Illinois Therapists: Your 90837 Rates Could Jump in 2027

Last updated: June 3, 2026.

For years, many Illinois therapists have seen commercial insurance rates that make the therapy hour hard to sustain.

A 53 to 60 minute individual therapy session billed as CPT 90837 might be allowed at $95, $107, or another number that feels disconnected from the clinical work, documentation, overhead, and time required to run a therapy practice.

That may be changing. Illinois HB1085 is now Public Act 104-0446. The bill was approved by the governor on December 12, 2025, became Public Act 104-0446, and has an effective date of June 1, 2026. The reimbursement-floor provisions apply to covered plans amended, delivered, issued, or renewed on or after January 1, 2027. Illinois General Assembly.

Practice takeaway: if you bill 90837 in Illinois, start tracking payer allowed amounts now. The practices that benefit most will be the ones ready to prove the gap.

TL;DR: Some Illinois Therapy Rates May Need to Rise in 2027

The headline is simple:

If a covered Illinois commercial plan is paying below the new reimbursement floor for CPT 90837, that rate should need to come up.

NASW-IL summarizes HB1085's reimbursement floor as 141.7% of what Medicare would pay for the mental health or substance-use service. NASW-IL also says the floor is set by formula and that the formula does not change. NASW-IL summary.

Using a Medicare benchmark of $122.92 for 90837 as an example, $122.92 x 1.417 = $174.18. That means the estimated floor would be about $174.18.

• Cigna example: $95.00 current allowed amount, $174.18 estimated floor, possible increase of $79.18 per session.

• Aetna example: $107.00 current allowed amount, $174.18 estimated floor, possible increase of $67.18 per session.

Those are not official Cigna or Aetna fee schedules. They are examples based on common therapist rate comparisons and the numbers modeled here.

The key point: if the plan is covered by HB1085 and the current allowed amount is below the applicable 2027 floor, the rate should need to increase.

Why Therapists Are Paying Attention

A move from $95 to around $174 for 90837 would not be a small adjustment.

For a therapist seeing 20 covered 90837 sessions per week, 48 weeks per year, the difference could be significant.

• Cigna example: $79.18 more per 90837 session x 20 sessions per week x 48 weeks = $76,012.80 per year.

• Aetna example: $67.18 more per 90837 session x 20 sessions per week x 48 weeks = $64,492.80 per year.

That kind of gap can change the math of private practice. It can affect whether a therapist can afford to stay in-network, reduce burnout, hire admin support, keep a reasonable caseload, or continue taking insurance at all.

This is why Illinois therapists should start tracking their current allowed amounts now. Not just what insurance paid. The allowed amount.

First: What Is 90837?

When therapists say therapy hour, they often mean a longer individual psychotherapy session billed as CPT 90837.

CMS coding guidance says psychotherapy services are time-based. For individual psychotherapy, CMS describes 90834 as 38 to 52 minutes and 90837 as 53 minutes or more. CMS also says start and stop times or total time should be documented for 90832, 90834, and 90837. CMS psychotherapy coding guidance.

A 50-minute session generally belongs in 90834 territory. A session that reaches 53 minutes or more may support 90837, assuming the service is medically necessary and properly documented.

HB1085 matters because the law specifically addresses 90837.

What HB1085 Says About 90837

Public Act 104-0446 says covered plans amended, delivered, issued, or renewed on or after January 1, 2027 must cover medically necessary 60-minute psychotherapy billed using CPT 90837 for individual therapy. It also says plans cannot impose more onerous documentation requirements on 90837 than they require for other psychotherapy CPT codes, and cannot audit 90837 more frequently than other psychotherapy CPT codes. Public Act 104-0446.

That is a big deal.

• It does not mean every 90837 claim will be paid automatically.

• It does not mean documentation no longer matters.

• It does not mean therapists should bill 90837 for 50-minute sessions.

But it does appear designed to prevent payers from treating 90837 as uniquely suspicious simply because the session is longer. For therapists whose clinical model depends on 53+ minute sessions, that protection matters.

The Practical Math: 141.7% of Medicare

NASW-IL summarizes the reimbursement floor as 141.7% of Medicare for the same behavioral health service. The rough formula is:

Applicable Medicare benchmark x 1.417 = estimated HB1085 floor

Using the example benchmark, $122.92 x 1.417 = $174.18. That creates a simple way to compare your current allowed amounts.

