CMS Transparency in Coverage Rate Intelligence

Stop Leaving $33,500* on the Table. Know What Insurers Actually Pay in Your County.

Empowering independent mental health practices with audited, county-level commercial reimbursement benchmarks extracted directly from CMS Transparency in Coverage (TiC) disclosures.

Get Your Negotiation Dossier Preview Real Benchmarks

100% Zero PHI
County-level percentiles
Federal TiC source data

Wake County, NC is our published pilot. Dossiers are available for all 3,143 U.S. counties and county-equivalents (50 states + DC), resolved by FIPS code from the Census county gazetteer — including Louisiana parishes, Alaska boroughs and census areas, and Virginia independent cities.

Coverage depends on the payer publishing in-network rates for your county and specialty. If your county returns insufficient records, we tell you before charging and issue a full refund.

Wake Co. · 90837 Median

$120.96

Wake Co. · 90837 P75

$139.72

Zero PHI · Public data only

Wake County, NC / CPT 90837 / P25 $104.79 ◆ County median P50 $120.96 ◆ County P75 $139.72 ◆ County P90 $144.40 ◆ Medicare CY2026 $164.08 ◆ Median = 73.7% of Medicare ◆ P25 to P75 +$34.93 / session ◆ Source CMS TiC machine-readable files ◆ Patient data None — Zero PHI ◆

The Reimbursement Gap

Same session. Same county. Very different checks.

Recent payer reimbursement volatility and one-sided fee schedule resets across major networks make it harder than ever to know what fair looks like. Federal Transparency in Coverage rules (45 CFR § 147.212) require health plans to publish their in-network rates—we turn those massive disclosure files into a clear benchmark for the county where you practice, and set it against the published federal fee schedule.

Per-session gap: +$34.93; P25 $104.79 → P75 $139.72, CPT 90837
Annual gap^*: $33,533; ≈ $33,500 at 20 sessions/week, 48 weeks/year
Share of Medicare: 73.7%; Commercial median $120.96 vs. Medicare $164.08
PHI required: 0; Built only on public rate disclosures

^*Arithmetic illustration from Wake County, NC pilot benchmarks for CPT 90837: 25th percentile $104.79 vs. 75th percentile $139.72 = $34.93 per session × 20 sessions per week × 48 weeks = $33,533, shown in the headline as approximately $33,500. This is a rate differential at a user-supplied volume, not a projection or a guarantee of any negotiation outcome. See Methodology & Compliance Disclosures.

Live Interactive Benchmark Preview

See the numbers before you negotiate.

Benchmarks from our Wake County, North Carolina pilot. Every rate is an in-network negotiated amount published in payer Transparency in Coverage files—no surveys, no self-reported guesses.

Pilot Benchmark Wake County, NC · FIPS 37183

Wake County Commercial Benchmark

UHC/Optum network · TiC in-network file, reporting month 2026-09-01 · USD per session

Psychotherapy, 60 minutes · n = 111 contracts

Minimum
Lowest observed $85.25
P25
25th percentile $104.79
Median
P50 $120.96
P75
75th percentile $139.72
P90
90th percentile $144.40
Medicare
CY2026 PFS $164.08
+$34.93 gap / session

Observed contract rate County benchmark (P50 / P75 / P90) Medicare allowed (CY 2026 PFS) P25 → P75 gap

Source: Payer-published TiC in-network file (45 CFR § 147.212)

Filter: negotiated_type = negotiated · billing_class = professional

Percentiles: Non-parametric, linear interpolation

Scope: one payer network (UnitedHealthcare of North Carolina / Optum Health Behavioral Services), covering 96 of the 7,578 behavioral health NPIs registered in the county. This is not a whole-market or all-payer view. Full methodology

Revenue Gap Calculator

Drag to model your practice

CPT 90837

Your $104.79 is 63.9% of the CY 2026 Medicare allowed amount ($164.08) · Wake County median $120.96 = 73.7%

Annual difference at these rates

$33,533

Per session

+$34.93

Per month

$2,794

Dossier pays back

6 sessions

Get the Dossier — $199

Arithmetic illustration only: (target rate − current rate) × sessions per week × weeks per year. Defaults are the Wake County, NC pilot P25 → P75 spread ($104.79 → $139.72 × 20 × 48 = $33,533). Not a projection, forecast, or guarantee of any negotiation outcome. Methodology & disclosures

CY 2026 CMS Physician Fee Schedule Wake County, NC · Locality 00

The federal floor is public. Commercial rates sit 26% below it.

Medicare publishes exactly what it allows for every psychotherapy code. Placing the county's commercial medians next to that published number turns a negotiation from opinion into arithmetic.

