CPT code 90791: Psychiatric evaluation, without medical services2026 Medicare rate & RVUs in Missouri
Psychiatric diagnostic assessment of symptoms, history, and mental status, reported when a clinician evaluates a behavioral health concern without furnishing medical services.
Medicare pays $167.20–$171.22 for 90791 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 90791 covers
A clinician uses this evaluation to assess a behavioral health concern, establish or clarify a diagnosis, and recommend treatment. The work includes psychiatric and psychosocial history, a mental status examination, and review of relevant medical history. Information may also come from family members, caregivers, or prior records. Psychologists, clinical social workers, and mental health counselors commonly perform the assessment in offices, community settings, hospitals, or by telehealth. A psychiatrist or psychiatric nurse practitioner may use this code when the evaluation includes no medical services.
Select 90791 for the diagnostic evaluation rather than a psychotherapy visit focused on treatment or 90792 when medical services are furnished as part of the evaluation. Document the presenting problem, relevant history, mental status findings, diagnostic impression, and plan. The code is not time-based: assign units for distinct, medically necessary evaluations, not for minutes or interview segments. A further evaluation on another date needs documentation supporting why additional diagnostic work was necessary. Do not separately report psychotherapy or an E/M service furnished by the same clinician as part of this evaluation. Interactive complexity may be reported when its specific requirements are met and documented.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Billing guides for 90791: 90791 vs 90792 · Mental health billing
Where 90791 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$167.20 to $171.22
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $170.63 | $136.75 |
| Metropolitan St. Louis, MO | $171.22 | $136.88 |
| Rest of Missouri | $167.20 | $136.11 |
How the 90791 rate is calculated
Each of 90791’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 90791
RVUs × geographic indexes × conversion factor
Work3.84
3.84 RVUs× 1.000 GPCI
Practice expense1.33
1.33 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
5.1900
Conversion factor
$33.4009
Medicare rate
$173.35
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 90791
90791 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 90791
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$173.35
- Non-facility (office)
- $173.35
- Facility
- $137.28
Higher because the practice carries its own overhead.
90791 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 90792Psychiatric evaluationWith medical services
- Choose 90792 when the qualified clinician furnishes medical services as part of the psychiatric evaluation. Choose 90791 when the diagnostic evaluation includes no medical services.
- 90837Psychotherapy60 minutes, no E/M
- 90837 is time-based psychotherapy focused on treatment; 90791 is a psychiatric diagnostic evaluation and is not selected by psychotherapy session length.
- 90839Crisis psychotherapyInitial 60 minutes
- 90839 covers urgent crisis assessment and psychotherapy when immediate intervention is needed. 90791 covers a psychiatric diagnostic evaluation without that crisis intervention.
- 96130Psychological evaluationFirst hour
- 96130 covers a clinician's evaluation of psychological test data, including interpretation and integration of results. 90791 covers the psychiatric diagnostic evaluation based on clinical assessment rather than formal test evaluation.
90791 billing questions
When should 90792 be chosen instead of 90791?
Choose 90792 when a physician or other qualified clinician furnishes medical services as part of the psychiatric diagnostic evaluation. Prescribing is not required to report 90792; reviewing a medication list alone does not establish that medical services were furnished.
Can psychotherapy be billed the same day as 90791?
Do not separately report psychotherapy performed by the same clinician as part of the diagnostic evaluation. Choose a psychotherapy code when the service is a treatment session rather than a psychiatric diagnostic evaluation.
Can 90785 be added to 90791?
Yes, when an interactive complexity factor meets the code's requirements and is documented. Examples include caregiver behavior that interferes with the evaluation or play equipment needed to overcome a patient's limited expressive language; interpreter use alone does not qualify.
Is 90791 billed by time or units?
90791 has no CPT minimum time threshold. Report a unit for a distinct diagnostic evaluation, not for each hour or interview segment.
Can 90791 be reported more than once for the same patient?
Yes, when another psychiatric diagnostic evaluation is medically necessary. Document the new diagnostic question or why additional evaluation was needed rather than treating a continuing interview as an automatic new service.
Can 90791 be furnished by telehealth?
Yes. Document the diagnostic work performed and the telehealth modality, and report the place of service appropriate to the encounter.
90791 is in these specialty bundles: Behavioral health
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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