• $95.00 current rate -> $79.18 estimated gap.

• $107.00 current rate -> $67.18 estimated gap.

• $125.00 current rate -> $49.18 estimated gap.

• $150.00 current rate -> $24.18 estimated gap.

• $175.00 current rate -> no obvious gap in this example.

The actual floor should be calculated using the correct CPT or HCPCS code, service date, geographic location, and applicable benchmark. The statute says reimbursement for each service must be equal to or greater than the dollar amounts applicable on the date of service for the geographic location. Public Act 104-0446.

Do not treat $174.18 as the official statewide 2027 number. Treat it as a practical example using the Medicare benchmark number in this scenario.

Estimate Your 90837 Revenue Impact

Want to see what the new Illinois floor could mean for your practice? Use this calculator to compare your current 90837 allowed amounts against an estimated HB1085 floor.

This is not a legal determination and it is not a guarantee of payment. It is a planning tool to help you understand whether your current rates may be below the 2027 floor.

Default example: Medicare benchmark $122.92, HB1085 multiplier 1.417, estimated floor $174.18, Cigna example rate $95.00, Aetna example rate $107.00, and 48 weeks worked per year.

Use allowed amounts from EOBs or ERAs, not just insurance-paid amounts.

Does This Mean Cigna and Aetna Have to Raise Rates?

For a covered plan, if the allowed amount is below the applicable floor, the rate should need to increase once the 2027 reimbursement-floor requirement applies.

But the phrase covered plan is doing a lot of work.

A card may say Cigna, Aetna, BCBS, United, or Optum, but the actual plan could be a fully insured commercial plan regulated by Illinois, a self-funded employer plan administered by a major insurer, an HMO arrangement, a Medicaid/MCO product, or a plan where behavioral health benefits are administered by a third party.

NASW-IL summarizes HB1085 as applying to state-regulated private insurance plans, including fully funded individual, small group, large group, and marketplace plans. NASW-IL says Medicaid/MCOs, self-insured plans, state employee health plans, and HMO plans are not covered by HB1085. NASW-IL summary.

So the better question is not: Does Cigna have to raise my rate?

The better question is: Is this specific Cigna plan subject to HB1085, and is the current allowed amount for 90837 below the applicable 2027 floor?

Allowed Amount vs. Paid Amount

When you audit your rates, do not look only at what the payer paid. Look at the allowed amount.

The reimbursement floor is about the rate or allowed amount, not necessarily the check amount from the insurer after deductible, copay, coinsurance, or coordination of benefits.

• Deductible claim: $174.18 allowed, $0.00 insurance paid, $174.18 client responsibility. The allowed rate may still meet the floor.

• Low allowed amount: $95.00 allowed, $95.00 insurance paid, $0.00 client responsibility. The allowed rate may be below the estimated floor.

• Coinsurance claim: $174.18 allowed, $139.34 insurance paid, $34.84 client responsibility. The allowed rate may still meet the floor.

That distinction matters.

What If Medicare Rates Go Down?

NASW-IL says HB1085 includes a safeguard: if Medicare rates decrease in a given year, the mental health and substance-use reimbursement floor remains the same as the previous year. In other words, the floor should not automatically drop because Medicare drops. NASW-IL summary.

That matters because therapists may worry that the floor could disappear if Medicare changes. Based on NASW-IL's summary, the law is designed to prevent the reimbursement floor from moving backward in that way.

What Illinois Therapists Should Do Now

The biggest mistake would be waiting until 2027 to look at your rates. The law may create the floor, but your billing workflow still has to catch whether payers are actually paying correctly.

1. Pull your current 90837 allowed amounts. For each payer, review actual EOBs or ERAs. Track payer, plan name, CPT code, date of service, place of service, rendering provider, allowed amount, insurance paid, client responsibility, claim number, and whether the plan appears fully insured or self-funded.

2. Separate direct contracts from platform contracts. If you bill through Alma, Headway, Grow, Rula, or another platform, separate those rates from your direct payer contracts. A direct Aetna contract and an Aetna-related platform rate may not behave the same way.

3. Identify which plans may be covered. Do not assume every commercial-looking insurance card is covered. Large employer plans are often self-funded.

