90791 vs 90792: Which Diagnostic Evaluation Code Applies?

90791 vs 90792: both are psychiatric diagnostic evaluations. CPT 90791 is an evaluation without medical services. CPT 90792 is an evaluation with medical services, such as a medication assessment, so it fits prescribers. Psychotherapists bill 90791. Psychiatrists and other prescribers bill 90792. This guide covers the difference, frequency limits and documentation. Code references: diagnostic evaluation guide.

What is the difference between 90791 and 90792?

Code	Evaluation type	Typically billed by
90791	Psychiatric diagnostic evaluation, no medical services	Psychotherapists and other non-prescribing clinicians
90792	Psychiatric diagnostic evaluation with medical services	Psychiatrists and other prescribers

Both are described in the Medicare Mental Health booklet (MLN1986542). See also our CPT 90791 guide.

How often can you bill 90791 or 90792?

Medicare contractor article A57480 says once, at the onset of an illness or suspected illness. A repeat can be allowed after a break of about six months, an inpatient admission, a significant change in mental status, or when the diagnosis needs clarifying. Other Medicare contractors and commercial payers may word this differently.

Can you bill 90791 or 90792 with psychotherapy or an E/M?

The NCCI Policy Manual, Chapter XI (2026) says psychotherapy codes (individual, group, family, crisis) are not reported with 90791 or 90792 on the same date, and E/M codes are not reported with them either. Crisis psychotherapy 90839 is also not billed with them. See the crisis psychotherapy guide.

Is there a time requirement for 90791 or 90792?

CPT does not define a time range for either code. Document the start and end time anyway, because payers review long evaluations. Medicare contractor article A57480 says a session over 90 minutes needs documented face-to-face time and medical necessity.

What to document for 90791 and 90792

• Reason for referral, history and mental status findings
• Diagnosis and treatment plan
• For 90792: the medical services, such as medication review or physical findings
• Provider credentials, signature and date
• Why the evaluation was medically necessary

See the documentation requirements guide for the Medicare sources.

Which pays better, 90791 or 90792?

The rates come from each payer’s fee schedule and change by plan, year and state, so this page does not quote them. Medicare’s are searchable in the Physician Fee Schedule look-up tool. Your license and the services you performed decide the code, not the rate. Compare against 90791 or 90834 for an ongoing-therapy comparison.

90791 vs 90792 and Medicare, private payer and state rules

• Medicare (CMS.gov): the sources above; contractors can differ.
• Private payers: some require 90792 only from certain license types. Ask each payer.
• State law and Medicaid: scope of practice and prescribing authority vary by state. Never apply one state’s rule to another.

90791 vs 90792: common questions

Common 90791 vs 90792 billing mistakes

• Billing 90792 when no medical services were part of the evaluation
• Billing 90791 for a prescriber evaluation that included medication assessment
• Billing an E/M or psychotherapy code with 90791 or 90792 on the same date under Medicare rules
• Repeating the evaluation without a break, admission or significant change
• Skipping the start and end time because CPT does not define a range

Monday-morning 90791 vs 90792 checklist

• Match each 90792 note to documented medical services
• Confirm each 90791 note belongs to a non-prescribing clinician’s evaluation
• Check each payer’s rule on who may bill which code
• Review same-date claims for E/M or psychotherapy billed with an evaluation
• Record the payer’s repeat-evaluation rule in your billing notes

How MCM South handles these claims

MCM South Medical Billing Service works only in mental and behavioral health, with solo and mid-size practices run by psychotherapists and psychiatrists. We verify insurance benefits, submit claims electronically, follow up on denied and rejected claims, file secondary claims and bill out-of-network claims for clients. Clean code selection and complete notes at the front end keep that work simple, so most of the checklist above is what we review first. If you want a second pair of eyes on 90791 vs 90792 in your own claims, we can walk through it with you.

How do you decide between 90791 vs 90792 for a new patient?

Work through the decision in the same order every time. The 90791 vs 90792 choice then becomes a routine check, not a judgment call at claim time.

• Step 1: Confirm who performed the evaluation and what their license allows under your state and the payer’s policy.
• Step 2: Ask whether the visit included medical services, such as a medication assessment. If yes, 90792 fits. If not, 90791 fits.
• Step 3: Check whether the patient had an earlier evaluation, and what the payer’s repeat-evaluation rule says.
• Step 4: Make sure no psychotherapy or E/M code is on the same date of service under Medicare rules.
• Step 5: Write the note so the code is obvious to a reviewer: reason for referral, findings, diagnosis, plan and time.

A reviewer reading the note should reach the same code you billed without asking you a question. If they cannot, the note needs more detail before the claim goes out.

Where this applies

MCM South Medical Billing Service bills mental and behavioral health claims for psychotherapists and psychiatrists in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Payer rules differ by state and by plan, so confirm each rule with the payer before you bill. Ready for help? Get a free quote or schedule a consultation.

For quick reference only: verify against the current AMA CPT manual and each payer’s policy before billing. Operational billing guidance, not legal advice. Current as of last search (sources checked 9/29/26).