CPT 90792 Billing: Psych Eval With Medical

Mukesh MakwanaFounder & CEO · 8+ years hands-on in medical billing & RCM · Reviewed September 29, 2026

CPT 90792 is the prescriber's version of the intake. It carries more work value than any other behavioral health evaluation code, and practices lose money on it in two opposite directions: prescribers billing 90791 because that is what the template defaults to, and non-prescribers billing 90792 because it pays more.

What CPT 90792 covers

90792 is the psychiatric diagnostic evaluation with medical services: an integrated biopsychosocial assessment including history, mental status and recommendations, plus medical services.

Its counterpart, 90791, is the same evaluation without medical services. One code or the other, never both: Medicare pairs them with a modifier indicator of 0.

CPT 90792 vs 90791: what "medical services" actually means

This is the question the code turns on, and the answer is not "a physician did it". Medical services means medical work was genuinely part of the evaluation. In practice that looks like:

A physical examination component where clinically indicated.
Prescribing, or a documented decision about medication, including a decision not to prescribe.
Review and interpretation of laboratory results or other medical data.
Assessment of medical conditions that bear on the psychiatric presentation, and of drug interactions.
Ordering diagnostic studies.

A prescriber who performs no medical work during the evaluation has performed 90791, whatever their credential.

The reverse is equally true and more expensive. A clinician who cannot furnish medical services cannot reach 90792 by documenting harder. Where a payer checks the rendering provider's scope against the code, the claim denies; where it does not, the exposure is on audit rather than at adjudication, which is worse.

Documentation requirements

Everything a 90791 note needs, a 90792 note needs too. What follows is the part that is specific to this code, because the medical element is the only thing separating the two and it is the only thing a reviewer will look for first.

The medical work, named and located in the note. Not "medical services provided", but the examination performed, the medication decision reached, or the laboratory value interpreted.
Medication reasoning, including negative decisions. "Considered sertraline, deferred pending thyroid panel" is medical work. A medication list copied forward is not.
Interaction and contraindication review where the patient is on other medications.
The medical differential. Ruling out a thyroid, neurological or substance-induced cause is medical work and is frequently done but rarely written down.
Any studies ordered, and what question they were meant to answer.
Prescriber signature and credentials, which decides whether the code was available to this clinician at all.

The general evaluation elements, history, mental status examination, risk assessment, diagnosis and initial plan, are covered on the 90791 page and apply identically here.

After the intake: why follow-ups are not 90792

A prescriber sees the patient again in three weeks to adjust a dose. That visit is not another 90792. The evaluation code is for the evaluation, once per episode, and the ongoing work is an evaluation and management visit at the level the medical decision making supports.

Where the prescriber also delivers psychotherapy in that follow-up, the structure is E/M plus a psychotherapy add-on, 90833 for 16 to 37 minutes of therapy, 90836 for 38 to 52, 90838 for 53 or more. The add-on attaches to the E/M; it never sits next to a standalone psychotherapy code, and it never sits next to 90792.

Practices that bill 90792 for medication management follow-ups generate a frequency denial pattern that looks like a coverage problem and is actually a code-selection problem.

Frequency

Medicare's medically unlikely edit allows one unit per patient per day. Beyond that it is payer policy, and it works the same way it does for 90791: broadly one evaluation per patient per prescriber per episode, a further one payable after a defined interval or a documented change in condition, and a second clinician inside the same group frequently treated as the same provider.

Common denials and the exact fix

Billed with an office visit on the same date

Medicare pairs 90792 against 99202 to 99215 with a modifier indicator of 0. No modifier releases it.

Fix: 90792 already contains the medical work. Bill the single code, not an evaluation plus an E/M.

Billed with psychotherapy on the same date

Indicator 0 against the whole psychotherapy family, because psychotherapy includes continuing psychiatric evaluation.

Fix: put the evaluation and the first therapy session on different dates so both are billable.

Rendering provider cannot furnish medical services

A non-prescribing clinician billed under 90792, sometimes because the practice uses one intake template for everyone.

Fix: route the code by rendering provider scope, not by appointment type. 90791 is the correct code for a non-prescriber.

