CPT code 90791 is the billing code for a psychiatric diagnostic evaluation without medical services. It is the initial intake assessment that covers a client’s history, mental status, diagnosis, and treatment recommendations. Unlike psychotherapy codes, it has no minimum time, and payers usually allow it only once at the start of care.
Get it right and a new client starts treatment on a clean claim. Get it wrong and you face a denial, a frequency-limit rejection, or a repayment request for a thin note. The 90791 CPT code also decides what you can bill on the same day, so the choice matters.
This guide explains the CPT code 90791 description in plain language. You will see who can bill it, how 90791 vs 90792 differs, how often you can use it, the 90791 documentation requirements payers expect, and 2026 rates. Apna MBC delivers mental health billing services across the U.S., so we know where intake claims go wrong.
Key takeaways
- CPT code 90791 is a content-based intake code. It has no minimum time.
- Add medical services such as prescribing, and the code becomes 90792.
- Most payers allow one 90791 CPT code per client, per provider, at the start of care.
- Medicare pays about $173 for CPT code 90791 in 2026, so complete notes protect real revenue.
What Is CPT Code 90791?
CPT code 90791 describes an integrated biopsychosocial assessment, including history, mental status, and recommendations. That is the wording in the CPT manual, and it is the core of the 90791 CPT code description. The service may also include talking with family or other sources and reviewing or ordering diagnostic studies.
The code began in 2013 alongside 90792. It replaced the older 90801 and 90802. It covers evaluation only, so treatment does not belong in this code. A complete psychiatric diagnostic evaluation usually includes:
- A clinical interview about the presenting problem
- Psychiatric, medical, substance use, family, and social history
- A mental status exam
- A risk assessment
- A diagnosis with clinical reasoning
- Initial treatment recommendations
Medical services are what separate it from 90792. If you prescribe, examine, or order labs during the visit, a different code applies.
Who Can Bill the 90791 CPT Code?
Psychiatrists, clinical psychologists, clinical social workers, licensed counselors, marriage and family therapists, and psychiatric nurse practitioners can generally report the 90791 CPT code. This assumes no medical service is billed. Your state license, payer enrollment, and contract decide the final answer.
Medicare pays by credential. Therapists receive 75% of the psychologist rate, and nurse practitioners receive 85%, according to CMS guidance summarized by JotPsych. Enrollment matters here. Keep your medical credentialing services and payer contracts current before the first intake goes out.
Does CPT Code 90791 Have a Time Requirement?
No. CPT code 90791 is not a timed code. Unlike 90832, 90834, and 90837, it is billed once for the full evaluation. The CPT manual sets no minimum minutes. Most intakes run 45 to 90 minutes, depending on complexity.
Still write down start and stop times. Some commercial payers ask for them. Content, not the clock, supports the code. If the note lacks a mental status exam or a diagnosis, the claim is at risk no matter how long the visit lasted.
CPT Code 90791 Examples
These scenarios show how content and payer rules pick the code:
| Scenario | Code |
| LCSW completes a 75-minute intake with history, mental status exam, risk assessment, and diagnosis | 90791 |
| Psychiatrist evaluates a new patient and prescribes medication in the same visit | 90792, or an evaluation and management (E/M) code |
| Therapist finishes an intake and starts therapy in the same visit | 90791 only. Bill psychotherapy at the next visit |
| New client interviewed by video from home | 90791-95, place of service (POS) 10 |
| Intake needs an interpreter or caregiver input | 90791 plus 90785 (interactive complexity add-on), when criteria are met |
| Client returns after a long break with a new diagnostic question | Repeat 90791 may be allowed. Document why and check the payer |
The pattern is consistent. The content of the evaluation picks the code, and the payer’s frequency rules decide whether it pays.
90791 vs 90792 vs 90837: Which Code Fits?
| Code | Used for | Medical services | Timed |
| 90791 | Initial diagnostic evaluation | No | No |
| 90792 | Initial diagnostic evaluation with medical services | Yes | No |
| 90837 | Ongoing individual psychotherapy, 53+ minutes | No | Yes |
90791 vs 90792 comes down to one question: did you perform medical services? Prescribing, physical exams, and lab orders point to 90792, which prescribers such as psychiatrists and nurse practitioners typically bill. The two codes cannot be billed for the same client, provider, and date.
90791 vs 90837 is about timing in the care episode. 90791 opens treatment, and 90837 covers the sessions that follow. Payers generally will not pay a psychotherapy code with 90791 on the same date. Our guide to CPT code 90837 explains the 53-minute rule for those follow-up visits.
How Often Can You Bill CPT Code 90791?
Frequency comes from payer policy, not from CPT. Medicare and Medicaid typically allow one 90791 CPT code per client, per provider, per year. Some commercial plans allow one every six months. A Medicare coverage article, as quoted by ICANotes, says the evaluation can be done once at the onset of an illness.
Repeat evaluations may be allowed after an extended break, an inpatient admission, a significant change in mental status, or a need for diagnostic clarification. Document the reason every time. Check frequency limits before the intake, because a rejected claim after the visit is hard to fix.
90791 Documentation Requirements Payers Expect
Incomplete evaluations drive most denials. The most common cause is a missing mental status exam, treatment plan, or diagnosis. A strong note for 90791 billing includes:
- Client name, date of service, and referral source.
- Presenting problem and history of present illness, with a timeline.
