90791·CPT (AMA)

Psychiatric Diagnostic Evaluation

Initial intake / diagnostic evaluation without medical services. The standard "first session" code for therapists, psychologists, and other non-prescribing licensed clinicians.

Descripteur de code (verbatim AMA)

Psychiatric diagnostic evaluation.

Source: AMA Current Procedural Terminology, code 90791.

Who can bill 90791

90791 covers the diagnostic evaluation when no medical services are performed. Typical billers:

  • Licensed Clinical Social Workers (LCSW, LICSW)
  • Licensed Marriage and Family Therapists (LMFT)
  • Licensed Professional Counselors (LPC, LMHC)
  • Licensed Psychologists (PhD, PsyD)
  • Other non-prescribing licensed mental health clinicians

Prescribers (psychiatrists, psychiatric NPs/PAs) typically bill 90792 instead, the parallel code that includes medical services such as medication consideration, lab review, or other medical decision-making.

Frequency and re-evaluation rules

  • Generally one per episode of care, per provider. Most payers expect 90791 only at the start of treatment.
  • Re-evaluation policies vary. Some payers allow re-billing after a 6+ month gap in care; others require 90834/90837 for return-to-treatment encounters.
  • Major change in clinical status may justify a second 90791 (new presenting concern, significant deterioration, transition between settings). Document clearly.
  • Same-day same-provider rule. 90791 cannot be billed on the same day as 90832/90834/90837 by the same provider; the eval and the therapy session are separate encounters.

Documentation requirements

A 90791 evaluation note should include:

  • Identifying information, demographics, referral source, presenting concern.
  • History of present illness, onset, course, severity, prior treatment.
  • Past psychiatric history, prior diagnoses, hospitalizations, treatments, medications.
  • Substance use history, alcohol, drugs, prescription misuse.
  • Medical history and current medications.
  • Family psychiatric history.
  • Social/developmental history, relevant trauma, relationships, work, education.
  • Mental status exam, appearance, behavior, mood, affect, thought, cognition, insight, judgment.
  • Risk assessment, suicide, self-harm, harm to others.
  • DSM-5-TR diagnosis with ICD-11-CM code(s).
  • Clinical formulation, your synthesis of why this presentation, what's maintaining it.
  • Treatment plan, modality, frequency, goals, measurable outcomes.

Common ICD-11 pairings

The 90791 evaluation establishes the diagnosis. Common ICD-11 pairings (any DSM-5-TR-aligned diagnosis identified during evaluation):

See the full ICD-11 reference for diagnosis-specific scale recommendations.

Sources

  • American Medical Association. Current Procedural Terminology (CPT) 2026, code 90791.
  • Centers for Medicare & Medicaid Services. Physician Fee Schedule.
  • American Psychological Association. CPT Coding Resources.

Foire aux questions

What is CPT 90791?

CPT 90791 is the AMA billing code for 'Psychiatric diagnostic evaluation' (without medical services). It covers the initial intake interview that establishes diagnosis, treatment plan, and clinical formulation. Billed by therapists, psychologists, social workers, and other non-prescribing licensed clinicians.

What is the difference between 90791 and 90792?

Both are diagnostic evaluations. 90791 is performed without medical services, used by therapists, psychologists, social workers, counselors. 90792 includes medical services, used by prescribers (psychiatrists, psychiatric NPs, PAs) and includes consideration of medication, lab review, or other medical decision-making. 90792 reimburses higher (~$160–220 vs ~$140–200).

How often can 90791 be billed?

Generally once per episode of care, per provider. Most payers allow 90791 to be billed only at the start of treatment. Some payers allow re-billing 90791 after a defined gap in care (typically 6+ months); others require 90834/90837 codes for any return-to-treatment encounters. Check specific payer policies for re-evaluation rules.

What does 90791 reimburse?

Reimbursement varies by payer. Approximate national medians: $140–200 per evaluation for commercial payers, somewhat lower for Medicare. 90791 reimburses substantially higher than a single therapy session because the evaluation represents 60–90 minutes of clinical work and includes diagnostic formulation. Verify with your specific payer fee schedules.

Can 90791 be billed alongside 96127?

Yes. 90791 is the primary evaluation service code; 96127 (brief assessment with scoring and documentation) is an add-on billed in addition. A typical intake administering PHQ-9 + GAD-7 + AUDIT bills 90791 + 96127×3.

How much does CPT 90791 pay?

CPT 90791 pays approximately $174 per evaluation under the 2026 Medicare Physician Fee Schedule national average, with locality adjustments. Commercial payer rates typically range from $140 to $220 per evaluation and vary by contract. The 90791 reimburses higher than a single therapy session because the evaluation usually represents 60 to 90 minutes of clinical work and includes diagnostic formulation. Verify your specific payer fee schedule.

Who can bill CPT 90791?

Licensed non-prescribing mental health clinicians bill CPT 90791, including licensed clinical social workers (LCSW, LICSW), licensed marriage and family therapists (LMFT), licensed professional counselors (LPC, LMHC), and licensed psychologists (PhD, PsyD). Prescribers (psychiatrists, psychiatric nurse practitioners, physician assistants) typically bill CPT 90792 instead, which includes medical decision-making such as medication consideration or lab review.

Is CPT 90791 billable for telehealth?

Yes, CPT 90791 is billable for telehealth visits. Use place of service code 02 (telehealth, non-home) or 10 (telehealth, patient home), with modifier 95 for synchronous audio-video evaluations when required by the payer. Medicare and most commercial payers continued telehealth coverage for 90791 after the public health emergency. The full diagnostic evaluation, including mental status exam and risk assessment, must still be completed by video. Audio-only intakes have stricter payer rules; verify before billing.

What is the MUE limit for CPT 90791?

Medicare's Medically Unlikely Edit (MUE) limit for CPT 90791 is 1 unit per date of service per provider. Most commercial payers follow the same rule: one diagnostic evaluation per episode of care. Some payers allow re-billing 90791 after a defined gap in care (typically 6 or more months) or when there is a major change in clinical status, such as a new presenting concern or transition between care settings. Same-day same-provider billing of 90791 with 90832, 90834, or 90837 is not allowed.

Can 90791 be billed alongside… · How much does CPT 90791… · Who can bill CPT 90791 · Is CPT 90791 billable for…
← Tous les codes CPTRéférence CIM-10 →Centre des codes de facturation →