CPT 90791 and 90792: Psychiatric Diagnostic Evaluation Codes

CPT 90791 is the psychiatric diagnostic evaluation without medical services, billed by therapists and psychologists. 90792 is the same evaluation plus medical services such as prescribing, billed by prescribers. Both are usually once at the start of care, and neither goes on the same date as psychotherapy or an E/M visit. Ona feeds intake answers into the evaluation note.

Quick answer:

• 90791 or 90792 is decided by whether medical services were part of the evaluation, not by how long it took. Neither code is timed.
• Medicare contractor and commercial policies treat the evaluation as a start-of-care service, repeatable after a long break, a hospital stay or a significant change.
• The same-day rules are strict: no psychotherapy code and no E/M code alongside either evaluation, per the CMS NCCI Policy Manual.

What 90791 and 90792 Each Cover

Both codes describe the evaluation a clinician does to understand a new problem and decide on treatment. First Coast Service Options, a Medicare Administrative Contractor, describes it in LCD L33252 as an integrated biopsychosocial assessment: history, mental status, a tentative diagnosis, and an assessment of whether the patient can take part in treatment. The difference is what is layered on top.

	90791	90792
What it describes (paraphrased)	Psychiatric diagnostic evaluation without medical services	Psychiatric diagnostic evaluation that also includes medical services
Medical elements included	None	Other physical exam elements as indicated, prescribing, ordering or reviewing labs and studies, per LCD L33252
Typically billed by	Psychologists, clinical social workers, counselors and marriage and family therapists, within state scope	Psychiatrists and other prescribers, such as psychiatric nurse practitioners, within state scope
Timed?	No	No
Interactive complexity add-on 90785	Allowed when documented	Allowed when documented
Same day as psychotherapy	No	No
Same day as E/M by the same clinician	No	No
Medicare telehealth code	Yes	Yes

The telehealth row comes from CMS's MLN booklet Medicare and Mental Health Coverage (March 2026), which marks both codes as current telehealth codes. Blue Cross and Blue Shield of Texas describes 90792 in its psychotherapy policy CPCP051 as the evaluation with additional medical services such as physical examination and prescribing.

The practical test is simple. If the evaluating clinician's license does not include medical services, the code is 90791. If a prescriber does a full psychiatric evaluation and also manages the medical side in the same encounter, it is 90792. First Coast notes that a physician or nonphysician practitioner doing an evaluation with medical assessment may use 90792 or an E/M code instead, which matters because E/M and 90792 are alternatives, not a pair.

Who Can Bill Which Code

Licensure decides this, not the software. Blue Cross and Blue Shield of Texas lists the provider types that usually bill behavioral health codes: psychiatrists, licensed psychologists, independently licensed master's-level clinicians such as LCSWs, LPCs and LMFTs, and licensed medical providers such as nurse practitioners and physician assistants. LCD L33252 adds that psychotherapy must be provided by someone whose state license covers it.

For Medicare, the list of who can enroll has widened. CMS's mental health booklet includes marriage and family therapists and mental health counselors among the practitioner types it covers, alongside clinical psychologists and clinical social workers. What none of these non-prescribing clinicians can bill is 90792, because they do not provide the medical services that define it.

How Often You Can Bill an Evaluation

There is no single national number, so read your payers rather than a blog. What the policies fetched for this article say:

• First Coast LCD L33252 (Medicare). The evaluation is done once at the onset of an illness or suspected illness. It can be repeated after an extended hiatus of about six months, after an inpatient admission, or when the patient's mental status has changed significantly.
• Blue Cross and Blue Shield of Texas CPCP051. The evaluation is reported once at the onset of treatment, and repeated only after a break in treatment of at least six months since the patient was last seen for the psychiatric condition.
• CGS Medicare fact sheet. The evaluation is reported once per day and covered once at the outset of an illness or suspected illness, with exceptions in the LCD.

Two operational points follow. A group practice that hands a new patient from an intake clinician to a treating clinician should not bill a second evaluation for the handoff; the second clinician's first visit is usually psychotherapy. And a patient returning after a long gap is the case where a new evaluation is most often supportable, as long as the note says why.

Same-Day Rules With Psychotherapy and E/M

The CMS National Correct Coding Initiative Policy Manual, Chapter XI (revision January 1, 2026), sets two hard boundaries:

• No psychotherapy on the same date. Because psychotherapy already includes continuing psychiatric evaluation, 90791 and 90792 are not separately reportable with individual, group, family, crisis or other psychotherapy codes for the same date of service.
• No E/M on the same date. E/M codes such as 99202 to 99215 are not reported with either evaluation code.

In practice this means a long first session is billed as the evaluation, not as an evaluation plus 90837. If the clinician spent the second half of an intake doing therapy, the claim still carries one evaluation code. Blue Cross and Blue Shield of Texas also lists crisis psychotherapy (90839, 90840) among the codes not reported with 90791 or 90792, and First Coast's article A57520 says the same from the crisis side.

These edits apply to the same clinician, or the same specialty in the same group, on the same patient and date. Two different clinicians doing genuinely different services on one day is a separate question, and the answer depends on the payer.

Interactive Complexity With an Evaluation

90785 can be added to 90791 or 90792 when one of the documented communication factors in LCD L33252 applied: maladaptive communication among participants, caregiver behavior that interferes with the plan, a sentinel event that triggered a mandated report, or play equipment, devices or an interpreter used to overcome a barrier. Evaluations of children with parents in the room are where it comes up most. It is not billed because the evaluation was long or emotionally difficult, and Blue Cross and Blue Shield of Texas states it is not reported for translation alone.

