90792 CPT Code (2026): Psych Eval + Medical

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• 90792

90792 CPT Code (2026): Psych Eval + Medical

CPT code 90792 for psychiatric diagnostic evaluation with medical services. Billing guidance for behavioral health providers.

Quick Reference

Code

90792

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

7 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 90792: Psychiatric Diagnostic Evaluation with Medical Services

CPT code 90792 represents a psychiatric diagnostic evaluation that includes medical services. This code is essential for behavioral health treatment centers where prescribing providers — psychiatrists, nurse practitioners, and physician assistants — conduct initial evaluations that combine psychiatric assessment with medical examination. The code captures the full scope of work involved when a prescriber evaluates a new patient and formulates both a psychiatric and medical treatment plan.

In addiction treatment settings, 90792 is particularly important because substance use disorders frequently co-occur with medical conditions that require integrated assessment. The prescribing provider must evaluate both the psychiatric presentation and its medical context to make safe, informed treatment decisions about medications and level of care.

Definition and Purpose

CPT 90792 is defined as a psychiatric diagnostic evaluation with medical services. It encompasses the same comprehensive psychiatric assessment components as CPT 90791 — including history, mental status examination, diagnostic formulation, and treatment planning — but adds a medical services component. This medical component includes elements such as physical examination, review of systems, ordering and interpreting laboratory tests, and medical decision-making related to prescribing.

The purpose of 90792 is to properly capture and reimburse the additional clinical complexity involved when a prescribing provider performs an initial psychiatric evaluation that integrates medical assessment. This is distinct from a purely psychiatric evaluation because the provider is applying medical training to assess physical health factors that influence psychiatric diagnosis and treatment.

In behavioral health treatment centers, 90792 is typically the code used when a psychiatrist, psychiatric nurse practitioner, or physician assistant conducts the initial medical-psychiatric evaluation during the intake process, particularly for patients entering residential treatment, PHP, or IOP programs.

When to Use 90792 in Behavioral Health

Use CPT 90792 when a qualified prescribing provider performs an initial psychiatric diagnostic evaluation that includes medical services. Common scenarios include:

Do not use 90792 when the evaluation does not include medical services — use CPT 90791 instead. Do not use 90792 for medication management follow-up visits, which should be billed using appropriate E&M codes (99211-99215). Also avoid using 90792 for evaluations performed by non-prescribing clinicians who cannot provide the medical services component.

• Medical-psychiatric intake evaluations at residential treatment centers where the prescriber assesses the patient’s psychiatric, substance use, and medical status simultaneously
• Initial psychiatrist evaluations that include medication assessment, physical exam components, and laboratory ordering
• Nurse practitioner or PA evaluations that combine diagnostic assessment with medical decision-making about pharmacotherapy
• Evaluations for medication-assisted treatment (MAT) where the prescriber must assess medical readiness for buprenorphine, naltrexone, or other medications
• Detoxification assessments where medical evaluation is integral to determining safe withdrawal management protocols

Documentation Requirements

Documentation for 90792 must support both the psychiatric evaluation and the medical services component. The medical record should include all elements required for 90791, plus additional medical documentation:

The documentation must clearly demonstrate that medical services were provided as an integral part of the evaluation, not as a separate service. This distinction is critical for supporting the higher reimbursement associated with 90792 compared to 90791.

• All psychiatric evaluation components — Chief complaint, HPI, psychiatric history, substance use history, social history, family history, mental status examination, risk assessment, diagnostic formulation, and treatment plan
• Review of systems (ROS) — A systematic inquiry into symptoms across body systems relevant to the psychiatric presentation
• Physical examination — Documented findings from the physical exam, focused on elements relevant to the psychiatric and substance use diagnoses. This may include vital signs, general appearance, cardiovascular, neurological, and other relevant system examinations
• Medical history integration — Documentation of how medical conditions, medications, and physical findings influence the psychiatric diagnosis and treatment plan
• Laboratory and diagnostic orders — Any labs or tests ordered as part of the evaluation (e.g., urine drug screen, comprehensive metabolic panel, thyroid function, hepatic function for patients starting certain medications)
• Medical decision-making — Clear documentation of the medical reasoning behind medication selection, dosing decisions, and any medical precautions or contraindications considered
• Medication plan — Specific medications prescribed or planned, including dosage, frequency, and rationale