Medicare allowed amounts compared with Wake County commercial medians
CPT	Medicare allowed	Commercial median	Gap	% of Medicare
90837 · 60 min	$164.08	$120.96	−$43.12	73.7%
90834 · 45 min	$111.80	$84.89	−$26.91	75.9%
90791 · intake	$190.75	$137.50	−$53.25	72.1%
90847 · family	$143.01	$92.85	−$50.16	64.9%

Medicare allowed amounts computed from the published CY 2026 CMS Physician Fee Schedule: [(Work RVU × Work GPCI) + (Non-facility PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × conversion factor 33.4009 (non-QP). North Carolina is a single statewide Medicare locality (00, MAC 11502), so this figure applies to every county in the state. Commercial medians are from the payer's own Transparency in Coverage in-network file. Commercial and Medicare pricing are separate systems; the difference between two published numbers is stated here without any conclusion about its cause.

Data Pipeline

From federal disclosure files to a negotiation-ready dossier.

Health plans publish in-network rates as massive machine-readable files—often hundreds of gigabytes per payer. We stream-parse them so you don't have to.

01

Stream-parse TiC files

Payer-published in-network rate files are ingested and parsed as streams, row by row.
02

Filter & geolocate

Rates are narrowed to psychotherapy CPT codes and behavioral health provider types, then mapped to counties.
03

Compute percentiles

County minimum, P25, median, P75 and P90, set against the CY 2026 Medicare allowed amount—sources retained.
04

Deliver your dossier

A clear PDF report and CSV export, delivered to your inbox within 24–48 hours (business days).

Why StarTorch & Compliance

Built on public data. Engineered for trust.

Public Data Only

100% Zero PHI

We never request, receive, store, or process protected health information. Our benchmarks are built exclusively from payer-published rate disclosures—there is simply no patient data in the system.

Never collected

Patient names or DOBs
Diagnoses or claims
EHR or member IDs

Only used

Published payer rates
Public provider directories
Your county & CPT codes

data_source = public_tic_disclosures · phi = none

Gag Clause Protection

Your contract may limit what you can disclose—public data doesn't. Every figure comes from files health plans are federally required to publish under the Transparency in Coverage rule (45 CFR § 147.212), so you can cite market rates without revealing any confidential contract terms.

Audit-Ready Negotiation Demand Letter

An editable, professionally structured rate-adjustment request that cites your county percentiles, source files, and reporting periods.

Federal source of truth

Transparency in Coverage machine-readable files required by 45 CFR § 147.212—not surveys or crowdsourcing.

County-level precision

Statewide averages hide local markets. We benchmark where you actually practice.

Audit trail included

Each benchmark references its payer, source file, and reporting period.

Transparent Pricing

Clear prices. No surprises.

All prices in USD. Reports are one-time purchases; the annual renewal is optional. No hidden fees. Checkout takes about a minute; we confirm your county and deliver by email.

Enter any of the 3,143 U.S. counties and county-equivalents at checkout — Wake County, NC is simply our published interactive sample. If your county returns insufficient records, we tell you before charging and issue a full refund.

Single County Snapshot

A fast reality check on what payers pay in your county.

$49one-time

1 county of your choice
CPT 90837 & 90834 benchmarks
Min, P25, median, P75 & P90 rates
PDF report delivered to your inbox

Get the Snapshot

The Negotiation Dossier

Everything you need to request a higher rate—with evidence.

$199one-time

Everything in Snapshot
Medicare (CY 2026 PFS) comparison for your county
Audit-ready negotiation demand letter (editable)
Revenue gap analysis for your session volume
Rate tiers by contract & provider taxonomy
Source citations & CSV data export

Get the Dossier

Annual Benchmark Renewal

Keep your numbers current as payers publish new rates.

$99/ year

Refreshed benchmarks for your county
Updated demand letter figures
For existing Dossier customers
Cancel anytime before renewal

Start Annual Renewal

Secure card checkout by Stripe Delivered to your inbox within 24–48 hours (business days)

Legal & HIPAA

Zero PHI. By design, not by policy.

StarTorch LLC is a B2B information services company (NAICS 51 — Information). We sell data reports derived from publicly available price-transparency disclosures. We are not a healthcare provider, health plan, or healthcare clearinghouse, and we do not create, receive, maintain, or transmit protected health information (PHI) on behalf of any covered entity.

Because our products contain no PHI, StarTorch does not act as a HIPAA Business Associate and no Business Associate Agreement is required to purchase or use our reports.

