CPT 90792: Psychiatric Diagnostic Evaluation with Medical Services
Medicare pays $208 and commercial payers pay $296 on average nationally for this procedure.
CPT code 90792 describes a psychiatric diagnostic evaluation with medical services, where a clinician conducts a comprehensive psychiatric assessment to establish a diagnosis and also provides additional medical interventions (such as medication management or medical evaluation) during the same encounter; typical service type is psychiatric diagnostic evaluation with medical services, and the usual site of service is an office or outpatient behavioral health clinic focused on establishing diagnosis and initiating 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 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.