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CPT 90791: Psychiatric Diagnostic Evaluation

CPT code 90791 represents a psychiatric diagnostic evaluation used to assess a patient’s mental health symptoms and to establish an initial psychiatric diagnosis. This evaluation is foundational to mental health care delivery and affects care pathways, documentation requirements, and billing practices across outpatient behavioral health settings nationwide. The code is widely used by psychiatrists, psychologists, and other behavioral health specialists.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical scope of the service, the typical settings where it is delivered, and how it relates to common behavioral health services. The publication summarizes benchmarking considerations, relevant billing relationships to commonly billed psychotherapy and evaluation codes, and clinical context for common diagnostic groups such as mood, anxiety, adjustment, bipolar, and psychotic disorders.

This national summary is intended for revenue cycle, clinical leadership, and policy analysts seeking a clear, practical reference for the code’s clinical role, payer coverage landscape, and related coding context. Data not available in the input for payor-specific rates or utilization trends.

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Billing Code Overview

CPT code 90791 describes a psychiatric diagnostic evaluation performed by a qualified mental health provider with the primary aim of establishing a psychiatric diagnosis. The service typically involves a comprehensive history, mental status examination, assessment of risk and functioning, and formulation of an initial diagnostic impression.

Service type: Psychiatric diagnostic evaluation
Typical site of service: Outpatient psychiatric clinic, behavioral health center, or office-based mental health practice

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).

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CPT 90791: Psychiatric Diagnostic Evaluation

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Billing Code Overview

Service type: Psychiatric diagnostic evaluation
Typical site of service: Outpatient psychiatric clinic, behavioral health center, or office-based mental health practice

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 34-year-old adult presents to an outpatient mental health clinic reporting a 3-month history of pervasive low mood, anhedonia, poor sleep, and excessive worry interfering with work and relationships. The patient has no prior psychiatric diagnoses documented in the current clinic but reports intermittent mood swings and a family history of bipolar disorder. The initial visit is a comprehensive psychiatric evaluation performed by a psychiatry physician (or appropriately credentialed mental health clinician) to establish diagnostic impressions, assess safety risk, document psychiatric history, perform mental status examination, review medical comorbidities and medications, and formulate a preliminary treatment plan. The clinician obtains past psychiatric records when available, administers structured symptom screens as indicated, discusses differential diagnoses such as F32.9 (major depressive disorder), F41.1 (generalized anxiety disorder), F43.23 (adjustment disorder with mixed anxiety and depressed mood), F31.9 (bipolar disorder, unspecified), and F20.9 (schizophrenia, unspecified), and documents diagnostic decision-making to support billing of 90791. The typical workflow includes check-in, collection of history and collateral information, focused review of systems and medications, mental status exam, risk assessment (including suicidal ideation), and documentation of diagnostic formulation and recommended next steps (e.g., psychotherapy referral, medication management, or psychological testing). Typical site of service is an office-based outpatient behavioral health clinic or mental health center; inpatient consultation or emergency department evaluation may use different CPT codes or modifiers.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service	Use when a psychiatric evaluation is performed on the same day as another E/M service and documentation supports a distinct, significant evaluation separate from the other service.
`26`	Professional component	Use when billing only the professional component of a service that has distinct technical and professional components (rare for `90791`, but applicable if split-billing occurs under specific arrangements).
`59`	Distinct procedural service	Use when services are distinct and not normally reported together; supports bundling exceptions when documentation shows separate and distinct services.
`22`	Increased procedural services	Use when the psychiatric evaluation requires substantially more work than typical and documentation supports unusually high complexity or time.
`52`	Reduced services	Use when the psychiatric evaluation is partially reduced or discontinued, with documentation of extent of reduction.
`53`	Discontinued procedure	Use if the psychiatric evaluation was started but terminated due to unforeseen circumstances before completion, with documentation.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when `90791` is delivered via an interactive telehealth audiovisual platform.
`GT`	Via interactive audio and video telecommunications systems (CMS telehealth)	Use per payer policy when `90791` is provided through CMS-recognized telehealth modalities.
`91`	Repeated clinical diagnostic test within the same encounter (multiple-quote)	Use when repeat assessment tools or testing are performed during the same encounter and payer guidance requires this modifier for repeat testing reporting.
`59`	Distinct procedural service	(Note: `59` appears above; included only once in billing. See first `59` row.)

