{"id":162292,"date":"2026-07-23T09:35:07","date_gmt":"2026-07-23T09:35:07","guid":{"rendered":"https:\/\/pabau.com\/?p=162292"},"modified":"2026-08-17T11:46:26","modified_gmt":"2026-08-17T11:46:26","slug":"cpt-code-90791","status":"publish","type":"post","link":"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-90791\/","title":{"rendered":"CPT Code 90791: Psychiatric diagnostic evaluation billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"CPT Code 90791: Psychiatric diagnostic evaluation billing guide\",\"description\":\"CPT Code 90791 covers psychiatric diagnostic evaluation without medical services. Learn 2026 Medicare rates, documentation requirements, eligible providers, and billing rules.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90791\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-08\",\"dateModified\":\"2026-07-23\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key Takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key Takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>CPT Code 90791 is the psychiatric diagnostic evaluation code without a medical services component, used for initial mental health assessments.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Eligible providers include psychiatrists, psychologists, LCSWs, LPCs, licensed marriage and family therapists, NPs, and PAs enrolled in Medicare.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Missing a mental status exam, treatment plan, or DSM-5\/ICD-10 diagnosis in the clinical note is the most common reason claims for 90791 are denied.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau, practice management software for mental health practices, offers digital intake forms and claims management tools that capture required 90791 documentation and support clean claim submission.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">CPT Code 90791 is the <a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt\/cpt-code-set-overview\" target=\"_blank\" rel=\"nofollow noopener\">AMA&rsquo;s designated code<\/a> for a psychiatric diagnostic evaluation performed without a medical services component. It covers the initial comprehensive mental health assessment: gathering psychiatric history, conducting a mental status examination (MSE), establishing a diagnosis, and formulating a treatment plan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This guide covers eligible providers, documentation requirements, reimbursement rates, telehealth rules, and the most common claim denial patterns for CPT 90791 in 2026.<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\">\n<div class=\"wp-block-embed__wrapper\">\n<iframe title=\"CPT Coding Pitfalls Every Medical Practice Faces\" width=\"800\" height=\"450\" src=\"https:\/\/www.youtube.com\/embed\/vbvV5okdXKg?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div>\n<\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">CPT Code 90791: Definition and clinical description<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The official AMA descriptor reads: <em>Psychiatric diagnostic evaluation.<\/em> \u00ab\u00a0Without medical services\u00a0\u00bb means no prescribing, no medication management, and no E\/M service is bundled into the encounter.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The moment a provider performs a medical evaluation alongside the psychiatric assessment, such as reviewing labs or ordering medications, CPT 90791 is no longer the right code. CPT 90792 takes over instead.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">CPT 90791 quick reference<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Use this table for a fast check before billing. Verify the current-year rate using the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">CMS fee schedule lookup<\/a>, since Medicare locality adjustments apply.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Detail<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">CPT Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90791<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Psychiatric diagnostic evaluation<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medical services included<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical session duration<\/td>\n<td style=\"padding:12px 16px;color:#374151\">45-90 minutes (no time threshold in the code descriptor)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 Medicare non-facility rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Approximately $168-$180 (verify via MPFS; locality-adjusted)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 Medicare facility rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower than non-facility (overhead borne by facility)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Global period<\/td>\n<td style=\"padding:12px 16px;color:#374151\">XXX (not applicable)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Telehealth eligible<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (modifiers 95 or GT required)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Add-on code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90785 (interactive complexity, when criteria met)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The non-facility rate reflects services performed in an office or outpatient setting where the practice bears overhead costs. Always confirm the rate for your specific Medicare Administrative Contractor (MAC) locality before submitting claims. Mental health practices using EHR for private practice workflows can automate this cross-check at the point of claim submission.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Who can bill CPT Code 90791?