What did the Aetna/Alma reversal save you?

The cut that survived

The reversal did not restore current rates. Aetna's final schedule still reduces reimbursement: 90837 lands above the withdrawn proposal but below its current level, and less frequently billed codes take reductions. The new rates apply to dates of service on or after August 15, 2026, and they appear only inside each clinician's Alma account, so no public numbers exist. Your own before and after regional fee schedules in the Alma portal are the only reliable source for your numbers; compare them line by line, including the add-on codes.

Methodology and assumptions

The prescriber formula, applied to the withdrawn proposal: (your 99215 rate minus your 99214 rate) times your weekly 99215 count, plus (your MD rate minus the NP rate) times all your weekly E/M visits, times your working weeks. The therapist formula: your weekly 90837 count times the per-session gap between 90837 and 90834, times your working weeks. The same arithmetic works on the surviving cut once you have your new schedule: multiply each code's rate change by your weekly volume, then by working weeks.

• The calculator models the proposal Aetna withdrew on July 9, 2026, so its result is the amount the reversal preserved for your panel each year, not a cut you will take on August 15.
• The default rates ($130 for 99214, $180 for 99215) are illustrative, in the range platforms have historically quoted. Your Alma fee schedule is the real number; swap in your own rates.
• The default NP differential is 15 percent, which is Medicare's exact MD-to-NP differential. Commercial differentials vary by contract.
• Under the withdrawn proposal, every E/M visit would have paid the 99214 rate, and MD/DO clinicians would additionally have taken the NP differential haircut on that flattened rate. NP and PA inputs skip the haircut because their rate was already the flattened one.
• The therapist default gap of $20 per session reflects the historical Alma gap between 90837 and 90834, which ran about $15 to $25.
• The default year is 48 working weeks.
• Neither the May notice nor Alma's July 9 outcome email addresses the psychotherapy add-on codes (90833, 90836, 90838). Read your updated regional fee schedule in the Alma portal rather than assuming either way.

Sources

• Chris Larson, Behavioral Health Business, May 21, 2026: the story that broke the rate cut
• Laura Lovett, Behavioral Health Business, June 9, 2026: data follow-up on Aetna psychotherapy reimbursement
• Barbara Griswold, LMFT, Navigating the Insurance Maze: detailed clinician-side breakdown
• American Psychiatric Association and American Psychological Association joint letter to Aetna urging a pause, June 4, 2026
• CMS physician fee schedule lookup: on the 2026 Medicare schedule, 99215 pays roughly $50 more than 99214 nationally
• Our analysis: What Aetna's Alma Rate Cut Means for Psychiatrists (July 2, 2026), by Sina Hartung, reviewed by David Cohen, CPA, JD

The default rates in this calculator are illustrative, not quotes from any fee schedule. Your actual numbers live in your updated regional fee schedule in the Alma portal; read it before making decisions. This tool is not billing, legal, or financial advice.

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