What the Evaluation Note Should Contain

LCD L33252 lists what a psychiatric evaluation record should include. Treat it as the skeleton of your evaluation template:

1. Reason for the evaluation and the referral source.
2. History of the present illness.
3. Past psychiatric history and relevant medical history.
4. Social and family history.
5. Mental status examination.
6. Strengths and liabilities.
7. Diagnoses.
8. An initial treatment plan.

For 90792, the note also needs the medical work that justifies the code: the exam elements performed, medications reviewed or prescribed, labs ordered or reviewed. A 90792 note that reads exactly like a 90791 note is the most common reason the higher code gets questioned.

Diagnosis is the clinician's decision. The note supports the code; the software records the decision; neither replaces clinical judgment.

Where Intake Forms Fit

Most of items 1 to 4 on that list are information the patient can give before the visit. That is the work intake should do, so the evaluation hour goes to the mental status exam and the clinical conversation instead of transcribing a family history.

In Ona, forms and interviews attached to a service go out when the visit is booked, or a set time before it, as a one-time link that needs no sign-in. A form holds fixed questions and ends in a drawn signature; an interview takes a history as a conversation and follows up on vague answers. Both land on the chart with a summary and suggested records that stay flagged until a clinician confirms them. If the practice already has a paper intake packet, Ona can read a PDF of up to 20 MB into a draft form for review, as described in building forms.

Validated screeners sit in the same place. PHQ-9 and GAD-7 import with their scoring already set up, and Ona scores them at submission. A screener total is a screening result, not a diagnosis, and it does not decide which code you bill. PHQ-9 and GAD-7 scoring inside the chart explains what the screener result does and does not do.

How the Evaluation Flows to the Claim in Ona

Ona is an AI-native, all-in-one practice management platform for outpatient practices, used by solo clinicians and by multi-location behavioral health groups where intake and treating clinicians are different people. The evaluation follows the same path as every other visit:

• A dedicated evaluation service. Each service carries a CPT code, place of service, modifiers and a default copay. Separate services for "Diagnostic evaluation" (90791) and "Psychiatric evaluation with medical services" (90792) keep therapists and prescribers on the right code from booking.
• An evaluation template. Ona's note template library includes intake and assessment templates, among them a Mental Status Exam and an ADHD Assessment, and any template can be edited to follow the LCD skeleton above. With a recording, the draft fills from what was said, plus the intake answers and the chart; fields Ona cannot support stay marked as left empty.
• A billable diagnosis. Diagnoses are added with ICD-10 search, and Ona will not add a non-billable category code from the coded picker.
• Prescriber add-ons where they apply. For 90792 visits that end in a prescription, Ona's e-prescribing runs DoseSpot inside the chart at $45 per prescribing practitioner per month, with EPCS for Schedule II to V a further $25.
• Claim or superbill. For insured patients, eligibility runs at booking and again in the 48 hours before the visit, so a plan that requires a prior authorization for the first visit is caught before the patient arrives. The draft claim builds from the signed note's diagnoses and services, and billing rules can require a diagnosis on every line and a note before billing. For out-of-network patients, staff create a superbill from the completed visit, per From visit billing to superbill and claim.

Telehealth evaluations follow the same path. Video visits in Ona default to POS 10 on the claim, which matches the CMS Telehealth FAQ (updated October 8, 2026) for a patient at home.

Frequently asked questions

What is the difference between 90791 and 90792?

90791 is a psychiatric diagnostic evaluation without medical services. 90792 is the same evaluation with medical services added, such as physical exam elements, prescribing, and ordering or reviewing labs. Therapists and psychologists bill 90791; prescribers such as psychiatrists and psychiatric nurse practitioners bill 90792 when they do the medical work.

Can 90791 be billed on the same day as 90837?

No, not by the same clinician. The CMS NCCI Policy Manual states that 90791 and 90792 are not separately reportable with psychotherapy codes for the same date of service, because psychotherapy already includes continuing evaluation. A long first session that included therapy is still billed as one evaluation code.

How often can I bill 90791?

Usually once at the start of care. First Coast's Medicare LCD L33252 allows a repeat after an extended hiatus of about six months, an inpatient admission, or a significant change in mental status, and Blue Cross and Blue Shield of Texas allows a repeat after a break of at least six months. Check each payer's own policy.

Can 90792 be billed with an E/M code?

No. The CMS NCCI Policy Manual states that E/M codes such as 99202 to 99215 are not reported with 90791 or 90792. A prescriber doing an evaluation with medical assessment chooses either 90792 or an E/M code, per First Coast's billing article A57520, not both.

Can I add 90785 to a diagnostic evaluation?

Yes, when the note documents one of the qualifying communication factors: maladaptive communication among participants, caregiver behavior that interferes with care, a sentinel event that required a mandated report, or play equipment, devices or an interpreter used to overcome a barrier. A long or difficult evaluation alone does not qualify.

How does Ona support the 90791 intake?

Ona sends intake forms and conversational interviews when the evaluation is booked, scores screeners like PHQ-9 and GAD-7 at submission, and puts answers and a summary on the chart before the visit. The evaluation note drafts from your own template, the diagnosis is added with ICD-10 search, and the claim or superbill builds from the signed note.

Next step

Coding guidance in this article is general. Payer rules vary, so confirm frequency limits, same-day rules and coverage with each payer before you bill.

The evaluation is the visit where intake quality shows up in the claim. Attach your intake to the evaluation service, build the template around the LCD skeleton, and let the claim build from the signed note. See forms and interviews and the pricing page, or book a 15-minute demo and bring your current intake packet. The 14-day free trial needs no credit card.