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Provider eligibility is where many practices hit unexpected denials. CPT Code 90791 is not restricted to psychiatrists. Under Medicare, any qualified mental health professional enrolled in the program may bill 90791, subject to state licensure and payer enrollment requirements. Scope-of-practice rules vary by state, so verify before billing for any provider type not listed below as having explicit Medicare recognition.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Psychiatrists (MD, DO)<\/strong>: Fully eligible; may also use 90792 when medical services are performed.<\/li><li><strong>Psychologists (PhD, PsyD)<\/strong>: Eligible; independently licensed in most states; cannot bill 90792 (no prescribing authority).<\/li><li><strong>Licensed Clinical Social Workers (LCSWs)<\/strong>: Eligible under Medicare Part B when independently licensed; 75% of physician fee schedule rate applies.<\/li><li><strong>Licensed Professional Counselors (LPCs) and Licensed Mental Health Counselors (LMHCs)<\/strong>: Eligible for Medicare as of January 1, 2024 under the Consolidated Appropriations Act provisions; 75% rate applies.<\/li><li><strong>Licensed Marriage and Family Therapists (LMFTs)<\/strong>: Also eligible as of January 1, 2024 under the same provisions.<\/li><li><strong>Nurse Practitioners (NPs) and Physician Assistants (PAs)<\/strong>: Eligible; must bill under their own NPI and within their scope of practice, which varies by state. Depending on state regulation, NPs and PAs may also bill 90792.<\/li><li><strong>Addiction counselors and peer support specialists<\/strong>: Generally not eligible for Medicare 90791 billing independently; must bill incident-to or through a supervising physician.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices using psychiatry EMR software can configure provider-level billing permissions to prevent ineligible providers from submitting 90791 claims accidentally. Supervision requirements for non-physician practitioners should be confirmed with your MAC and state licensing board before billing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The right <a href=\"https:\/\/pabau.com\/blog\/primary-care-software\/\">software for primary care practices<\/a> turns immunizations and in-office tests into charted, billable entries automatically.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Documentation requirements for CPT 90791<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A clean 90791 claim starts with a complete clinical note. Payers audit psychiatric diagnostic evaluation claims closely because the service is not time-based, which means documentation must substantiate the medical necessity of a full diagnostic workup, not just a brief intake. Use this checklist before submitting any 90791 claim.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Documentation element<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">What to include<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Common omission<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Chief complaint<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patient&rsquo;s presenting reason in their own words<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Generic \u00ab\u00a0therapy evaluation\u00a0\u00bb with no patient voice<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">History of present illness (HPI)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Symptom onset, duration, severity, triggers, prior treatment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incomplete HPI without prior treatment history<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Psychiatric history<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Prior diagnoses, hospitalizations, medications tried<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Omitted entirely for first-time patients<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Mental status examination (MSE)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Appearance, behavior, speech, mood, affect, thought, cognition, insight, judgment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">MSE absent or limited to \u00ab\u00a0affect appropriate\u00a0\u00bb<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Risk assessment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Suicidal\/homicidal ideation, self-harm, protective factors<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Not documented when patient denies SI. An emotional regulation checklist supports structured risk documentation.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">DSM-5\/ICD-10-CM diagnosis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Specific diagnosis with full ICD-10-CM code to highest specificity<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Unspecified codes when a more specific code exists<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Treatment plan<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Modality, frequency, goals, estimated duration<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Missing or copied from a previous patient&rsquo;s record. A cognitive triangle worksheet can help structure CBT-based goals.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Structuring intake notes to capture every element above is easier with a purpose-built psychiatric evaluation template that prompts clinicians through each section. Practices that use digital intake forms can pre-populate demographic and history fields from the patient intake, reducing the clinical documentation burden at the time of the evaluation itself.