CPT® Code 90791

Quick Reference: CPT 90791

• Definition: Initial comprehensive psychiatric assessment without medical services (no prescriptions/physical exams).
• Who Bills It: Psychologists (PhD/PsyD), LCSWs, LPCs, LMFTs. (Psychiatrists use 90792 if managing meds).
• Telehealth 2026: Fully covered. In-person visit requirements for Medicare are waived until January 30, 2026.
• Frequency: Typically limited to 1 per year per patient.
• Reimbursement: Approx. $173.35 (Medicare National Avg).

CPT 90791 is the code for a psychiatric diagnostic evaluation without medical services. In practice, this represents an initial comprehensive mental health assessment. The American Medical Association (AMA) defines 90791 as an "integrated biopsychosocial assessment, including history, mental status, and recommendations".

During a 90791 visit, the clinician performs a thorough evaluation of the patient's psychiatric condition, gathering information on the patient's medical, psychiatric, family, and social history, conducting a mental status examination, and formulating diagnostic impressions and treatment recommendations.

No medical services (such as physical exams, medication prescription, or lab orders) are included in 90791, it is purely a diagnostic evaluation of mental health status.

Clinical Indications and Appropriate Use

CPT 90791 is intended for initial psychiatric evaluations or intake assessments in behavioral health settings. Common clinical scenarios for using 90791 include:

• New patient intake: The first appointment with a new client to assess their mental health and establish a treatment plan.
• New episode of care: An established patient presents with a new or significantly changed mental health concern that requires a full re-assessment and updated diagnosis.
• Transfer of care: When a patient transfers from another provider or facility and a comprehensive psychiatric evaluation is needed to inform ongoing treatment.
• Re-evaluation after long absence: If a patient has not been seen for an extended period (e.g., a year or more), a repeat diagnostic evaluation (90791) may be justified.

CPT 90791 vs. 90792 -- Differences and Who Can Bill

While 90791 and 90792 are both psychiatric diagnostic evaluation codes introduced in 2013, there are crucial differences between them. CPT 90792 is defined as a psychiatric diagnostic evaluation with medical services, whereas 90791 is without medical services.

90791 -- without medical services: Typically used by non-prescribing mental health professionals (Psychologists, LCSWs, LPCs, LMFTs). Psychiatrists may use 90791 if they perform an intake with no prescription or medical decision-making.

90792 -- with medical services: Reserved for clinicians who can provide medical evaluation (Psychiatrists, NPs, PAs). These providers evaluate medical aspects, prescribe psychiatric medications, and order relevant tests.

flowchart TD
    A[New Patient Psychiatric Evaluation] --> B{Will medical services be provided?}
    B -->|No - History, MSE, & Recommendations only| C[Bill CPT 90791]
    B -->|Yes - Physical exam, Rx, or labs| D[Bill CPT 90792]
    C --> E{Provider type?}
    E -->|Psychologist, LCSW, LPC, LMFT| F[90791 is the standard code]
    E -->|Psychiatrist, NP, PA| G[90791 if no medical services rendered]
    D --> H{Provider type?}
    H -->|Psychiatrist, NP, PA| I[90792 is the standard code]
    H -->|Psychologist, LCSW, LPC, LMFT| J[Cannot bill 90792 - use 90791]

Telehealth Usage and 2026 Reimbursement Rules

Medicare Rules (2026)

As of 2026, Medicare continues to allow CPT 90791 to be provided via telehealth. Patients can receive evaluations at home with no geographic restrictions.

Important Date: Congress and CMS have waived the in-person visit requirement for tele-mental health until January 30, 2026. Beginning January 31, 2026, an in-person visit within the prior 6 months may be required for new telehealth patients, unless legislation is extended.

Billing 90791 for telehealth under Medicare requires using the proper Place of Service code (e.g., 02 or 10) or the 95 modifier. Reimbursement is at parity with in-person rates (approx $173.35).

Medicaid & Commercial Payers

Medicaid: Policies vary by state, but most permit 90791 via telehealth. Check the Center for Connected Health Policy (CCHP) for state rules.

Commercial: Most private insurers (Blue Cross, Aetna, etc.) cover 90791 via telehealth. Always verify if the plan requires a specific platform or modifier (95 or GT).

Common ICD-10-CM Diagnosis Codes

CPT 90791 must be paired with an ICD-10 code representing the finding of the evaluation. Common codes include:

• Depression: F32.9 (Major Depressive Disorder, single) or F33.x (Recurrent).
• Anxiety: F41.1 (Generalized Anxiety Disorder).
• PTSD: F43.10 (Post-Traumatic Stress Disorder).
• Adjustment Disorders: F43.23 (Adjustment disorder with mixed anxiety and depressed mood).
• ADHD: F90.2 (ADHD, combined type).

Documentation Best Practices (Audit-Proofing)

To withstand audits, your 90791 note must contain specific elements:

• Reason for Evaluation: Presenting problem (e.g., "Patient presents for depression").
• History: Biopsychosocial history including medical, psychiatric, family, and social history.
• Mental Status Examination (MSE): Appearance, mood, affect, thought process, suicidal ideation, etc.
• Assessment/Diagnosis: Clinical formulation linking symptoms to DSM-5/ICD-10 criteria.
• Risk Assessment: Suicide/Homicide risk and safety plan.
• Treatment Plan: Recommendations (e.g., start CBT, refer for meds) and goals.
• Time: Document duration (e.g., "60 minutes face-to-face"). While not strictly time-based, CMS expects 16-90 minutes.

Billing Frequency Limits

Most payers consider 90791 an "initial" service. You generally cannot bill repeated 90791 sessions for the same patient in a short span.

• Medicare: Implicitly once per episode of care. One per day maximum.
• Commercial (e.g., Anthem): Often limited to 1 per 365 days for adults and 2 per 365 days for children.
• Exceptions: A second 90791 may be allowed if there is a major change in status or a long absence (e.g., >12 months).

Real-World Coding Scenarios

Scenario 1: The Non-Prescribing Intake A Licensed Clinical Social Worker (LCSW) sees a new patient for an hour. She takes a full history, performs a mental status exam, diagnoses Major Depression (F32.9), and recommends weekly therapy. Code: 90791. (No medical services were performed).

Scenario 2: The Psychiatrist Intake A Psychiatrist sees a new patient. She takes a history, performs an MSE, checks the patient's thyroid (physical exam), reviews lab work, and writes a prescription for an SSRI. Code: 90792. (Medical services -- exam and prescription -- were included).

Frequently Asked Questions

Can I bill 90791 and a psychotherapy code (e.g., 90837) on the same day?

Generally, no. Most payers view the diagnostic evaluation and the first therapy session as distinct services that should not overlap. However, if distinct services are provided, some payers might allow it with a modifier, but it is high-risk for audit.

Is CPT 90791 a time-based code?

No, 90791 does not have a specific time requirement in its descriptor. However, standard practice is 60 minutes. If the session is exceptionally long (>90 min), you may need prolonged service add-on codes (99354/99355).