The Aetna and Alma Rate Cuts Hit August 15. Here's What Actually Changed.
Rate cuts. Nobody wants to read that sentence, and I don't love writing it.
But the cuts Alma announced under their Aetna contract take effect August 15, and there's been enough noise around this that a lot of therapists still aren't clear on what's real. That’s why I’m clearing things up in this post.
So here's what I’ll cover:
What was originally announced
What Alma has since confirmed is off the table
What the actual percentage change looks like code by code
I'm an independent therapist with a group practice in New York City. I'm in this with you too. If big tech has a bad year, I don't want my practice to have a bad year with it and I don't want yours to either. So I’ll finish this post with what I actually think you should do about these changes.
What Was Announced, and What Got Walked Back
Several weeks ago, Alma told its members that Aetna was cutting rates under their contract. Two pieces got the most attention.
The first was 90837 — the 60-minute session code. The plan was to pay 90837 at the same rate as 90834, the 45-minute code. That never made sense. A 90837 is more work, or a longer session, however you want to frame it. Paying it identically to a shorter session isn't a rate adjustment, it's a message about how the work is valued.
The second was credentials. Reimbursement was going to be flattened across license types — LCSW, PhD, all the same.
Both of those have since been walked back. Alma's most recent email confirmed two things directly:
90837 and 90834 will not be consolidated into a single rate. There will still be a difference between them.
Reimbursement will continue to reflect degree type and training. Your credential still matters to what you're paid.
From Alma's side, that's the good news, and it is genuinely better than where this started, but none of this is good news. The rates are being cut significantly.
Many codes are still being reduced
The Actual Numbers: New York
I'm licensed in New York and New Jersey, so those are the two states I can speak to directly. I'd expect other states to look broadly similar, but check yours to be sure. Don't assume all cuts are the same.
These are four of the commonly used CPT codes, and this is the change to the reimbursement rate:
90791 will be reduced by 9.7%
90832 will have no reduction
90834 will be reduced by 3.6%
90837 will be reduced by 10.6%
Nearly ten percent off your 60-minute session. That's the code many therapists use for their weekly sessions.
The Actual Numbers: New Jersey
90791 will be reduced by 16.8%
90832 will have no reduction
90834 will be reduced by 1.9%
90837 will be reduced by 15.2%
One thing worth naming: the "no change" on 90832 is not a win. The 30-minute session has always been reimbursed poorly. A bad rate holding steady is still a bad rate. Don't let a flat line in a column read as good news.
Run these percentages against your own volume for a year and you'll see the real number. It's not pretty.
The Cut Is only part of the Problem. Having No Say Is Another.
Here's what I keep coming back to.
You couldn't have stopped this. You can't tell Alma not to make this change. You can't tell Aetna not to make it. It got decided somewhere else, by people who were never going to ask you, and it lands on your practice on August 15 whether it works for you or not.
That's the part that should really get your attention.
And the reason it lands so hard for so many therapists is that they've put all their eggs in one basket. Their entire practice runs off Alma. Or off one big tech platform. Or off one insurance panel. When that single company makes a decision like this one, the whole practice moves with it. That’s scary.
I'm not telling you to drop insurance or leave these platforms. That's not realistic, and it's not what I did. If you take insurance, you're going to feel some version of this — always. If you've got clients on Alma, same. The goal is not to cut ties with all platforms. The goal is that no single company's Tuesday morning announcement should reshape your income.
Your Home Base Should Belong to You…
The most concrete version of this: your practice's home base should be a dedicated EHR or medical record system that you control.
Don't let the whole operation live inside Alma or Headway. I wouldn't keep all my documents in those platforms. I wouldn't run all my billing through them. When your records, your credentialing, your referrals, your billing, and your client relationships all sit inside a company you have no influence over, you haven't chosen a vendor; you've inherited a landlord.
Have a real record system as your home base, and use the other platforms to meet specific needs. Not the other way around.
The Way You Get Control Back Is Learning to Market
There's a bigger fight here — advocacy, structural change, rates that reflect the work. That fight matters and it's slow. Meanwhile your practice has to survive this quarter.
The lever you actually control is referrals. If you can bring in your own clients, you get to decide whether you go cash pay or stay on panels. You can open one channel when another tightens. That is what control looks like in practice.
There are two honest paths, and both work:
Learn enough to hire well. You don't have to run your own marketing. But you need enough understanding to hire someone good, know what you're paying for, and tell the difference between work that's producing and work that's just billing you.
Learn enough to do it yourself. Build a basic website. Run a Google ad. It's more learnable than most therapists assume.
Either way it takes some baseline knowledge, and that's been my biggest push lately — because it was the shift for me. Once I understood the basics, announcements like this one stopped scaring me because I finally had somewhere else to turn.
Where to Start
August 15 is going to happen. You can't negotiate it. What you can do is make sure the next announcement doesn't have this much leverage over you.
If you want a place to start, I run a free community focused on private practice building. I manage it myself and I respond to every post in there, and the goal is to teach the marketing basics that give you your options back.
It's free. Come in, ask a question, and start building the part of your practice that nobody else gets to vote on.