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-90791\/customizable-consent-and-intake-forms.webp\" alt=\"Customizable consent and intake forms\"\/><figcaption class=\"wp-element-caption\"><em>Customizable consent and intake forms<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n\n<h2 class=\"wp-block-heading\">CPT 90791 reimbursement rates (2026)<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimbursement for CPT Code 90791 is set annually through the Medicare Physician Fee Schedule (MPFS). Rates are locality-adjusted, meaning a practice in Manhattan will receive a different payment than one in rural Mississippi. The figures below reflect national averages for 2026. Always verify the exact amount for your MAC locality using the <a href=\"https:\/\/fastrvu.com\/tools\/rvu-lookup\" target=\"_blank\" rel=\"nofollow noopener\">FastRVU RVU lookup tool<\/a>.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Setting<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Approximate 2026 Medicare rate<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Non-facility (office\/outpatient)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$168-$180<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher rate; practice bears overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Facility (hospital, CMHC)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Lower than non-facility<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Facility receives separate payment for overhead<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LCSWs, LPCs, LMFTs, LMHCs<\/td>\n<td style=\"padding:12px 16px;color:#374151\">75% of physician rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare Part B statutory reduction applies<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medicaid<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varies by state<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Check your state Medicaid fee schedule directly<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Commercial insurers<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Varies by contract<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Often higher than Medicare; negotiate at credentialing<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The 2026 non-facility rate is subject to the Centers for Medicare and Medicaid Services (CMS) final rule. Rates marked \u00ab\u00a0approximate\u00a0\u00bb above require verification against the published MPFS because locality adjustments can shift the effective rate by 15% or more depending on geographic area. Medicaid rates are entirely state-specific and must be confirmed with your state Medicaid agency.<\/p>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a quarterly audit of your 90791 reimbursement rates against your MAC locality payment file. Many practices discover they are leaving 10-20% of expected reimbursement uncollected because their billing system defaults to a national average instead of the locality-specific fee schedule. Download the current MPFS from CMS and compare it against your posted procedure charges.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">CPT 90791 vs 90792: Key differences<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The distinction between CPT Code 90791 and CPT 90792 is one of the highest-risk coding decisions in outpatient mental health billing. Using 90792 when no medical services were rendered is considered upcoding and can trigger payer audits. This comparison table clarifies when each code applies.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Factor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 90791<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 90792<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Official descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Psychiatric diagnostic evaluation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Psychiatric diagnostic evaluation with medical services<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Medical services component<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (medication management, prescribing, labs)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Who can bill<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Psychiatrists, psychologists, LCSWs, LPCs, LMFTs, NPs, PAs<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Physicians and prescribing NPs\/PAs only<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 Medicare rate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">~$168-$180 (non-facility)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Higher than 90791 (reflects additional medical work)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Prescribing required<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (or at minimum, medication review\/management)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Typical use case<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial intake by therapist, psychologist, or counselor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Initial psychiatric intake with medication discussion by psychiatrist or prescribing NP<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Psychologists and licensed counselors should never bill CPT 90792, regardless of how comprehensive the evaluation was. Their scope of practice does not include medical services, making 90791 the correct code every time. Psychiatrists and prescribing NPs should use 90792 only when they genuinely performed a medical evaluation, such as ordering labs, reviewing current medications, or initiating a prescription.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">CPT 90791 vs 90837: When to use each<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Confusing CPT Code 90791 with CPT 90837 is a common billing error, especially among newer practice managers. The two codes describe completely different clinical activities. 