance use medical necessity decisions on generally accepted standards of care. Health and Safety Code section 1374.721, added by SB 855, also requires the plan to use the latest criteria from the relevant nonprofit professional association. DMHC regulations in effect since April 1, 2024 name four instruments for level-of-care decisions.

• The ASAM Criteria for a primary substance use disorder in adolescents and adults.
• LOCUS for a primary mental health diagnosis in adults 19 and older.
• CALOCUS-CASII for children 6 to 18.
• ECSII for children 5 and younger.

When the plan delays, denies or changes a requested service, the same regulations require a written notice within 5 calendar days of the decision, or 72 hours for urgent care. The notice must list every criterion the reviewer used.

For a routine outpatient practice, this matters less than for intensive programs. Aetna’s fall 2024 bulletin says routine outpatient psychotherapy and medication management do not need prior authorization. Where Aetna does review care, check the notice for the criteria it applied, and cite section 1374.721 in any appeal.

What Do California Therapists Charge Self-Pay for an Hour of Therapy?

Two California therapists who publish their fees charge $250 and $275 for about an hour of therapy. The first is a marriage and family therapist based in Westlake Village who sees clients online, at $250 for 60 minutes. The second is a marriage and family therapist offering online therapy across California, out of network, at $275 per clinical hour. Both sit well above Aetna’s 90837 median of $146.15. That gap is what a practice weighs when deciding how much of its week to give to in-network patients.

What This Means for Your Practice

Start with your own Aetna fee schedule, not the median. Pull your remittances, check which rate Aetna actually pays you for 90791, 90837 and 96130, and see where it sits in the table. If you also bill Blue plans, our 90837 rates by state show the same code across six of them.

The timely access rules can help at renewal. Aetna must show the DMHC it can offer therapy appointments within 10 business days, so a practice with open appointments has something to offer. Our guide to negotiating insurance contract rates covers how to use numbers like these in a rate request.

Fuse helps practices with this work. We offer CPT-level verification of benefits before the visit, reimbursement checks against past claims, and analytics that flag the gap between contracted and paid before it compounds. Reach out if you think we can help.

Disclaimer: This article uses rate information from the Machine Readable Files that Aetna publishes under the federal Transparency in Coverage rule. These files are posted to satisfy the regulation, not to be read. The files behind this analysis unpack to 88 gigabytes of raw pricing data that no spreadsheet can open. Fuse built its own software to extract and verify the figures above. This analysis focuses on a single payer and will not reflect rates from all available insurance options in California. Fuse makes every effort to provide accurate and current information, but healthcare pricing and coverage policy change frequently, and individual circumstances affect actual payment. This information does not guarantee specific pricing. Practices should verify current rates directly with Aetna before relying on them for billing or negotiation decisions.