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Free tool for Alma clinicians

What will the Aetna/Alma pay cut cost you?

Effective July 15, 2026, Aetna cuts what it pays clinicians who bill through Alma. Alma notified clinicians on May 20. Three differentials flatten: a 53-plus-minute session (90837) pays the same as a 38-to-52 minute one (90834), a high-complexity visit (99215) pays at the moderate (99214) rate, and physician-level reimbursement drops to the NP and master's level. For prescribers, the E/M changes stack on every visit. Enter your own numbers to see what the change costs your panel.

Illustrative default. Use the rate on your Alma fee schedule.

Illustrative default. Use the rate on your Alma fee schedule.

Medicare's MD-to-NP differential is exactly 15 percent. Commercial differentials vary.

Estimated weekly loss

$442.50

Estimated annual loss

$21,240

Complexity flattening (99215 paid at the 99214 rate)$150.00/week
Credential flattening (MD/DO paid at the NP rate)$292.50/week

How this is calculated: (your 99215 rate minus your 99214 rate) times your weekly 99215 visits, plus, for MDs and DOs, (your 99214 rate times the NP differential) times all your weekly E/M visits. Weekly loss times working weeks gives the annual figure.

Methodology and assumptions

The prescriber formula: (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 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.
  • After July 15, every E/M visit is modeled as paying the 99214 rate, and MD/DO clinicians additionally take the NP differential haircut on that flattened rate. NP and PA inputs skip the haircut because their rate is 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.
  • The announced changes do not address the psychotherapy add-on codes (90833, 90836, 90838). Read your updated regional fee schedule in the Alma portal rather than assuming either way.

Sources

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.

Embed this calculator

Writing about the rate cut? You are welcome to embed the calculator on your own site. Paste this snippet where you want it to appear. The calculator grows a little when optional fields appear, so the snippet leaves it some room.

HTML

<iframe
  src="https://eureka.md/aetna-alma-calculator/embed"
  width="100%"
  height="1050"
  style="border: 1px solid #e5e5e5; border-radius: 12px;"
  title="Aetna/Alma pay cut calculator"
  loading="lazy"
></iframe>

The calculator tells you the size of the problem. The three ways to respond, staying and pushing back, restructuring, or treating the cut as your exit ramp, are covered in our full analysis: What Aetna's Alma Rate Cut Means for Psychiatrists.

Built by Eureka, a practice platform for cash-pay psychiatrists: automatic superbills, cards on file charged after each visit.