- Psychiatric, medical, substance use, family, and psychosocial history.
- A complete mental status exam, including normal findings.
- A risk assessment with clinical reasoning, not just a checkbox.
- A diagnosis (DSM-5 or ICD-10) with rationale and differentials.
- An initial treatment plan with modality, frequency, and measurable goals.
- Start and stop times.
- Telehealth details: the modality and the client’s location.
- Signature and credentials.
Treatment plans draw real scrutiny. In an HHS OIG audit of 216 Medicare psychotherapy visits, 43 had a missing or incomplete treatment plan. The intake note is where that plan begins.
90791 Reimbursement Rate in 2026
Medicare’s national non-facility payment for CPT code 90791 is $173.35 in 2026, up 3.9% from $166.91 in 2025. The facility rate is $137.28. Therapists receive about $130, and nurse practitioners about $147.
| Payer | Average 90791 rate |
| Cigna | $205.36 |
| Blue Cross Blue Shield | $184.47 |
| Medicare (national, non-facility) | $173.35 |
| Aetna | $164.22 |
| UnitedHealthcare | $160.15 |
These are national averages before local adjustment, so your contract may differ. Medicare pays about 6morefortheintakethanfora60-minutesessionof90837(167.01). Verify benefits and prior authorization before the first visit, and compare your contracted rate with these benchmarks at renewal.
90791 Telehealth Modifier 95 and Place of Service
Telehealth does not change the code, only how you report it. Use modifier 95 for live audio and video and modifier 93 for audio-only. Place of service 10 applies when the client is at home, and POS 02 applies elsewhere. A video intake with a client at home is 90791-95, POS 10.
CMS says Medicare telehealth flexibilities, including audio-only at home, run through December 31, 2027. For mental health telehealth, an in-person visit is required within six months before the first telehealth service and every 12 months after. CMS states that requirement does not take effect until after December 31, 2027. Commercial payers set their own rules, so confirm each one.
Common 90791 Billing Mistakes
- Incomplete mental status exam. Listing only abnormal findings invites a denial.
- Risk assessment without reasoning. State why the risk level was chosen.
- Cloned or templated notes. Each intake must be individualized.
- Repeat intake with no reason. Frequency rejections are common.
- Wrong code. Using 90791 where 90792 or an E/M code applies, or the reverse.
- Billing 90791 for routine therapy. It is an evaluation code only.
- Wrong telehealth modifier or POS. Mismatches stop otherwise clean claims.
Strong claim denial management catches these early. Periodic compliance audits show whether your intake notes would survive a payer request.
How Apna MBC Supports 90791 Billing
Apna MBC is a mental-health-focused medical billing company based in Arlington, Texas, serving practices in 30+ states. Before the intake, we verify the client’s benefits, so frequency limits and authorization rules are known up front. After the visit, we scrub claims for the right code, modifier, and place of service. We submit daily, follow up on accounts receivable, and fix and resubmit denials. We also work inside the systems you already use, such as SimplePractice, TherapyNotes, and Tebra, with HIPAA-compliant processes throughout.
Conclusion
CPT code 90791 is simple to describe and easy to misbill. Use it for the initial psychiatric diagnostic evaluation without medical services. Check the payer’s frequency limit first. Then document the history, mental status exam, risk assessment, diagnosis, and treatment plan in every note. Once the intake is billed cleanly, apply the same discipline to the sessions that follow with our guide to CPT code 90837.
Want a second set of eyes on your 90791 billing? Request a free practice audit and let our team review your claims.
Frequently Asked Questions
What is CPT code 90791?
CPT code 90791 is the code for a psychiatric diagnostic evaluation without medical services. It is the initial intake assessment that reviews a client’s history, mental status, and diagnosis, and recommends treatment.
What does CPT code 90791 mean?
It means a psychiatric diagnostic evaluation. The CPT manual describes it as an integrated biopsychosocial assessment, including history, mental status, and recommendations. “Without medical services” separates it from 90792.
What is CPT code 90791 used for?
It is used for the first evaluation of a new client or a new episode of care. Licensed mental health professionals report it after completing the intake. It is not for routine therapy sessions.
Does CPT code 90791 require a modifier?
Not for an in-person visit. Telehealth usually needs modifier 95 for video or 93 for audio-only, plus the correct place of service. Interactive complexity is reported with the add-on code 90785, not a modifier.
Is there a time requirement for 90791?
No. It is not a timed code, and most intakes run 45 to 90 minutes. Document start and stop times anyway, since some payers ask for them.
How often can you bill 90791?
Medicare and Medicaid typically allow one per client, per provider, per year. Some commercial plans allow one every six months. Check each payer’s policy and document the reason for any repeat.
What is the difference between 90791 and 90792?
90792 includes medical services such as prescribing, physical exams, or lab orders. 90791 does not. They cannot be billed together for the same client, provider, and date.
Can you bill 90791 and 90837 on the same day?
Payers generally do not allow it for the same provider and date. Bill the 90791 CPT code for the intake, then use 90837 for the follow-up sessions.
How much does 90791 pay in 2026?
Medicare’s national non-facility rate is about $173. Commercial national averages range from roughly $160 to $205, depending on the payer.
Can 90791 be done by telehealth?
Yes. Use modifier 95 for live video, modifier 93 for audio-only where the payer allows it, and POS 10 for a client at home. Confirm each payer’s telehealth policy.
