CPT 90791: Psychiatric Diagnostic Evaluation
Medicare pays $179 and commercial payers pay $276 on average nationally for this procedure.
CPT code 90791 represents a psychiatric diagnostic evaluation in which a qualified provider performs a comprehensive assessment to establish a psychiatric diagnosis; the service is an initial psychiatric evaluation typically delivered in an office or outpatient behavioral health setting and focuses on history, mental status, risk assessment, and clinical formulation to guide treatment planning.
For related coverage guidance, see recent payer policy updates: DRG Newborn Inpatient Stays - Facility, Pediatric Preventive Screening, Pediatric Preventive Screening.
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National Reimbursement Benchmarks
Nationally, Medicare's mean rate for CPT 90791 sits at $178.7, which is notably lower than BUCA’s average commercial mean of $275.6; this places Medicare roughly $96.9 below BUCA on average, highlighting a consistent gap between public and these commercial reimbursements. Blue Cross Blue Shield, Aetna, Cigna, and UnitedHealth Group all have commercial means above Medicare, with BUCA representing one of the higher commercial averages overall.
Dispersion varies across payers when measured by the interquartile range (P75 minus P25): Blue Cross Blue Shield shows the widest IQR at $107.3 ($377.0 − $269.7), indicating greater variability in the middle 50% of rates, while Aetna has the tightest IQR at $75.8 ($214.0 − $138.2). UnitedHealth Group and Cigna present intermediate dispersion at $120.1 ($263.3 − $143.2) and $115.2 ($265.2 − $151.0) respectively; BUCA’s IQR is $105.6 ($321.5 − $215.9).