90791 is a one-time diagnostic activity. 90837 is ongoing treatment. Billing 90837 at the first session is a compliance risk.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Factor<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 90791<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">CPT 90837<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Service type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Diagnostic evaluation<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Individual psychotherapy, 60 minutes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">When to use<\/td>\n<td style=\"padding:12px 16px;color:#374151\">First session; new episode of care<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Ongoing treatment sessions after diagnosis established<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Time-based<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (requires 53+ minutes face-to-face)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing frequency<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Once per new patient or new episode; some payers allow re-eval after extended gap<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Each qualifying therapy session<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Add-on codes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90785 (interactive complexity)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">90785 (interactive complexity); E\/M codes when applicable<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The transition from 90791 to 90837 marks the shift from intake to active treatment. Once a diagnosis and treatment plan are in place, a psychology treatment plan template helps formalize ongoing therapy goals, reducing the risk of code mix-ups between the diagnostic and treatment phases of a patient&rsquo;s episode of care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Add-on codes that can be billed with CPT 90791<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 90791 supports one primary add-on code: CPT 90785, the interactive complexity add-on. Not every 90791 encounter qualifies. The clinical criteria must be met and documented, or the add-on claim will be denied.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>CPT 90785 (interactive complexity)<\/strong>: Billed in addition to 90791 when the encounter involves specific complicating factors. Qualifying criteria include: mandated reporting or involvement of a third party (such as a guardian or family member active in the session), translation services, evidence of maladaptive communication, or the need to manage threatening behavior. The add-on requires documentation of the specific complicating factor, not just a general note that the session was complex. Practices managing complex psychiatric caseloads through mental health EMR software can build 90785 criteria prompts directly into clinical note templates.<\/li><li><strong>E\/M add-ons<\/strong>: Not applicable with 90791. If a medical evaluation component is added, the correct primary code becomes 90792, not 90791 plus an E\/M code.<\/li><li><strong>Crisis codes (90839, 90840)<\/strong>: These are not add-ons to 90791. If a patient enters crisis during the diagnostic evaluation, documentation should reflect whether the encounter transitioned to a crisis intervention service, which would be billed separately per payer guidelines.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Telehealth billing for CPT Code 90791<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 90791 is on the Medicare telehealth services list, meaning a psychiatric diagnostic evaluation conducted via video can be billed to Medicare. The rules below reflect post-Public Health Emergency policy. Because telehealth regulations have continued to evolve through Congressional action, confirm current requirements with your MAC before billing.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Modifier 95<\/strong>: Required for synchronous telehealth services billed to Medicare. Append modifier 95 to CPT 90791 when the session was conducted via audio-video connection.<\/li><li><strong>Modifier GT<\/strong>: Used by some payers and for Medicare Advantage plans. Check your specific payer&rsquo;s modifier requirements; some commercial insurers still require GT instead of or in addition to 95.<\/li><li><strong>Audio-only<\/strong>: Medicare has allowed audio-only psychiatric evaluations under certain circumstances. The patient must be in a location with limited access to video technology and must have the right to refuse audio-only services. Audio-only policy remains subject to annual legislative extension; verify before billing.<\/li><li><strong>Originating site<\/strong>: For Medicare, originating site requirements were waived during the PHE and extended in subsequent legislation. As of 2026, the patient&rsquo;s home qualifies as an originating site for mental health telehealth services. Confirm the current status of the home-as-originating-site rule for your MAC.<\/li><li><strong>Place of service code<\/strong>: Use POS 02 (telehealth provided other than in patient&rsquo;s home) or POS 10 (telehealth provided in patient&rsquo;s home), depending on where the patient is located.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices conducting telehealth psychiatric evaluations should ensure their platform meets HIPAA security requirements. See our HIPAA compliance software guide for a checklist of required safeguards. Pabau&rsquo;s telehealth software is built with HIPAA-aligned security controls for remote clinical sessions.