CPT 90792Other

Psych diag eval w/med srvcs

CPT 90792 covers a comprehensive psychiatric evaluation that includes medical services, typically performed when a prescribing clinician conducts an initial mental health assessment and considers medication management.

Showing rates for

National Average

Base Medicare rate

$187.93

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

4.16

PE RVU (NF)

1.49

MP RVU

0.16

Total RVU

5.81

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document the medical component explicitly to justify 90792 over 90791
Impact: Using correct code captures additional $24.26 per visit on Medicare non-facility ($187.93 vs $163.67 for 90791). Must document review of systems, medical history relevant to psychiatric diagnosis, and medical decision-making for medication management.
Verify provider credentials before billing 90792
Impact: Non-prescribing clinicians (psychologists, LCSWs, LPCs) cannot bill 90792 and must use 90791. Incorrect code selection results in 100% denial and potential audit exposure. Credential verification prevents $187.93 denials.
Bill 90792 only once per patient per provider for initial evaluation
Impact: 90792 is an initial diagnostic evaluation code. Subsequent visits require different codes (99213-99215 for medication management or 90833-90838 for psychotherapy). Repeat billing of 90792 triggers automatic denials and audit flags.
Ensure time and complexity documentation supports the 4.16 work RVUs
Impact: Typical time is 60 minutes. Documentation should reflect comprehensive psychiatric history, mental status exam, medical review, and treatment planning. Inadequate documentation may result in downcoding to lower-level E/M codes (losing $100+ in reimbursement).
Understand facility vs non-facility settings to expect correct reimbursement
Impact: Non-facility rate is $187.93 vs facility rate of $163.67, a difference of $24.26. Billing location (POS code) must be accurate. Office/clinic is non-facility; hospital outpatient departments are facility rates.
Do not bill 90792 with psychotherapy codes on the same date of service

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Frequently asked questions

What is the difference between CPT code 90792 and 90791?

CPT 90792 includes medical services and is used by prescribing clinicians (psychiatrists, nurse practitioners, physician assistants) when evaluating patients for potential medication management. CPT 90791 is the diagnostic evaluation without medical services, used by non-prescribing providers like psychologists, licensed clinical social workers, and counselors. The 2025 Medicare non-facility rate for 90792 is $187.93 compared to approximately $163.67 for 90791.

How much does Medicare pay for CPT code 90792 in 2025?

Medicare pays $187.93 for CPT 90792 in non-facility settings and $163.67 in facility settings for 2025, based on the national average rates. Actual payment may vary by geographic locality due to GPCI adjustments. The code has a total RVU of 5.81 (4.16 work RVU, 1.49 non-facility PE RVU, 0.16 MP RVU).

Can a psychologist bill CPT code 90792?

No, psychologists cannot bill CPT 90792 because they cannot prescribe medication in most states and therefore cannot provide the 'medical services' component required for this code. Psychologists must use CPT 90791 for psychiatric diagnostic evaluations. Only physicians, nurse practitioners, physician assistants, and clinical nurse specialists with prescribing authority can bill 90792.

How often can you bill CPT 90792 for the same patient?

CPT 90792 should typically be billed only once per patient per provider as an initial diagnostic evaluation. Subsequent visits for medication management use E/M codes (99212-99215) or psychotherapy codes (90832-90838). Re-evaluation with 90792 may be appropriate after a significant gap in treatment (usually 6+ months), when transferred from another provider, or if a comprehensive re-evaluation is medically necessary due to major changes in condition.

Can you bill 90792 and psychotherapy on the same day?

No, CPT 90792 is for diagnostic evaluation only and should not be billed with psychotherapy codes (90832-90838) on the same date. The initial evaluation focuses on assessment and diagnosis, not treatment. If psychotherapy is provided during an initial visit, consider using an E/M code with psychotherapy add-on codes instead, or provide psychotherapy at a subsequent visit after the initial diagnostic evaluation.

What documentation is required for CPT 90792?

Documentation for 90792 must include comprehensive psychiatric history, detailed mental status exam, medical history, review of systems, substance use assessment, risk assessment, DSM-5 diagnosis, and medical decision-making regarding medication management. The medical component distinguishing 90792 from 90791 must be clearly documented, including how medical factors impact psychiatric treatment and medication considerations. Typical encounter time is 60 minutes.

Is CPT 90792 covered by telehealth?

Yes, CPT 90792 is covered via telehealth by Medicare and most commercial payers when using modifier 95 (or GT for some payers). The 2025 reimbursement rate for telehealth is the same as in-person visits at $187.93 non-facility rate. The service must be provided via real-time interactive audio and video, and all documentation requirements remain the same as for in-person visits.