90792 CPT Code: Psychiatric Evaluation Billing Rules for 2026

The 90792 CPT code is the psychiatric diagnostic evaluation with medical services. It is the intake code for prescribers whose first visit includes medical work, such as prescribing or ordering labs. Psychiatrists and psychiatric nurse practitioners report it for that visit. Whether it pays turns on what the evaluation contains and what else you bill that day. It also turns on whether an office visit code would have fit better.

Every rule below is taken from a primary source and attributed where it appears. Where a rule belongs to one Medicare contractor or to the individual payer, this page says so. The sources are:

• The CMS Medicare NCCI Policy Manual, Chapter XI, revised January 1, 2026
• First Coast Service Options LCD L33252 and billing article A57520, the Medicare contractor for Florida, Puerto Rico and the US Virgin Islands
• The CMS 2026 physician fee schedule relative value file, January release
• The CMS CY 2026 list of Medicare telehealth services
• The American Psychiatric Association CPT Primer for Psychiatrists

What is CPT code 90792?

CPT code 90792 reports an initial psychiatric diagnostic evaluation that includes medical services. The APA primer describes it as an initial diagnostic interview for an adult or adolescent that includes medical services. It names the chief complaint, history of present illness, review of pertinent systems, family and psychosocial history, and a complete mental status examination. On top of that sits the medical work: ordering and interpreting labs or other studies, or prescribing medication.

The NCCI manual puts the split in one line. 90791 is psychiatric evaluation without medical E&M, and 90792 is psychiatric evaluation with medical E&M. The medical component is the whole reason the second code exists.

What does a 90792 evaluation have to include?

First Coast LCD L33252 defines the evaluation with medical services as an integrated biopsychosocial and medical assessment. It lists history, psychiatric history, a complete mental status exam and other physical examination elements as indicated. It adds a tentative diagnosis and an evaluation of the patient's ability and willingness to take part in the proposed treatment plan. The same LCD lists what the record should contain:

1. The reason for the evaluation or the patient's chief complaint
2. A referral source, if applicable
3. History of present illness, including how long the problems have existed
4. Past psychiatric history
5. Significant medical history and current medications
6. Social history
7. Family history
8. Mental status exam
9. Strengths and liabilities
10. A diagnostic impression or problem list
11. A treatment plan

The record should also show a psychiatric illness, or emotional or behavioral symptoms that suggest one or significantly alter baseline functioning. That is the medical necessity line in L33252. L33252 is one contractor's policy. Other Medicare contractors and commercial payers publish their own, and most cover the same ground.

Who can bill 90792?

First Coast billing article A57520 covers the evaluation with medical assessment. It says the physician or non-physician practitioner may use 90792 or an E/M code. The deciding factor is scope. The clinician has to be licensed to deliver the medical services the code describes.

• The license and the work done both have to support the medical component.
• A prescriber who does an evaluation with no medical work at all is describing 90791.
• Payer credentialing rules still apply. Check which codes each plan lets each license bill.

90792 vs 90791: which one applies?

The split is the medical services. If the evaluation includes prescribing, ordering or interpreting labs, or other medical work, it is 90792. If it does not, it is 90791. The content of the psychiatric interview is otherwise the same.

For the therapist side of the intake, see our 90791 CPT code guide, which covers the two codes side by side in more detail.

90792 vs 99204 and 99205: which should a prescriber bill?

A prescriber seeing a new patient has two routes. One is 90792. The other is a new patient office visit, 99204 or 99205, picked by medical decision making or total time. First Coast A57520 allows either. The NCCI manual rules out billing both for the same evaluation. The choice changes what else you can bill that day.

Read the table as a decision, in this order:

1. If you also deliver psychotherapy at the first visit and want to bill it, use the E/M route. NCCI lists 90833, 90836 and 90838 as add-ons to an E&M code, and 90792 cannot carry psychotherapy on the same date.
2. If decision making is high or total time reaches 60 minutes, 99205 carries more relative value than 90792 under Medicare.
3. If the visit supports 99204 and no more, 90792 carries more relative value than 99204 in the office setting.
4. If the payer requires 90792 for psychiatric intakes, follow the contract. Some plans set their own code rules.