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Common billing errors with CPT 90791 and how to avoid them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most expensive 90791 billing mistakes are not the obscure ones. They are the repeatable, systematic errors that recur across every new patient intake unless a practice has explicit safeguards in place. Here are the patterns that generate the most denials.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Upcoding to 90792<\/strong>: Billing 90792 when no medical services component was present. This is the single highest-risk error and can trigger fraud and abuse review if it appears systematically across claims.<\/li><li><strong>Billing 90791 for established patients without clinical justification<\/strong>: Most payers treat 90791 as a once-per-episode code. Billing it again for an existing patient without documenting a new episode of care or a clinically significant gap in treatment will be denied. Some payers require a gap of 12-24 months; others require clinical justification. Verify the rule with each payer in your panel.<\/li><li><strong>Missing or unspecified diagnosis codes<\/strong>: Submitting 90791 with a Z code or an unspecified ICD-10-CM code (for example, F32.9 instead of F32.1) when a more specific diagnosis is supported by the clinical record increases audit risk and may trigger medical necessity denials.<\/li><li><strong>Incorrect modifiers for telehealth<\/strong>: Failing to append modifier 95 or GT when the session was conducted via video is a straightforward denial cause.<\/li><li><strong>Duplicate billing<\/strong>: Billing 90791 and 90792 for the same encounter with the same patient on the same date. Only one psychiatric diagnostic evaluation code can be billed per encounter.<\/li><li><strong>Incomplete MSE<\/strong>: Submitting a claim where the clinical note contains only \u00ab\u00a0mood\/affect WNL\u00a0\u00bb without a structured mental status examination. Payers expect a complete MSE at the initial evaluation level.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices with high 90791 denial rates should run a denial-reason analysis by claim type. <\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/cpt-code-90791\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automate claims and billing with Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n\n\n<h2 class=\"wp-block-heading\">ICD-10 codes commonly paired with CPT 90791<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every 90791 claim requires at least one supporting ICD-10-CM diagnosis code. The diagnosis must be supported by the clinical documentation; billing the most common code rather than the most accurate one is a documentation integrity issue. Use the most specific code the documentation supports. The <a href=\"https:\/\/www.aapc.com\/codes\/cpt-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC Codify lookup tool<\/a> is a useful cross-reference for verifying code-to-service pairing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">ICD-10-CM code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Notes<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F32.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Major depressive disorder, single episode, moderate<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Prefer over F32.9 (unspecified) when severity is documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F41.1<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Generalized anxiety disorder<\/td>\n<td style=\"padding:12px 16px;color:#374151\">One of the most frequently paired codes with 90791<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F43.10<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Post-traumatic stress disorder, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Specify acute (F43.11) or chronic (F43.12) when documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F90.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Attention-deficit hyperactivity disorder, predominantly inattentive type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Commonly paired with 90791 at ADHD diagnostic intake. See ADHD strategies for adults for treatment planning.<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F84.0<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Autistic disorder<\/td>\n<td style=\"padding:12px 16px;color:#374151\">See F84.0 for the full code description<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F43.21<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Adjustment disorder with depressed mood<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Also see F43.2 for related subtypes<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">F31.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Bipolar disorder, unspecified<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use a more specific F31 sub-code when episode type is documented<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Z03.89<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Encounter for observation for other suspected diseases and conditions ruled out<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Use when the evaluation results in ruling out a psychiatric diagnosis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">ICD-10-CM code specificity requirements mean that under-coding (using F32.9 when the record supports F32.1) can flag a claim for medical necessity review just as over-coding can. A coder familiar with DSM-5 criteria alignment should review the ICD-10 selection before billing if the diagnosing clinician is not the billing provider.