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CPT 90792: Psychiatric Diagnostic Evaluation With Medical Services
CPT code 90792 designates a psychiatric diagnostic evaluation that includes additional medical services rendered during the same encounter. Nationally, this code distinguishes evaluations that require both psychiatric assessment and medical management components — an important distinction for billing, clinical documentation, and payer adjudication across outpatient behavioral health settings. Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise understanding of the clinical scope of 90792, its relation to purely diagnostic evaluations, common clinical indications, and how it maps to outpatient psychiatric care. The report outlines comparisons to related evaluation and psychotherapy codes, highlights typical sites of service, and summarizes payer coverage considerations and coding nuances relevant to clinicians, billing professionals, and health plan policy staff. The content prepares readers to identify when 90792 is the appropriate code for encounters involving diagnostic assessment plus medical services, and to anticipate the documentation and clinical context commonly associated with its use.
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Billing Code Overview
CPT code 90792 describes a psychiatric diagnostic evaluation with medical services. The procedure includes a comprehensive psychiatric assessment aimed at establishing a diagnosis, combined with additional medical services provided by the clinician during the same encounter.
Service type: Psychiatric diagnostic evaluation with medical services
Typical site of service: Outpatient behavioral health or ambulatory clinic setting, including psychiatric offices, community mental health centers, and outpatient hospital clinics. Data not available in the input.
National Reimbursement Benchmarks
Nationally, Medicare's mean allowed amount for CPT 90792 sits at $207.6, closely aligned with the commercial BUCA mean of $295.8 but materially lower — a gap of $88.2. This positions Medicare near the lower end of the national commercial spectrum while BUCA tracks above Medicare and nearer the mid-to-upper commercial averages, indicating commercial payers generally reimburse at higher mean rates than Medicare for this code.
Dispersion measured as the interquartile spread (P75 minus P25) varies meaningfully: Blue Cross Blue Shield shows the widest IQR at $120.0 ($397.8 - $277.8), followed by BUCA at $121.4 ($346.8 - $225.4) and Cigna at $144.4 ($309.7 - $165.3). UnitedHealth Group and Aetna are tighter, with IQRs of $138.7 ($289.3 - $150.6) and $86.6 ($237.7 - $151.0) respectively. Medicare’s IQR is narrow at $12.0 ($211 - $199), indicating the most compressed rate band among the listed payers.