Geriatric Psychiatrist Salary in 2026: Nursing Home, Academic, and Telepsychiatry Pay

Geriatric psychiatrists are board-certified psychiatrists who have completed a one-year ACGME-accredited fellowship in geriatric psychiatry and hold an ABPN subspecialty certificate in Geriatric Psychiatry. Their clinical scope centers on the intersection of aging, neurodegeneration, and psychiatric illness: behavioral and psychological symptoms of dementia (BPSD), late-life depression and anxiety, delirium management, late-onset bipolar disorder, and the psychiatric presentations of Lewy body dementia, frontotemporal dementia, and Parkinson's disease. Geriatric psychiatry is the second most undersupplied psychiatric subspecialty after child and adolescent psychiatry, with fewer than 2,000 ABPN-certified geriatric psychiatrists actively practicing against a rapidly growing aging population and a Medicare beneficiary pool projected to reach 80 million by 2030.

Training and Board Certification

The pathway requires four years of ACGME-accredited general psychiatry residency followed by a one-year fellowship in geriatric psychiatry. Unlike child and adolescent psychiatry, the geriatric psychiatry fellowship is one year rather than two, making total training time six years post-medical school (including internship year). ABPN administers the Geriatric Psychiatry subspecialty examination, and the certificate must be renewed through a maintenance of certification (MOC) process. Some geriatric psychiatrists hold dual certification in both General Psychiatry and Geriatric Psychiatry, which is valued in academic settings and hospital-based positions that require broad psychiatric coverage. Fellowship programs are concentrated at academic medical centers, with a limited number of community-based training programs; many graduating geriatric psychiatrists enter the academic or VA system before transitioning to private consulting practice.

Key CPT Codes and Billing in Long-Term Care Settings

• Psychiatric evaluation (90792): Initial psychiatric diagnostic evaluation with medical services ($200–$380 Medicare/commercial); used at admission to nursing facilities and for new behavioral episodes in established residents
• Established patient medication management (99213–99215): Outpatient E&M coding for ongoing medication management visits; complexity coding (99215 with MDM) is important for high-acuity dementia-with-BPSD cases where medication decisions involve weighing mortality risk of antipsychotics against behavioral management goals
• Nursing facility E&M (99304–99306, 99307–99310): Initial nursing facility care ($100–$185 Medicare) and subsequent care ($65–$145); consultants billing nursing facility E&M are reimbursed at lower rates than outpatient codes but the efficiency of seeing 8–12 nursing home patients per half-day makes the model viable
• Domiciliary/assisted living E&M (99324–99328, 99334–99337): Used for patients in assisted living facilities and group homes; often underutilized by non-geriatric-psychiatry-trained physicians who default to outpatient coding
• Psychotherapy add-ons (90833, 90836, 90838): Brief supportive psychotherapy add-ons to E&M visits; used in outpatient and clinic settings for patients who retain capacity for psychotherapy participation despite early-to-moderate cognitive impairment
• Cognitive assessment (99483): Comprehensive care planning service for patients with cognitive impairment ($282 Medicare); typically billed once per year per patient; includes review of medications, safety assessment, caregiver support, and care planning

Salary Ranges by Practice Setting

• Academic geriatric psychiatry division: $220,000–$300,000; university-affiliated positions combine clinical work in a memory clinic or inpatient geriatric psychiatric unit with teaching and research responsibilities; academic supplements from AAMC benchmarks; PSLF-eligible; pathway to research funding (NIA/NIMH R01 grants) and geriatric psychiatry fellowship director roles
• Nursing home and long-term care consulting: $280,000–$400,000; consulting psychiatrists who contract with nursing facilities earn per-visit compensation ($80–$160 per patient visit) or negotiate capitated per-facility monthly fees; high-volume consultants visiting 3–5 facilities per week and seeing 10–15 patients per facility day generate the strongest income in the subspecialty; corporate long-term care chains (Genesis Healthcare, Brookdale, Sunrise Senior Living) have structured psychiatry consulting contracts
• Hospital-employed geriatric psychiatry (inpatient unit): $250,000–$340,000; geriatric psychiatric inpatient units are rare outside academic medical centers and VA hospitals; call obligations (shared with general psychiatry) typically add $20,000–$35,000 in supplemental compensation; CON requirements in some states limit the number of freestanding geriatric psychiatric inpatient beds
• VA geriatric psychiatry: $230,000–$320,000; Title 38 VA pay scales for psychiatry are competitive; VA geriatric research centers (GRECCs — Geriatric Research Education and Clinical Centers) at 20 VA sites offer academic infrastructure for geriatric psychiatric research without traditional RVU production pressure
• Telegeriatric psychiatry: $230,000–$320,000; telepresence psychiatry for nursing facilities has grown rapidly since CMS expanded Medicare telemedicine reimbursement; telegeriatric psychiatrists can serve multiple facilities remotely, improving efficiency while maintaining clinical breadth; platforms like InSight Telepsychiatry and Inpathy specialize in nursing facility telepsychiatry contracts

The Medicare Reimbursement Landscape for Geriatric Psychiatric Services

Geriatric psychiatry is almost entirely Medicare-dependent — the patient population is elderly by definition, and Medicare Part B covers outpatient psychiatric services at 80% after the deductible (patients pay 20% coinsurance). The Medicare physician fee schedule applies to all Part B services regardless of setting, which caps per-visit reimbursement. The financial viability of geriatric psychiatry practice depends on volume efficiency — seeing enough patients per day to generate adequate collections — combined with accurate billing for the complexity level of dementia-associated cases. CMS has progressively increased reimbursement for cognitive assessment (99483) and care planning codes, recognizing the clinical intensity of comprehensive dementia evaluation. The antipsychotic prescribing audit environment for nursing facility psychiatry is an important regulatory consideration: CMS's National Partnership to Improve Dementia Care tracks antipsychotic prescribing rates at the facility level, and geriatric psychiatrists who work in nursing facilities must document behavioral nonpharmacological alternatives before prescribing antipsychotics, per F758 requirements.

Geographic Variation

• High-demand regions: Florida, Arizona, North Carolina, and other Sun Belt retirement destinations have the highest density of nursing facilities, assisted living communities, and memory care units, creating concentrated demand for geriatric psychiatric services; academic geriatric psychiatry divisions at major medical schools in these states compete aggressively for the limited fellowship graduate pool
• Rural shortage: Rural nursing facilities in the Midwest and South are the most acutely underserved; telepsychiatry has partially addressed this gap but many rural facilities lack adequate broadband infrastructure for video-based consultations, creating continued demand for traveling consulting psychiatrists who visit facilities monthly

What we see at Ava Health

Geriatric psychiatry recruiting is characterized by a very small fellowship graduate pool (fewer than 150 new geriatric psychiatry fellowship graduates per year nationally) and sustained institutional demand from academic medical centers, VA hospitals, and nursing facility consulting groups. Most positions are filled within 2–3 months of fellowship graduation through direct institutional relationships, making external recruitment challenging but not impossible — particularly for nursing facility consulting roles where the relationship is more contractual than institutional. The strongest candidates in our geriatric psychiatry pipeline are psychiatrists with at least 5 years of general psychiatry practice experience who complete a geriatric psychiatry fellowship mid-career; they bring practice-management skills that new fellowship graduates lack, which is highly valued by nursing facility consulting groups that expect the physician to build and manage their own patient panel efficiently. Telegeriatric psychiatry is the fastest-growing segment of our geriatric psychiatry placement activity.

Related: Psychiatrist Salary Guide, Child & Adolescent Psychiatrist Salary Guide, Palliative Care Physician Salary Guide, Hospitalist Salary Guide.