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Related CPT codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-93356\/\">CPT code 93356 \u2014 Myocardial Strain Imaging<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90839\/\">CPT code 90839 \u2014 Psychotherapy for crisis<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90868\/\">CPT code 90868<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/cpt-code-90901\/\">CPT code 90901 \u2014 Biofeedback training<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">How Pabau supports psychiatric diagnostic evaluation billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Most psychiatric billing errors are documentation errors. The clinical note is complete on paper but missing one element that the payer requires for clean adjudication. Pabau addresses this at the intake stage rather than the claims stage, making it a prevention tool rather than just a billing tool.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mental health practices using Pabau can configure intake templates to capture every required 90791 documentation element: chief complaint, HPI, psychiatric history, full MSE, risk assessment, diagnosis, and treatment plan. These templates can be sent to patients before the appointment as part of the pre-assessment workflow, or completed by the clinician during the session using structured fields that prevent accidental omissions.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The same platform handles claim generation, so the jump from clinical note to CMS-1500 submission involves no manual re-entry of diagnosis codes or service dates.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For practices billing 90791 across multiple providers with different license types, provider-level billing rules can flag claims where a non-prescribing provider has been assigned a 90792 code.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The practice management software features that matter most for 90791 compliance connect documentation completeness directly to claim submission, rather than treating them as two separate workflows.<\/p>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    See how Pabau streamlines mental health billing                <\/h3>\n\n                <p class=\"description\">\n                    From 90791 intake templates to claims management and denial tracking, Pabau gives mental health practices a single platform for documentation and billing. Book a demo to see how it works for your practice.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau mental health billing platform dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 class=\"wp-block-heading\">Conclusion<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">CPT Code 90791 is straightforward in concept but surprisingly easy to misapply in practice. Choosing 90792 when no medical services were performed, billing 90791 repeatedly without clinical justification for a new episode, or submitting with an incomplete mental status examination: these are the errors that drive denial rates up and reimbursement down for mental health practices.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Practice management software like Pabau connects intake documentation directly to claim submission, giving billing staff a clean chain from the clinical note to the CMS-1500. If your practice wants to reduce 90791 denials and build a more consistent psychiatric billing workflow, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> to see how Pabau handles it.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a structured intake template for psychiatric evaluations?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/psychiatric-evaluation-template\/\" rel=\"noopener\">Psychiatric evaluation template<\/a> provides a step-by-step framework for capturing every required 90791 documentation element.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need additional structured assessment tools for the diagnostic interview?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/16pf-questionnaire\/\" rel=\"noopener\">16PF questionnaire<\/a> gives clinicians a validated personality assessment to complement a psychiatric evaluation.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Documenting behavioral observations as part of an evaluation?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/abc-behavior-chart\/\" rel=\"noopener\">ABC behavior chart<\/a> structures antecedent-behavior-consequence notes for the clinical record.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Frequently Asked Questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1784795292591\"><h3 class=\"schema-faq-question\">What is CPT Code 90791 and when should it be used?<\/h3> <p class=\"schema-faq-answer\">CPT Code 90791 is the psychiatric diagnostic evaluation code for initial mental health assessments performed without a medical services component. Use it at the first session with a new patient, or at the start of a new episode of care, when the encounter involves a comprehensive psychiatric history, mental status examination, diagnosis, and treatment planning but no prescribing or medication management.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784795292592\"><h3 class=\"schema-faq-question\">What is the difference between CPT 90791 and 90792?<\/h3> <p class=\"schema-faq-answer\">CPT 90791 covers a psychiatric diagnostic evaluation without medical services, while CPT 90792 covers the same evaluation with medical services, such as medication management or prescribing. Only physicians and prescribing NPs or PAs may bill 90792. Psychologists and licensed counselors must always use 90791 regardless of how comprehensive the evaluation was.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784795292593\"><h3 class=\"schema-faq-question\">How often can CPT 90791 be billed per patient?