CPT 90791: How to Bill the Diagnostic Evaluation
CPT code 90791 is the psychiatric diagnostic evaluation without medical services. It is the intake code for most psychotherapists. Psychiatrists and other prescribers use 90792 when the evaluation includes medical services. This guide covers when to bill 90791, how often, what you cannot bill with it, and what the note has to show.
For the full reference, see our diagnostic evaluation guide.
What CPT code 90791 and 90792 mean
CPT descriptors (AMA): 90791 is a psychiatric diagnostic evaluation without medical services. 90792 is a psychiatric diagnostic evaluation with medical services. CMS lists both under “psychiatric diagnostic evaluation” and describes it as a “psychiatric evaluation to create a treatment plan based on a psychiatric disorder’s causes, symptoms, course, and consequences” (CMS, Medicare & Mental Health Coverage, MLN1986542, March 2026).
90791 or 90792?
| 90791 | 90792 | |
|---|---|---|
| Medical services included | No | Yes |
| Typical billers | Psychotherapists and psychiatrists | Prescribers |
| Not billed with | Psychotherapy codes on the same date | E/M codes on the same date |
Contractor article A57520 (First Coast, rev. 1/1/2025) says that when an evaluation includes a medical assessment, the physician or non-physician practitioner may use 90792 or an E/M code. Learn the E/M side in our E/M and home-visit guide.
How often can you bill CPT code 90791
Contractor article A57480 (WPS, rev. 1/1/2026) says a psychiatric diagnostic evaluation “can be conducted once, at the onset of an illness or suspected illness.” A repeat is allowed after a break of about six months, an inpatient admission, a significant change in mental status, or when the diagnosis needs clarifying. Commercial payers set their own limits, so ask each one.
What you cannot bill with it
Per the NCCI Medicare Policy Manual (Ch. XI, 1/1/2026): 90791 is not reported with any psychotherapy code on the same date, and E/M codes are not reported with 90791 or 90792. CMS also says not to bill the evaluation with crisis psychotherapy 90839 and +90840. See the crisis psychotherapy guide and the individual psychotherapy guide.
Time and documentation
No time range is defined for CPT code 90791 or 90792. Record the date of service and the start and end time (recommended). Document the history, the mental status findings, the diagnosis and the treatment plan. See documentation requirements.
Who bills it
Psychotherapists: CPT code 90791 is your evaluation code. Do not bill psychotherapy the same date.
Psychiatrists: use 90792 for an evaluation with medical services. A57520 says a prescriber may use 90792 or an E/M code for an evaluation with medical assessment. Keep the choice consistent with your documentation.
Medicare vs private payers vs state rules
The rules above are Medicare. Private payers and state Medicaid programs set their own frequency limits and authorization requirements, and they vary by state. Check each payer.
FAQ
What is CPT code 90791?
The psychiatric diagnostic evaluation without medical services.
How often can I bill CPT code 90791?
Once, at the onset of an illness or suspected illness, under Medicare contractor article A57480, with repeats after a break of about six months, an inpatient admission, a significant change in mental status, or when the diagnosis needs clarifying. Private payers set their own limits.
What is the difference between 90791 and 90792?
90792 includes medical services; 90791 does not. 90792 is for prescribers.
Can I bill therapy the same day as CPT code 90791?
Not under NCCI. Psychotherapy codes are not reported with 90791 on the same date.
Where this applies
MCM South supports psychotherapists and psychiatrists in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Payer rules differ by state. 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).
