90791 vs 90792: Psychiatric Intake Codes Compared (2026)

90791 and 90792 are both the psychiatric diagnostic evaluation, the intake visit that starts a course of mental health care. The difference is medical services: 90792 adds a medical assessment, such as reviewing medications or physical health, so it belongs to clinicians who can provide medical care (psychiatrists, psychiatric nurse practitioners and physician assistants). Psychologists, social workers, counselors and marriage and family therapists bill 90791.

90791 vs 90792 at a glance

What 90792 adds

Novitas describes the evaluation with medical services as "a biopsychosocial and medical assessment" (LCD L35101). In practice that means the clinician also evaluates the patient's physical health and medications as part of the intake: reviewing current prescriptions, considering medical causes of symptoms, ordering labs or starting medication. First Coast says "the physician or non-physician practitioner (NPP) may use CPT code 90792" when the evaluation includes a medical assessment (A57520).

That's why the code follows the clinician, not the patient's needs alone:

• Psychiatrists, psychiatric NPs, PAs and CNSs choose between 90791 and 90792 depending on whether medical services were part of the visit. A prescriber who does only the psychological evaluation bills 90791.
• Clinical psychologists, social workers, marriage and family therapists and mental health counselors bill 90791. CMS says they "cannot independently bill Medicare for E/M visits" (89 FR 97929), and 90792 includes medical evaluation work.

90791 vs 90792 reimbursement

90792 pays more because it carries more work and malpractice value for the medical component. Provider type then changes the amount: psychiatrists and psychologists are allowed 100% of it, NPs and PAs 85%, and social workers, MFTs and counselors 75% of the 90791 amount. Check a specific clinician in Medicare reimbursement by provider type.

The intake rate also anchors pricing outside Medicare. Commercial contracts, EAP panels and cash-pay practices often price the intake against the Medicare 90791 amount for the locality, which makes it a useful number to know before you set a self-pay intake fee or accept a payer's rate.

Is 90791 or 90792 timed?

No. Neither code has a time range, so you bill one unit for the evaluation whether it took 45 minutes or 90. Novitas notes the standard length "is generally considered to be between 45 minutes and one hour" (L35101). If the evaluation can't be finished in one visit, contractor rules on repeat evaluations apply; don't bill a second 90791 the next day as if it were a new intake.

How often can you bill 90791?

Medicare doesn't pay for routine repeat intakes. Contractor limits differ:

• WPS: once at the onset of an illness or suspected illness. The same provider can repeat it after an extended break in treatment (about six months since the patient was last seen for the condition), an inpatient psychiatric admission or a significant change in mental status (A57480).
• Novitas: no more than three diagnostic evaluations per beneficiary per year by the same provider, and three per year per group NPI (L35101).

Check your own Medicare contractor's article before scheduling a re-evaluation.

90791 and 90792 by telehealth

Both evaluation codes are on the Medicare Telehealth Services List (MLN1986542). Behavioral health telehealth has no geographic or location restrictions, and the patient can be at home: POS 10, paid at the office rate. The statutory in-person visit before mental health telehealth doesn't apply until after December 31, 2027, and patients who start telehealth care before then are treated as established (CMS Telehealth FAQ, February 26, 2026). See telehealth rules for therapy.

Common 90791 and 90792 mistakes

• A therapist billing 90792. It's priced, so it looks billable, but a psychologist, LCSW, LMFT or LPC can't bill it under Medicare.
• A new 90791 for every new episode. Without a long gap or real change in condition, a repeat evaluation is likely to deny.
• Interactive complexity without a reason. 90785 needs a documented communication factor, such as a caregiver whose involvement complicates the visit. It isn't for a long or emotionally difficult intake.
• Billing an evaluation for ongoing therapy. After the intake, sessions are psychotherapy by time: 90832, 90834 or 90837.

Keep reading

• Mental health billing: every behavioral health code, payment by provider type, telehealth and incident-to.
• Psychotherapy CPT codes: the session codes that follow the intake.
• Psychotherapy add-on codes: how prescribers bill therapy with an E/M visit after a 90792.
• Behavioral health fee schedule: 90791, 90792 and the rest of the code set for your ZIP.

Sources: First Coast Billing and Coding Article A57520 (revision effective Jan 1, 2025); WPS Billing and Coding Article A57480 (revision effective Jan 1, 2026); Novitas LCD L35101, Psychiatric Codes (revision effective Jan 1, 2024); CY 2025 PFS final rule, 89 FR 97929; CMS MLN1986542, Medicare & Mental Health Coverage (March 2026); CMS Telehealth FAQ (updated Feb 26, 2026). Verified October 7, 2026.