<\/h3> <p class=\"schema-faq-answer\">Most payers treat CPT 90791 as a once-per-episode code, meaning it can be billed again only when a clinically significant new episode of care begins. Some payers require a gap of 12-24 months before allowing a repeat billing. Always verify frequency limitations with each payer in your panel, as rules vary and billing 90791 twice for the same episode without justification is a common denial trigger.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784795292594\"><h3 class=\"schema-faq-question\">Can I bill 90791 when a patient changes insurance plans?<\/h3> <p class=\"schema-faq-answer\">A change in insurance does not automatically justify a new 90791 billing. The clinical rationale must support a new diagnostic evaluation, not just an administrative change. If the patient has been continuously in treatment and there is no new episode of care, most payers will deny a re-billed 90791 based solely on an insurance change. Document the clinical reasoning for any re-evaluation separately from the insurance change event.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784795292595\"><h3 class=\"schema-faq-question\">Can CPT 90791 be billed for telehealth sessions?<\/h3> <p class=\"schema-faq-answer\">Yes. CPT 90791 is a covered telehealth service under Medicare. Append modifier 95 for audio-video sessions or confirm with your commercial payer whether modifier GT is required instead. Use place of service code 10 when the patient is in their home. Audio-only billing is allowed under certain Medicare provisions, but the rules are subject to annual legislative extension, so verify current policy before billing.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784795292596\"><h3 class=\"schema-faq-question\">Who is eligible to bill CPT Code 90791?<\/h3> <p class=\"schema-faq-answer\">Eligible providers under Medicare include psychiatrists, psychologists, LCSWs, LPCs, LMFTs, LMHCs, NPs, and PAs, subject to their enrollment status and state licensure. LCSWs, LPCs, LMFTs, and LMHCs bill at 75% of the physician fee schedule rate. Scope-of-practice rules vary by state, so confirm eligibility for each provider type with your MAC and state licensing board.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>CPT Code 90791 is the AMA&rsquo;s designated code for a psychiatric diagnostic evaluation performed without a medical services component. It covers the initial comprehensive mental health assessment: gathering psychiatric history, conducting a mental status examination (MSE), establishing a diagnosis, and formulating a treatment plan. This guide covers eligible providers, documentation requirements, reimbursement rates, telehealth rules, [&hellip;]<\/p>\n","protected":false},"author":77,"featured_media":162290,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"88","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1546,1132,1137],"tags":[1599,1236,1365,1247],"class_list":["post-162292","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-cpt-codes","category-mental-health-therapy","category-psychiatry","tag-90791-cpt-code","tag-medicare-reimbursement","tag-mental-health-billing","tag-psychiatric-evaluation"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>CPT Code 90791: Psychiatric diagnostic evaluation billing guide<\/title>\n<meta name=\"description\" content=\"CPT Code 90791 is the psychiatric diagnostic evaluation code, reimbursed at roughly $168-$180 by Medicare per session in 2026.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-90791\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CPT Code 90791: Psychiatric diagnostic evaluation billing guide\" \/>\n<meta property=\"og:description\" content=\"CPT Code 90791 is the psychiatric diagnostic evaluation code, reimbursed at roughly $168-$180 by Medicare per session in 2026.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/fr\/procedure-codes\/cpt-code-90791\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-23T09:35:07+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-17T11:46:26+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/07\/cpt-code-90791.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Katy Piper\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"\u00c9crit par\" \/>\n\t<meta name=\"twitter:data1\" content=\"Katy Piper\" \/>\n\t<meta name=\"twitter:label2\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data2\" content=\"15 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-90791\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-90791\\\/\"},\"author\":{\"name\":\"Katy Piper\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/5de22f4ff3ec59b1925ef02dce956d7d\"},\"headline\":\"CPT Code 90791: Psychiatric diagnostic evaluation billing guide\",\"datePublished\":\"2026-07-23T09:35:07+00:00\",\"dateModified\":\"2026-08-17T11:46:26+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-90791\\\/\"},\"wordCount\":2971,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/procedure-codes\\\/cpt-code-90791\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/cpt-code-90791.webp\",\"keywords\":[\"90791 Cpt Code\",\"Medicare reimbursement\",\"mental health billing\",\"psychiatric evaluation\"],\"articleSection\":[\"Billing Codes\",\"CPT Codes\",\"Mental Health &amp; 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/fr\\\/#\\\/schema\\\/person\\\/5de22f4ff3ec59b1925ef02dce956d7d\",\"name\":\"Katy Piper\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"caption\":\"Katy Piper\"},\"description\":\"Katy Piper is a content writer covering aesthetics, dermatology, and clinic operations, with a knack for making clinical detail feel approachable. 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