4. Keep 90837 documentation clean. HB1085 may limit special targeting of 90837, but it does not remove documentation requirements. A good note should support actual psychotherapy time, medical necessity, diagnosis and symptoms, interventions, client response, progress toward goals, and why the session length was clinically appropriate.

5. Watch for Illinois Department of Insurance guidance. Public Act 104-0446 requires the Illinois Department of Insurance to adopt rules necessary to implement the section by September 1, 2026. NASW-IL also says the Department will publish the reimbursement floor in a Company Bulletin before January 2027.

Where Bomi Fits

Bomi is watching HB1085 because it hits the exact place where therapy practices feel the most pressure: payer rates, EOBs, claims, credentialing, underpayments, and whether insurance-based care is financially sustainable.

A higher reimbursement floor could be a major win for Illinois therapists. But it still requires operational follow-through.

Practices will need to know:

• Which plans are covered.

• What their actual 90837 allowed amounts are.

• Whether a claim paid below the applicable floor.

• Whether the issue is a rate problem, deductible issue, processing issue, or plan-type issue.

• How to track and escalate underpayments.

A law can create the floor. Your billing workflow still has to catch whether the payer actually honored it.

Bomi helps therapy practices with eligibility, claims, denials, credentialing, EOB review, reimbursement tracking, stale claim follow-up, and underpayment workflows. Talk to Bomi about billing.

FAQ

Is HB1085 already law?

Yes. HB1085 is now Public Act 104-0446. The official Illinois General Assembly bill status shows the governor approved it on December 12, 2025, with an effective date of June 1, 2026.

When does the reimbursement floor start?

The rate-floor provisions apply to covered plans amended, delivered, issued, or renewed on or after January 1, 2027.

Does the law specifically mention 90837?

Yes. Public Act 104-0446 says covered plans must cover medically necessary 60-minute psychotherapy billed using CPT 90837 for individual therapy. It also says plans cannot impose more onerous documentation requirements on 90837 than on other psychotherapy CPT codes and cannot audit 90837 more frequently than other psychotherapy CPT codes.

Does 90837 mean exactly 60 minutes?

Not exactly. CMS guidance says psychotherapy codes are time-based and that 90837 applies to 53 minutes or more. CMS also says time should be documented with start and stop times or total time for 90832, 90834, and 90837.

If Medicare is $122.92, what would 141.7% be?

Using $122.92 as the Medicare benchmark, $122.92 x 1.417 = $174.18. So the estimated floor in that example would be about $174.18.

If Cigna allows $95 for 90837, is that below the example floor?

Yes. Using the $122.92 Medicare benchmark example, a $95.00 allowed amount would be about $79.18 below the estimated $174.18 floor. That would be an 83.3% increase from the current $95.00 rate if the rate rose to $174.18.

If Aetna allows $107 for 90837, is that below the example floor?

Yes. Using the same example, a $107.00 allowed amount would be about $67.18 below the estimated $174.18 floor. That would be a 62.8% increase from the current $107.00 rate if the rate rose to $174.18.

Does this apply to every Cigna or Aetna plan?

No. It depends on the plan type. NASW-IL says HB1085 covers state-regulated fully funded plans, including individual, small group, large group, and marketplace plans. NASW-IL says self-insured plans, state employee health plans, HMO plans, and Medicaid/MCOs are not covered.

Should therapists expect a guaranteed raise?

No. Many Illinois therapists whose covered commercial 90837 rates are below the new floor may see rates increase in 2027, but actual impact depends on the plan, code, geography, date of service, contract status, and implementation details.

Bottom Line

Illinois therapists should pay attention to HB1085 now. If you bill 90837 and your current in-network allowed rates are $95, $107, or otherwise far below the estimated floor, this law could materially change your reimbursement in 2027.

Using the example Medicare benchmark of $122.92, the estimated floor is about $174.18.

• Cigna example: $95.00 -> $174.18.

• Aetna example: $107.00 -> $174.18.

Again, not every plan is covered. Not every low rate automatically changes tomorrow. And the official implementation details still matter.

Start tracking your allowed amounts now. The practices that benefit most will be the ones ready to prove the gap.

Sources

• Illinois General Assembly bill status for HB1085

• Illinois General Assembly Public Act 104-0446

• NASW-IL summary of HB1085

• CMS psychotherapy billing and coding guidance