CPT code 90791: Psychiatric diagnostic evaluation (intake)

When to use 90791

• The first appointment with a new client, or a formal re-evaluation
• A comprehensive biopsychosocial assessment that ends in a diagnosis and plan
• Not for routine ongoing sessions, which use 90832, 90834 or 90837

What to document

• Presenting problem and reason for referral
• Relevant psychiatric, medical, social, family, and substance-use history
• Mental status exam and risk assessment
• ICD-10 diagnosis (or diagnostic impression) and treatment recommendations
• Date and time spent on the evaluation

Common reasons 90791 gets denied

• Billed more often than the payer allows. Most plans cover 90791 once per episode of care per provider, and some allow it once every 6 to 12 months
• No documented diagnosis or medical necessity for the evaluation
• Billed on the same day as an individual psychotherapy code by the same clinician (often not allowed)
• Used for a routine follow-up session instead of a true evaluation

Add-on codes you can bill with 90791

An add-on code goes on the same claim as 90791 and is never billed by itself.

Billing 90791 by telehealth

The CPT code stays the same when you see a client by video or phone. For Medicare, the place of service changes. Use 10 when the client is at home and 02 when they are somewhere else, such as a clinic. Add modifier 93 when the session was audio-only. Commercial plans and Medicaid set their own rules, and many of them also want modifier 95 on video sessions, so check each payer's telehealth policy.

Medicare covers mental health telehealth in the client's home permanently, wherever the client lives. Through 2027 it pays for audio-only sessions with no extra conditions. From January 1, 2028, audio-only needs a client who can't use video or doesn't agree to it. In 2028 Medicare also starts requiring an in-person visit within 6 months before a client's first mental health telehealth session, then one every 12 months. Clients who start telehealth before 2028 only need the yearly visit. The CMS telehealth page has the current Medicare rules.

How much does 90791 pay in 2026?

Medicare, national non-QP

$173.35

Typical commercial range

$191 to $260

• The commercial range is 110 to 150% of Medicare. Real contracts run from below 80% to above 200%.
• Medicare pays master's-level clinicians (LCSW, LMFT, LPC) about 75% of the listed amount.
• Your locality's geographic adjustment (GPCI) moves the rate a little.
• Out-of-network clients claim 90791 on a superbill, and their plan pays back a share of what it allows for the code, not a share of your fee.
• Qualifying APM Participants are paid under a slightly higher conversion factor than the non-QP $33.4009 used here.

Medicare figures checked against the official CMS 2026 Physician Fee Schedule Relative Value Files (RVU26D) on Oct 17, 2026.

Related codes

Frequently asked questions