CPT 90791

CPT Code 90791: Psychiatric diagnostic evaluation (intake)

Service
Psychiatric diagnostic evaluation (intake)
Category
Diagnostic
Time component
None - reported per session
2026 Medicare (non-QP)
$173.35

90791 is the intake. It's the comprehensive evaluation you bill for a new client's first appointment - history, mental status exam, diagnosis, and an initial treatment plan. It does not include medical services; that's 90792, which psychiatrists and other medical providers bill. Therapists, counselors, psychologists, and clinical social workers use 90791.

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 - those use 90832 / 90834 / 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 than the payer allows - most plans cover 90791 once per episode of care per provider; some allow it once per 6-12 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

How much does 90791 pay in 2026?

The 2026 non-QP Medicare national non-facility rate for 90791 is about $173.35. Commercial payers usually land somewhere around $191 - $260 (roughly 110-150% of Medicare), though contracts run from below 80% to above 200%. A few things worth remembering: these figures use the non-QP conversion factor ($33.4009) - clinicians who are Qualifying APM Participants (QPs) are paid under a slightly higher factor - Medicare pays master's-level clinicians (LCSW, LMFT, LPC) about 75% of the listed amount, and your locality's geographic adjustment (GPCI) shifts the number a little.

Want the math for your own week of sessions and payer mix? Try the CPT reimbursement calculator - stack your codes, set your rates, and see weekly, monthly, and annual revenue.

Related codes

90834 · 45-minute individual psychotherapy 90837 · 60-minute individual psychotherapy 90847 · Family or couples psychotherapy with the client present

Frequently asked questions

How often can you bill 90791?

Most payers reimburse 90791 once per episode of care per provider. Some allow it again for a re-evaluation after a period (often 6-12 months) or when a client returns after a gap in care. Always confirm the specific payer's frequency rule.

What is the difference between 90791 and 90792?

90791 is a diagnostic evaluation without medical services and is used by therapists, counselors, psychologists, and social workers. 90792 adds medical services (such as a physical exam or prescribing) and is billed by psychiatrists and other medical providers.

Can 90791 and a therapy code be billed on the same day?

Many payers do not allow 90791 and an individual psychotherapy code (90832/90834/90837) on the same day by the same clinician. Check the payer's policy before billing both.

This page is general reference for 2026 and is not billing, legal, or coding advice. Code rules, time ranges, and reimbursement depend on the current CPT and CMS guidelines, your payer contracts, state, locality, and credentials - always confirm against your payer's policy. See the full mental health CPT code list.