Taxonomy Code	Specialty	Notes
`2084P0800X`	Psychiatry Physician	Board-certified psychiatrists commonly perform `90791` in outpatient and consultative settings; documents medical management implications.
`103T00000X`	Psychologist	Clinical psychologists perform comprehensive psychiatric or psychological evaluations and provide diagnostic impressions; may bill depending on payer rules and licensure.
`101YM0800X`	Mental Health Counselor	Licensed mental health counselors perform intake and diagnostic assessments; billing depends on state and payer credentialing policies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.9`	Major depressive disorder, single episode, unspecified	A common primary diagnosis identified during a psychiatric evaluation for persistent low mood, anhedonia, and functional impairment.
`F41.1`	Generalized anxiety disorder	Frequently identified when excessive worry and anxiety symptoms are primary concerns evaluated in `90791`.
`F43.23`	Adjustment disorder with mixed anxiety and depressed mood	Relevant when symptoms follow identifiable psychosocial stressors and present with mixed depressive and anxiety features.
`F31.9`	Bipolar disorder, unspecified	Considered in evaluations with a history or suspicion of mood elevation or cycling; evaluation documents history to differentiate bipolar spectrum from unipolar depression.
`F20.9`	Schizophrenia, unspecified	Relevant when psychotic symptoms, thought disorder, or functional decline raise concern for a primary psychotic disorder during the diagnostic assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90834`	Psychotherapy, 45 minutes with patient	Common follow-up treatment after `90791` when psychotherapy is indicated based on the diagnostic evaluation.
`90837`	Psychotherapy, 60 minutes with patient	Used for longer individual psychotherapy sessions scheduled after initial diagnostic assessment when clinically warranted.
`96130`	Psychological testing evaluation services	May be ordered following `90791` when further standardized psychological testing is needed to clarify diagnosis or cognitive/behavioral functioning.
`99213`	Established patient office or other outpatient visit, typically 15 minutes	May be used for brief medication management or follow-up visits after initial diagnostic evaluation if payer and clinical circumstances support E/M coding rather than psychotherapy codes.

CPT 90792: Psychiatric Diagnostic Evaluation With Medical Services

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service	Use when a psychiatric evaluation is performed on the same day as another E/M service and documentation supports a distinct, significant evaluation separate from the other service.
`26`	Professional component	Use when billing only the professional component of a service that has distinct technical and professional components (rare for `90791`, but applicable if split-billing occurs under specific arrangements).
`59`	Distinct procedural service	Use when services are distinct and not normally reported together; supports bundling exceptions when documentation shows separate and distinct services.
`22`	Increased procedural services	Use when the psychiatric evaluation requires substantially more work than typical and documentation supports unusually high complexity or time.
`52`	Reduced services	Use when the psychiatric evaluation is partially reduced or discontinued, with documentation of extent of reduction.
`53`	Discontinued procedure	Use if the psychiatric evaluation was started but terminated due to unforeseen circumstances before completion, with documentation.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when `90791` is delivered via an interactive telehealth audiovisual platform.
`GT`	Via interactive audio and video telecommunications systems (CMS telehealth)	Use per payer policy when `90791` is provided through CMS-recognized telehealth modalities.
`91`	Repeated clinical diagnostic test within the same encounter (multiple-quote)	Use when repeat assessment tools or testing are performed during the same encounter and payer guidance requires this modifier for repeat testing reporting.
`59`	Distinct procedural service	(Note: `59` appears above; included only once in billing. See first `59` row.)

Taxonomy Code	Specialty	Notes
`2084P0800X`	Psychiatry Physician	Board-certified psychiatrists commonly perform `90791` in outpatient and consultative settings; documents medical management implications.
`103T00000X`	Psychologist	Clinical psychologists perform comprehensive psychiatric or psychological evaluations and provide diagnostic impressions; may bill depending on payer rules and licensure.
`101YM0800X`	Mental Health Counselor	Licensed mental health counselors perform intake and diagnostic assessments; billing depends on state and payer credentialing policies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`F32.9`	Major depressive disorder, single episode, unspecified	A common primary diagnosis identified during a psychiatric evaluation for persistent low mood, anhedonia, and functional impairment.
`F41.1`	Generalized anxiety disorder	Frequently identified when excessive worry and anxiety symptoms are primary concerns evaluated in `90791`.
`F43.23`	Adjustment disorder with mixed anxiety and depressed mood	Relevant when symptoms follow identifiable psychosocial stressors and present with mixed depressive and anxiety features.
`F31.9`	Bipolar disorder, unspecified	Considered in evaluations with a history or suspicion of mood elevation or cycling; evaluation documents history to differentiate bipolar spectrum from unipolar depression.
`F20.9`	Schizophrenia, unspecified	Relevant when psychotic symptoms, thought disorder, or functional decline raise concern for a primary psychotic disorder during the diagnostic assessment.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90834`	Psychotherapy, 45 minutes with patient	Common follow-up treatment after `90791` when psychotherapy is indicated based on the diagnostic evaluation.
`90837`	Psychotherapy, 60 minutes with patient	Used for longer individual psychotherapy sessions scheduled after initial diagnostic assessment when clinically warranted.
`96130`	Psychological testing evaluation services	May be ordered following `90791` when further standardized psychological testing is needed to clarify diagnosis or cognitive/behavioral functioning.
`99213`	Established patient office or other outpatient visit, typically 15 minutes	May be used for brief medication management or follow-up visits after initial diagnostic evaluation if payer and clinical circumstances support E/M coding rather than psychotherapy codes.

CPT 90792: Psychiatric Diagnostic Evaluation With Medical Services

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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CPT 90791: Psychiatric Diagnostic Evaluation

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Billing Code Overview

National Reimbursement Benchmarks

OpenPayer

CPT 90791: Psychiatric Diagnostic Evaluation

Sign up for cpt 90791 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References