Under the E/M route, keep the psychotherapy time separate. First Coast A57520 asks for the start and stop times or total time of the psychotherapy. That total does not include the E/M time.

What does 90792 pay in 2026?

Medicare pays 90792 from the national 2026 relative value file. The January release lists 90792 at 6.05 total RVUs in the office and 4.77 in a facility. The 2026 conversion factor in the same file is 33.4009. That gives a national amount of USD 202.08 in the office and USD 159.32 in a facility, before the geographic adjustment for your locality.

• These are national Medicare figures from total RVUs times the conversion factor. Your locality adjusts them.
• The CMS physician fee schedule look-up shows the amount for your locality.
• The file carries a second, higher conversion factor for qualifying alternative payment model participants. This page uses the standard one.
• Commercial plans and Medicaid set their own rates. Your contract is the number that counts.
• Facility amounts apply where the facility bills its own costs, such as a hospital outpatient department.

Can you bill 90792 and 90833 together?

No. The NCCI manual gives the reason. Psychotherapy includes continuing psychiatric evaluation, so 90791 and 90792 are not separately reportable with any psychotherapy code on the same date. It also lists 90833, 90836 and 90838 as add-ons reported with the appropriate E&M code, and 90792 is not an E&M code.

Say the first visit includes a medical evaluation and psychotherapy you want to bill. The NCCI-consistent route is a new patient E/M code plus the psychotherapy add-on. The two services need to be separately identifiable in the note, with the psychotherapy time recorded on its own.

What can you not bill with 90792 on the same day?

Can you bill 90785 with 90792?

Yes. First Coast A57520 lists the diagnostic evaluation codes 90791 and 90792 among the codes interactive complexity is used with. The NCCI manual describes interactive services as being for patients who lack the expressive language to explain their symptoms and response to treatment.

• Document what made the encounter interactive, such as a caregiver whose involvement complicated the visit.
• A57520 says 90785 should not be billed when a patient is unable to communicate by any means.
• The main example in the APA primer is the treatment of children.
• The 2026 national Medicare amount for 90785 is USD 14.70 in the office.

How often can you bill 90792?

First Coast LCD L33252 says a psychiatric diagnostic evaluation can be conducted once, at the onset of an illness or suspected illness. It says routine repeat evaluations of patients with chronic conditions are not medically necessary. The same provider may repeat it in these cases:

The APA primer adds that the code can be billed on subsequent days when an extended evaluation is medically necessary. Its example is a child who has to be seen with and without the parents. Commercial plans can set their own frequency limits, so check the plan before a repeat evaluation.

Is 90792 covered for telehealth in 2026?

Yes, for Medicare. The CMS CY 2026 final list of Medicare telehealth services carries 90792 with the status Maintain. 90791, 90785 and the psychotherapy add-ons 90833, 90836 and 90838 are on the list too.

• The list tells you the code is payable via telehealth under Medicare. It does not set modifiers or place of service.
• Modifier and place of service rules come from the payer and change by year.
• Commercial and Medicaid coverage of telehealth is set plan by plan and by state law.

What do payers check on a 90792 note?

A reviewer reads the note against the descriptor and the payer's policy. Build the evaluation so each check can be answered from the page.

Why do 90792 claims get denied, and how do you fix them?

For the wider denial workflow, see our guide to denial management. For checks to run before the visit, see insurance eligibility verification.

What should a 90792 note look like?