Prescriber billed 90791 by default

Quieter and more common than the reverse. No denial, just a materially smaller payment on every psychiatric intake.

Fix: audit a month of prescriber intakes against the two codes. Where medical services were performed and documented, 90792 is the correct code.

Both 90791 and 90792 on one claim

Usually a transfer of care inside a group, billed as if two separate evaluations occurred.

Fix: the pair carries indicator 0. Bill one, and document why the second clinician's assessment was necessary if you intend to appeal.

Neurobehavioral status exam billed alongside

96116 and 96121 are not reportable with 90792.

Fix: bill 96116 only for a complete neurobehavioral status exam performed as a distinct service on a different date.

Modifier rules and who may bill

No 26 or TC: PC/TC indicator 0.
95 or 93 for telehealth by audio-video or audio only, with place of service 10 when the patient is at home and 02 otherwise. The facility and non-facility gap on this code is one of the widest in the cluster, so place of service errors here are expensive rather than cosmetic.
59 and the X modifiers will not release the psychotherapy or E/M pairs, which carry indicator 0.
90785 may be added for genuine interactive complexity, never for interpretation or translation alone.

Who may bill it matters more than which modifier goes on it. Nurse practitioners and physician assistants may furnish and report 90792 within their state scope and their enrolment, and payers differ on whether they recognise it from each. Where a practice bills a physician's NPI for work an NPP performed, incident-to and supervision rules decide whether that is permissible, and they are the usual source of a take-back on this code years later.

Local coverage: is there an LCD for this code?

There is no national coverage determination for psychotherapy or psychiatric evaluation, so coverage is set locally and it differs by jurisdiction. Several Medicare Administrative Contractors publish a local coverage determination for psychiatric services together with a billing and coding article that carries the actual code list. Novitas Solutions, for example, maintains LCD L35101 (Psychiatric Codes, effective January 1, 2024) with billing and coding article A57130, which is where the covered CPT and HCPCS codes and the covered diagnoses actually live.

Two practical consequences. First, the diagnosis list that supports CPT 90792 in one jurisdiction may not support it in another, so the article to read is the one from the contractor that processes your claims. Second, LCDs and their articles are revised without much notice, which is why a claim that paid last quarter can deny this quarter with nothing changed on your side. Search the CMS Medicare Coverage Database by code and by your contractor, and re-check it when a denial pattern appears.

NCCI bundling edits

From the Medicare practitioner procedure-to-procedure file effective October 1, 2026. Indicator 0 means no modifier will release the pair.

90792 with 90791: indicator 0, by code definition.
90792 with 99202 to 99215: indicator 0.
90792 with 90832 to 90840, 90845, 90846, 90847, 90849, 90853, 90865 or 90880: indicator 0 across the psychotherapy family.
90792 with 96116, 96127, 96156, 96158, 96164 or 96167: indicator 0.
90792 with 97151, 97153, 97155 or 97156: indicator 0.
90792 with 99408 or 99409: indicator 0. Those two are non-covered by Medicare in any case.
99483 with 90792: indicator 0, so the cognitive assessment and care plan service is not reported alongside it.
90792 with G0396, G0397, G0442, G0443 or G0444: indicator 1, so a screening or intervention may be separately reportable where its time and work were genuinely distinct.

What CPT 90792 pays

90792 carries the highest physician work value of any evaluation code in this cluster, and it is paid as a whole service with no component split. Medicare publishes relative values rather than a price, so the amount depends on your locality's geographic adjustment.

2026 Medicare RVUs for CPT 90792

CPT 90792: 2026 Medicare RVUs (national, before GPCI)
Line	Work	PE, non-facility	PE, facility	Malpractice	Total, non-facility	Total, facility
Global (no modifier)	4.16	1.72	0.44	0.17	6.05	4.77

Source: CMS CY 2026 PFS Relative Value File, RVU26D (October release, published 08/26/2026). RVUs are national and unadjusted; commercial and Medicaid payers set their own rates and their own coverage.

