PracticeRates Negotiation Campaign

Example: a Chicago counselling practice

NPI 1999999984PREPARED AUGUST 25, 2026DATA VINTAGE JUNE 2026 TO AUGUST 20262 PAYERS

$3,973 to $19,209

Annual dollars at stake, from settling at the market median to landing the target

bottom 1%

Weakest position · Blue Cross Blue Shield of Illinois 90791

266 to 348

Illinois providers compared, per payer

What this is

Every figure below comes from the payers' own machine-readable in-network files, published under the federal Transparency in Coverage rule. You are compared against licensed counselors (LCPC/LPC) in Illinois, not against every provider who happens to carry these codes. Most of the providers with a published rate for a therapy hour are not behavioral-health clinicians at all, and including them inflates the apparent market by a wide margin.

Blue Cross Blue Shield of Illinois

CPT	Service	Your rate	Market median	Your percentile	Target	Gap / session	Confidence
90791	Diagnostic intake (no medical)	$132.00	$146.06	bottom 1%	$163.65	$31.65	High · n=347
90834	Psychotherapy, 45 min	$78.00	$91.84	bottom 1%	$107.94	$29.94	High · n=348
90837	Psychotherapy, 60 min	$127.82	$127.82	32nd	$151.47	$23.65	High · n=348
90847	Family therapy with patient	$95.00	$103.47	bottom 1%	$126.64	$31.64	High · n=348
90853	Group psychotherapy	$22.00	$24.80	bottom 1%	$34.62	$12.62	High · n=345

You are on the base tier for 90837. Blue Cross Blue Shield of Illinois pays $127.82 to most licensed counselors (LCPC/LPC) in Illinois, but 36% are paid above it, at a median of $151.47, about $23.65 more a session. The base tier is the default offer, not a rule: roughly one in three of your peers are not on it.

You are paid below the base tier for 90834. Blue Cross Blue Shield of Illinois pays $91.84 to most licensed counselors (LCPC/LPC) in Illinois, but 30% are paid above it, at a median of $107.94, about $16.10 more a session. Your rate is under the figure the payer gives most of your peers, which is the simplest possible ask to make.

90834 Psychotherapy, 45 min bottom 1% of 348 providers

90847 Family therapy with patient bottom 1% of 348 providers

90791 Diagnostic intake (no medical) bottom 1% of 347 providers

90837 Psychotherapy, 60 min 32nd percentile of 348 providers · tied with 64% of them at this exact rate

Aetna

CPT	Service	Your rate	Market median	Your percentile	Target	Gap / session	Confidence
90791	Diagnostic intake (no medical)	$132.00	$147.37	6th	$151.32	$19.32	High · n=265
90834	Psychotherapy, 45 min	$78.00	$84.29	2nd	$94.77	$16.77	High · n=264
90837	Psychotherapy, 60 min	$127.82	$123.79	71st	$135.78	$7.96	High · n=266
90847	Family therapy with patient	$95.00	$89.19	69th	$104.75	$9.75	High · n=260
90853	Group psychotherapy	$22.00	$22.68	14th	see below	n/a	High · n=246

Aetna does not price by licence. It publishes the same rate for these codes whether the provider is a counselor, a social worker, a psychologist or a psychiatrist. Your credential is not an argument here, and neither is anyone else's: the spread above the base rate comes from contract history, not qualifications, which is why the ask below cites what this payer already pays rather than what your licence is worth.

90853 is held back from the ask. This payer publishes $22.68 at the median for it and $48.00 in the top tenth. A spread that wide inside one code usually means two different billing arrangements sharing it, not a rate you can simply ask to be moved to. The letter raises it as a question instead, which is the move that keeps the other four asks credible.

You are paid below the base tier for 90834. Aetna pays $84.29 to most licensed counselors (LCPC/LPC) in Illinois, but 37% are paid above it, at a median of $94.77, about $10.48 more a session. Your rate is under the figure the payer gives most of your peers, which is the simplest possible ask to make.

You are paid below the base tier for 90791. Aetna pays $147.37 to most licensed counselors (LCPC/LPC) in Illinois, but 28% are paid above it, at a median of $151.32, about $3.95 more a session. Your rate is under the figure the payer gives most of your peers, which is the simplest possible ask to make.

90834 Psychotherapy, 45 min 2nd percentile of 264 providers

90791 Diagnostic intake (no medical) 6th percentile of 265 providers

90847 Family therapy with patient 69th percentile of 260 providers

90837 Psychotherapy, 60 min 71st percentile of 266 providers

What to ask for

Open at the figures in the Target column. Where a payer runs a base rate, that target is the median of the providers it already pays above that base rate; elsewhere it is the 75th percentile. Either way the payer has already agreed to the number with someone else, which is what makes it hard to refuse. Settle no lower than the median: below that you are subsidising the network. Across the codes in this report the difference between your current schedule and the target is $19,209 a year, and between your schedule and the market median alone it is $3,973 a year, at 22.0 sessions a week over 48 weeks.

Those two figures cover your whole caseload, not each payer separately. They assume it divides evenly across the payers here (Blue Cross Blue Shield of Illinois 50%, Aetna 50%). If one payer carries more of your week than that, its share of the gap rises in proportion, and the per-payer tables above show what each is worth on its own.

Sequence that works: send the letter to provider contracting (not the credentialing inbox), reference the published file by name and month, ask for a written response in 30 days, and follow up on day 31 by phone with the same numbers in front of you. Payers rarely counter on data they published themselves; they counter on volume and quality, so have your caseload and no-show rate ready.

The negotiation letters

Your campaign includes a ready-to-send letter for each payer, with your figures, your licence and the payer's own published medians already written in. Those are part of the paid campaign, so they are not reproduced here.

Methodology and limits

Source. Payer machine-readable in-network rate files (June 2026 to August 2026), published under the federal Transparency in Coverage rule. We stream the payers' published files directly and extract negotiated rates for behavioral-health CPT codes.

Who you are compared against. Licence type is taken from the public national provider registry, and this report uses licensed counselors (LCPC/LPC) only. A provider can also appear in many plan files at different rates, so we take each provider's median for a code first, then compute percentiles across providers.

Confidence. High is 200+ providers for that code, Moderate 40 to 199, Low 10 to 39, Very low under 10. Treat Low and Very low as directional, not as a negotiating anchor.

What this is not. Published rates are what payers disclose, not necessarily what lands after adjustments, and they do not account for your volume, quality metrics, or specialty. This report is market information, not legal, billing, or financial advice, and no outcome is promised. If a high-confidence figure here is contradicted by your own contracted rate, tell us and we refund the campaign.

PracticeRates, a product of Intelli-HealthCare LLC, Chicago, IL · admin@intelli-healthcare.com · practicerates.com
Prepared August 25, 2026 for NPI 1999999984. Licensed to this practice for its own negotiations.