Billing and Reimbursement

As of March 2026, the approximate Medicare national average reimbursement for CPT 90792 is approximately $185, reflecting the additional medical services component compared to 90791. Key billing considerations include:

Medicaid rates vary by state and may range from approximately $100 to $220. Commercial payer rates are typically negotiated and often exceed Medicare rates.

• Higher reimbursement than 90791 — The approximately $13 differential reflects the medical services component. However, this also means higher documentation requirements and greater audit scrutiny
• Facility versus non-facility rates — As with 90791, facility-based rates are lower because the facility receives a separate facility fee. Non-facility rates compensate the provider for overhead costs
• Cannot be billed with E&M codes on the same day — Because 90792 already includes medical services, billing an E&M code (99202-99215) on the same date for the same patient is considered duplicate billing
• Prescribing capability required — The rendering provider must have prescriptive authority. If a non-prescribing clinician performs the psychiatric evaluation and a prescriber separately provides medical services, each should bill their respective services appropriately rather than combining into a single 90792
• One per episode of care — Most payers allow one initial diagnostic evaluation (90791 or 90792) per treatment episode. Additional evaluations require clear medical necessity documentation

Common Modifiers

Modifiers used with CPT 90792 include:

Telehealth evaluations billed under 90792 require careful documentation of how the medical services component was addressed in the virtual setting. Some payers may have specific policies about what constitutes adequate medical evaluation via telehealth.

• Modifier 95 — Synchronous telemedicine service. For telehealth psychiatric evaluations with medical services, though note that the physical examination component may be limited in a telehealth setting. Document any telehealth-specific adaptations to the medical assessment
• Modifier 52 — Reduced services. Used when the evaluation is not completed in its entirety. Document the clinical reason the evaluation was abbreviated
• Modifier 53 — Discontinued procedure. Used when the evaluation was started but discontinued due to patient safety concerns or other circumstances beyond the provider’s control
• Modifier XE — Separate encounter. May be needed if 90792 is billed on the same date as another distinct service for the same patient

Compliance Considerations

Compliance with 90792 billing requires vigilance in several critical areas:

Medical services must be documented. The single most common compliance issue with 90792 is billing the code when the documentation does not support that medical services were actually provided. If the evaluation reads like a purely psychiatric assessment without physical exam findings, review of systems, or medical decision-making, auditors may downcode the claim to 90791 and recoup the difference.

Provider qualification verification is essential. Only providers with prescriptive authority should bill 90792. Billing 90792 for services rendered by a psychologist, LCSW, or LPC — regardless of whether a prescriber co-signs the note — is a compliance violation that can trigger audit findings, recoupment, and potential fraud allegations.

Avoid unbundling. Do not bill 90792 alongside E&M codes for the same patient on the same date unless the E&M service is for a clearly separate and distinct medical problem unrelated to the psychiatric evaluation. Even then, documentation must be exceptionally strong to withstand audit review.

Incident-to billing rules apply in some settings. If a mid-level provider (NP or PA) performs the evaluation under a physician’s supervision, ensure the arrangement meets Medicare’s incident-to requirements or that the mid-level is billing under their own NPI with appropriate credentialing.

MAT evaluations are an area of heightened payer scrutiny. When 90792 is billed for medication-assisted treatment initiation, ensure documentation demonstrates the full psychiatric evaluation was performed, not just a medical assessment for medication eligibility. The evaluation must meet all 90792 requirements, not just the medication-related components.

Related Billing Codes

• 90785
• 90791
• 90832
• 90833
• 90834

Common questions

Official sources

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