In the 2026 CMS relative value file, CPT 90792 carries 4.16 work RVUs, with 6.05 total RVUs in a non-facility setting and 4.77 in a facility. The gap is practice expense: in an office the practice carries it, in a facility the facility does. Its PC/TC indicator is 0: CMS treats it as a physician service, so modifiers 26 and TC do not apply to it in any setting. Its global indicator is XXX: the surgical global period concept does not apply, so there is no postoperative period bundling other services into it. Across the diagnostic evaluation codes, work RVUs run from 3.84 (90791) to 4.16 (90792), so 90792 carries the highest physician work in its group.

Units per day. Medicare's medically unlikely edit allows 1 unit of CPT 90792 per patient per day (a date of service edit set on clinical grounds, rationale: code descriptor / CPT instruction). A second unit on the same date will not pay. MUE values are published quarterly in the Medicare NCCI practitioner services MUE table; the value above is from the table effective October 1, 2026.

To turn RVUs into payment, each component is multiplied by your locality's geographic practice cost index, the three are added, and the sum is multiplied by the 2026 conversion factor: $33.4009, or $33.5675 for qualifying APM participants (CMS-1832-F; CMS fact sheet). The CMS Physician Fee Schedule Look-Up Tool runs that calculation for your own locality.

Frequently asked questions

What is the difference between CPT 90791 and 90792?

90792 is the psychiatric diagnostic evaluation with medical services and 90791 is the same evaluation without them. Medical services means medical work was genuinely part of the evaluation, such as a physical examination component, prescribing or a documented decision about medication, review of laboratory results, or assessment of medical conditions bearing on the psychiatric presentation. A prescriber who performs no medical work during the evaluation has performed 90791, whatever their credential.

Can a therapist or counselor bill CPT 90792?

No. A clinician who cannot furnish medical services cannot reach 90792 by documenting more thoroughly. 90791 is the correct code for a non-prescribing clinician. Where a payer checks the rendering provider's scope against the code the claim denies outright, and where it does not, the exposure shows up on audit instead, which is worse.

Can CPT 90792 be billed with an office visit on the same day?

No. Medicare's procedure-to-procedure edits pair 90792 against 99202 to 99215 with a modifier indicator of 0, so no modifier will release the pair. 90792 already contains the medical work, so the correct approach is to bill the single evaluation code rather than an evaluation plus an evaluation and management service.

How often can CPT 90792 be billed for the same patient?

Medicare's medically unlikely edit allows one unit per patient per day. Beyond that it is payer policy: typically one evaluation per patient per prescriber per episode of care, with a further evaluation payable after a defined interval or on a documented change in condition. A second prescriber inside the same group often does not get a fresh evaluation paid, because the group is treated as one provider.

Can CPT 90792 and psychotherapy be billed on the same date?

No. The edits carry a modifier indicator of 0 across the whole psychotherapy family, because psychotherapy includes continuing psychiatric evaluation. Scheduling the evaluation and the first therapy session on different dates makes both billable, which is a scheduling decision rather than a coding one.

Sources

American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, CY 2026 PFS Relative Value File RVU26D (October release, published 08/26/2026): RVUs, PFS status indicator, PC/TC indicator and global indicator for 90792.
Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, CMS-1832-F: conversion factors.
Centers for Medicare & Medicaid Services, Medicare NCCI Practitioner Services medically unlikely edit table, effective October 1, 2026.
Centers for Medicare & Medicaid Services, Medicare NCCI procedure-to-procedure edits for practitioner services, 2026 Q4 file effective October 1, 2026.
Centers for Medicare & Medicaid Services, Medicare Coverage Database: Novitas Solutions local coverage determination L35101 (Psychiatric Codes, effective 01/01/2024) and billing and coding article A57130.
Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual for Medicare Services, revision date 1/1/2026, Chapter XI (Medicine), Section C, Psychiatric Services.

CPT® is a registered trademark of the American Medical Association. Payer policy, NCCI edits and MUE values change quarterly, so check your own contractor and your commercial contracts before submission. How we verify this guidance.

Related codes

CPT 90791. The same evaluation without medical services, for non-prescribing clinicians.
CPT 90837. The 60-minute psychotherapy code, which cannot share a date with the evaluation.
CPT 90853. Group psychotherapy, also blocked against the evaluation codes on the same date.

CPT 90792: Psychiatric Diagnostic Evaluation With Medical Services