Please do not send us patient information. We will never ask for it. If any PHI is sent to us in error, we will delete it promptly and will not use it.

Regulatory references

45 CFR § 147.212 — Transparency in Coverage: requires group health plans and health insurance issuers to publicly disclose in-network negotiated rates in machine-readable files. This is the source of all StarTorch benchmark data.
CAA 2021 § 203 — Mental health parity: requires plans and issuers to perform and document comparative analyses of nonquantitative treatment limitations (NQTLs), which can include network admission standards and reimbursement rate methodologies.

StarTorch reports are informational business tools, not legal, tax, or financial advice. StarTorch is not affiliated with, endorsed by, or acting on behalf of the Centers for Medicare & Medicaid Services (CMS) or any health insurer. CPT® is a registered trademark of the American Medical Association. Payer names are trademarks of their respective owners and are used for identification only.

Methodology & Compliance

Methodology & Compliance Disclosures

Every figure on this page is traceable to a published government or payer file. These are the limits of what those files can tell you.

1 · Data vintage

Commercial rates: Transparency in Coverage in-network machine-readable files published under 45 CFR § 147.212, reporting month 2026-09-01 (file self-reported last_updated_on 2026-10-01, schema 2.0.0). Medicare benchmark: CY 2026 CMS Physician Fee Schedule, release RVU26C (PPRRVU2026_Jul_nonQPP + GPCI2026), conversion factor 33.4009. Provider identity and location: NPPES monthly full-replacement file, September 2026 (V2). Payers republish monthly; figures are a point-in-time extract, not a live feed.

2 · Statistical method

All percentiles are non-parametric with linear interpolation (no distributional assumption, no smoothing). We report the observed contract population for the county, not a sample estimate — no confidence intervals are implied. Records are included only where negotiated_type = "negotiated" and billing_class = "professional"; capitated, percentage-of-billed, per-diem and institutional arrangements are excluded.

3 · County assignment

Providers are assigned to counties by NPPES practice-location ZIP, mapped through the U.S. Census ZCTA-to-county relationship file. ZCTAs cross county lines; each ZCTA is assigned to its dominant county by land area, and ZCTAs where the target county is not dominant are excluded. Land-area share is a proxy for population share and may misclassify providers near county boundaries.

4 · Contract and coding variation

A single CPT code can carry different rates by modifier, place of service, provider licensure/taxonomy, product line, contract vintage, and group arrangement. In this pilot, CPT 90837 shows 20 distinct rates across 76 tax IDs, and psychiatrist-taxonomy rates run about 27% above clinical social worker rates. Rates shown are not modifier-adjusted. Your own contract may differ for legitimate reasons.

5 · Scope of this pilot

The Wake County figures reflect one payer network (UnitedHealthcare of North Carolina / Optum Health Behavioral Services), covering 96 of the 7,578 behavioral health NPIs registered in the county. They are not a whole-market or all-payer view and should not be read as “the Wake County rate.”

6 · No earnings or outcome representation

StarTorch LLC is an information services provider (NAICS 51). Revenue-gap figures are arithmetic illustrations of published rate differentials at user-supplied volumes. They are not projections, forecasts, guarantees, or representations of income. We do not promise any negotiation outcome, rate increase, or revenue result. Nothing here is legal, tax, actuarial, billing, or investment advice, and no professional relationship is created.

7 · Zero PHI

100% Zero PHI. Every input is a public government disclosure: payer rate files, the CMS fee schedule, the NPPES provider registry, and Census geography. We never request, receive, process, or store protected health information, patient records, claims, or remittance data. HIPAA does not apply to this data set. We are not a covered entity or a business associate, and no Business Associate Agreement is required or offered.

8 · Competitive conduct

Reports are prepared for, and delivered to, a single purchasing practice for evaluating its own contracts. StarTorch does not facilitate, host, or intermediate any exchange of pricing information among competing providers, and does not aggregate rates on behalf of any provider association or bargaining group. Source data is government-mandated public disclosure.

9 · Accuracy

Figures are derived from files published by the payers themselves. StarTorch makes no representation as to the accuracy, completeness, or timeliness of the underlying disclosures and does not independently verify them.

Contact & Company Verification

Talk to a real U.S. company.

Questions about coverage for your county, an order, or an invoice? Email us and we'll respond promptly.

WyomingLLC NAICS 51Information 0 PHIBy design

Walk into your next payer conversation with the numbers.

County-level benchmarks, a Medicare comparison, a ready-to-send letter, and zero PHI—for roughly the cost of six sessions at the $34.93 pilot gap.

Get the Dossier — $199 Try the Calculator