This outline covers the L33252 record list and the descriptor, plus substance use history and a risk assessment:

1. Identifying information and referral source
2. Reason for the evaluation and chief complaint
3. History of present illness, with onset and duration
4. Past psychiatric history, including prior treatment and hospitalizations
5. Medical history and current medications
6. Substance use history
7. Family psychiatric history
8. Social history
9. Review of pertinent systems
10. Mental status examination, every domain
11. Risk assessment
12. Strengths and liabilities
13. Diagnostic impression or problem list
14. Medical services delivered: medication decision, labs or studies ordered, exam findings
15. Treatment plan and the patient's ability and willingness to take part

Run these checks before the claim goes out:

• The note shows at least one medical service.
• The mental status exam covers every domain.
• No psychotherapy code is on the same date of service.
• No office E/M code is on the same date of service.
• Any repeat evaluation states the hiatus, admission or change in status.
• 90785, if billed, names what made the visit interactive.
• The clinician's license and payer credentialing allow 90792.
• The diagnosis is coded to the highest specificity.
• For telehealth, the payer's modifier and place of service rules are applied.

A 90792 example: choosing the code for a new patient

This scenario is illustrative and the patient is invented. A PMHNP sees a new adult patient for low mood and poor sleep. She takes a full history, completes a mental status exam, orders a thyroid panel, and starts an antidepressant. She spends some of the visit on supportive therapy but does not plan to bill it.

Change one fact and the answer moves. If she had delivered 20 minutes of separately identifiable psychotherapy and wanted to bill it, the claim becomes 99204 plus 90833. If decision making had been high, 99205 would carry more than 90792.

Which codes come after a 90792 intake?

The psychotherapy time bands above are the ones First Coast A57520 states: 16 to 37 minutes for 90832 and 90833, 38 to 52 for 90834 and 90836, and 53 or more for 90837 and 90838.

90792 CPT code FAQ

What is the difference between CPT 90791 and 90792?

90792 includes medical services such as prescribing or ordering and interpreting labs. 90791 does not. The NCCI manual describes 90791 as psychiatric evaluation without medical E&M and 90792 as psychiatric evaluation with medical E&M.

Is 90792 a timed code?

No. The descriptor carries no time, so the code is not selected by minutes.

How many times a year can you bill 90792?

First Coast LCD L33252 allows it once at the onset of an illness. Repeats are allowed after a hiatus of generally 6 months, an inpatient admission, or a significant change in mental status. Commercial plans set their own limits.

What pays more, 90792 or 99205?

Under the 2026 national Medicare fee schedule, 99205 carries 7.09 office RVUs and 90792 carries 6.05. 99205 needs high decision making or 60 minutes of total time to support it. Commercial rates depend on the contract.

Does 90792 pay more than 99204?

Under the 2026 national Medicare fee schedule, 90792 carries 6.05 office RVUs and 99204 carries 5.31. In a facility the figures are 4.77 and 3.50.

Can you bill 90792 and 90833 together?

No. The NCCI manual says 90792 is not separately reportable with psychotherapy on the same date, and 90833 is an add-on to an E&M code. Bill a new patient E/M plus 90833 instead.

Can you bill 90792 with an E/M code on the same day?

No. The NCCI manual says E&M codes 99202 to 99215 shall not be reported with 90791 or 90792.

Can a nurse practitioner bill 90792?

Yes, within state scope. First Coast A57520 says the physician or non-physician practitioner may use 90792 or an E/M code for an evaluation with medical assessment.

Can a psychologist or therapist bill 90792?

Generally no. A clinician whose evaluation includes no medical services reports 90791.

Is 90792 covered by Medicare for telehealth in 2026?

Yes. The CMS CY 2026 final list of Medicare telehealth services carries 90792 with the status Maintain.

Can 90785 be added to 90792?

Yes, when interactive complexity is documented. First Coast A57520 lists 90792 among the codes 90785 is used with.

What is the difference between 90792 and 99215?

90792 is an initial psychiatric diagnostic evaluation with medical services. 99215 is an office visit for an established patient at a high level, used for ongoing medication management once the evaluation is done.

For the psychiatric codes that follow the evaluation, see the mdhub page for psychiatrists and our guide to AI clinical documentation.

Where mdhub Fits

Emma, mdhub's AI clinical assistant, pre-charts before the visit. She drafts the evaluation note from the session in your template and suggests CPT codes for you to review. You make the coding call and sign the note. Start a free trial on your next intake, or book a demo to see it across a psychiatry practice.