Anthem Blue Cross Psychiatry Medication Management Reimbursement Rates in California (2026)

Medication management visits fill much of a psychiatric practice’s schedule. Most are short follow-ups billed as 99213 or 99214, often with a psychotherapy add-on code on top. A few dollars per visit adds up over hundreds of visits a month. This page shows what Anthem Blue Cross pays for those four codes in California.

The figures below come from Anthem’s September 2026 statewide California reimbursement rates file, 8 gigabytes of pricing data. We kept rates billed as professional claims in the office setting. We matched each NPI against the federal NPPES registry and kept individual psychiatric prescribers (psychiatrists and psychiatric nurse practitioners) whose practice location is in California. Statistics are computed over unique provider-rate pairs. Practices comparing service lines can see the same method applied to Anthem’s TMS rates in California and Anthem’s Spravato rates in California.

Anthem’s Negotiated Medication Management Rates in California

The table uses September 2026 data. 99213 and 99214 pay for the office visit itself, known as an evaluation and management (E/M) visit. 90833 and 90836 are add-ons for psychotherapy time, and they can only be billed together with an E/M visit.

CPT Code	Description	Mean Negotiated Rate	Median Negotiated Rate	Min	Max	Unique NPI Count
99213	Office/outpatient visit, established patient, low medical decision making or 20-29 minutes total time	$151.86	$107.25	$22.41	$381.16	3,932
99214	Office/outpatient visit, established patient, moderate medical decision making or 30-39 minutes total time	$210.93	$146.39	$22.41	$552.56	3,932
90833	Psychotherapy, 30 minutes with patient, when performed with an evaluation and management service (add-on)	$103.42	$61.00	$9.03	$361.83	3,762
90836	Psychotherapy, 45 minutes with patient, when performed with an evaluation and management service (add-on)	$151.80	$90.24	$46.97	$458.23	3,762

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

What Does Anthem Pay for a Medication Management Visit in California?

At Anthem’s California medians, a level 4 visit with 30 minutes of psychotherapy (99214 plus 90833) pays about $207.39. A level 3 visit with the same add-on (99213 plus 90833) pays about $168.25.

The add-on makes a real difference. At its median of $61.00, 90833 adds about 40 percent to what a 99214 visit pays. A clinician with ten qualifying visits a week who never bills the add-on gives up about $30,000 a year. Psychotherapy billed on its own, without a medication visit, uses different codes. See Anthem’s behavioral health rates in California for those.

California practices that take cash publish follow-up fees from $175 to $400. A San Diego concierge practice charges $175 for a 20-minute visit. A Los Angeles County practice charges $250 for 30 minutes, and a San Francisco solo practice charges $400 for 25 minutes. Anthem’s median of about $207.39 for 99214 plus 90833 falls inside that range. At the median, an in-network visit pays about what a mid-priced cash practice charges, and the network brings patients on top of that.

How Do You Bill a Psychotherapy Add-On With 99213 or 99214?

Choose the add-on by the minutes of psychotherapy you provide:

• Bill 90833 for 16 to 37 minutes.
• Bill 90836 for 38 to 52 minutes.
• Do not bill psychotherapy under 16 minutes.

Only the psychotherapy minutes count toward the add-on. Time spent on the medical part of the visit, such as reviewing symptoms and adjusting medication, does not. Record the psychotherapy minutes separately in the note.

The add-on also changes how you choose the visit level. Normally you can pick 99213 or 99214 based on total time or on the complexity of your medical decision making. With a psychotherapy add-on, you cannot use time, because the same minutes cannot count twice. The visit level must be chosen on medical decision making alone, and prolonged-service codes cannot be added. CPT guidance and the Medicare billing article for psychotherapy services both say this.

In practice, a 99214 billed with an add-on is only as strong as the note that explains the medical decision making. That matters in California because of the Anthem review program below.

What Happened to Anthem’s E/M Downcoding Review in California?

Anthem paused it, and the last public update extended the pause through at least September 1, 2026. We found no public update after that date as of September 23, 2026, so check with Anthem before assuming the program is on hold or in force.

Anthem announced the review in November 2025. It would target commercial claims from clinicians who bill higher visit levels than peers with similar patients. Anthem said flagged claims could be sent back for a lower code, held until records arrive, or paid at a lower level. The review was due to start February 15, 2026.

The California Medical Association objected, and the Department of Managed Health Care, which regulates most California health plans, began a review. Anthem has extended the pause several times since, most recently in June 2026, as the California Medical Association reported.

Which Patients Get the In-Person Rate for Telehealth in California?

Patients on state-regulated plans get it. California requires state-regulated health plans and insurers to pay the same rate for a telehealth visit as for the same visit in person. That includes video medication management follow-ups.

Whether the rule applies depends on how the patient’s plan is funded:

• Fully insured plans. The employer or individual buys coverage from Anthem. State law applies, so a telehealth visit pays the in-person rate.
• Self-funded plans. The employer pays claims itself and Anthem only administers the plan. Federal law applies instead, and the state rule does not.

Check how the plan is funded when you verify benefits.

Does Anthem Pay Less Than Medi-Cal for Any of These Codes?

Yes, for one. Anthem’s median 90833 of $61.00 is about a dollar below what Medi-Cal pays for the same code.

Medi-Cal raised these codes in January 2024 and made the new rates a floor for Medi-Cal managed care plans. The floor is $82.02 for 99213, $115.88 for 99214, $62.12 for 90833 and $78.73 for 90836. Anthem’s medians clear it on the visit codes, and its median 99214 pays about 26 percent more than Medi-Cal. A commercial rate below the state’s Medicaid rate is a strong point to raise when you negotiate, and it comes from Anthem’s own published data.

California is also short of psychiatrists. The state’s health workforce agency reported in January 2026 that every region has a shortage. The state is about 3,800 psychiatrists short today and projected to be more than 50 percent short by 2033. State rules require plans to offer a non-urgent psychiatrist appointment within 15 business days, and to arrange out-of-network care at in-network cost when they cannot. A plan that struggles to meet that standard needs the psychiatric prescribers it already has.

What This Means for Your Practice

The medians here are market references from Anthem’s own federal reimbursement rates disclosure, filtered to California psychiatric prescribers on office professional claims. You can pull your remittances and compare your effective 99213/99214 rates and add-on payments against the medians above. 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 Anthem Blue Cross publishes under the federal Transparency in Coverage rule. These files are posted to satisfy the regulation, not to be read. The file behind this analysis unpacks to 8 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 and criteria directly with Anthem before relying on them for billing or negotiation decisions.