Psychiatric Evaluation Cost
Psych diagnostic evaluation
$173.35In-office total2026 Medicare, nationalUnder 2026 Medicare rates, a psychiatric evaluation in a doctor's office costs about $173 nationally, with no separate facility fee. In a facility the total is up to about $319 at a hospital outpatient department, because the facility is paid its own rate on top of the physician. A ZIP code adjusts every figure to your area.
- ✓Your ZIP's wage-adjusted hospital and surgery center rates
- ✓Five nearby hospitals by name, with CMS star ratings
- ✓The add-on codes that typically land on the bill
- ✓A word-for-word script for asking for a good-faith estimate
- ✓A private link you can reopen and share
- ✓Everything in the Premium report
- ✓15 nearby hospitals instead of five
- ✓Filled good-faith-estimate request letter
- ✓Bill-negotiation letter
- ✓Printable PDF download
National Medicare physician rate (2026)
What it costs in a hospital or surgery center
In a doctor’s office, the office rate above is the whole Medicare payment. When the same procedure is done in a hospital or surgery center, the facility bills its own fee on top of the physician, which is what these totals show. They are 2026 national Medicare amounts.
Medicare may pay the facility separately for this code or package it into another service on the same day, so treat the facility share as an upper bound. Medicare allowed amounts are not what an uninsured patient is charged, and not a quote. Private plans typically allow more.
Get the rate for your ZIP
CMS adjusts this CPT by locality. A five-digit ZIP is enough: no account, no insurance card.
What psychiatric evaluation costs at hospitals near you
Everything above is a national average. The hospital you pick in your area moves the bill more than anything else you control.
Rates for your ZIP, 5 named hospitals with CMS ratings, the add-on codes, and the scheduler script.
For example 90001.
One-off payment, no account and no subscription. You get a private link and an email. No medical records and no insurance card, ever.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery center rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. For this code the office and hospital physician lines differ by $36.07.
How CMS prices CPT 90791
Work is about 74% of the office total RVU; practice expense is about 26%. Localities with a high PE GPCI move this code more when practice expense is a large share.
Office vs hospital for this code
Office (non-facility) physician rate: $173.35. Hospital (facility) physician rate: $137.28.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible, about $35 for the office physician fee, before any Medigap coverage. That coinsurance does not include a hospital facility fee.
Labeled private-plan and cash ranges on this page are arithmetic multiples of Medicare, not negotiated quotes. Ask the billing office for the CPT code, the site of service, and a good-faith estimate.
Psychiatric Evaluation cost by state
2026 Medicare office rate for CPT 90791, averaged across each state's localities. Open a state for its locality table and full cost breakdown.
What Is Psychiatric Evaluation?
A psychiatric diagnostic evaluation is the comprehensive first appointment with a mental health professional, typically a psychologist, therapist, or psychiatrist, covering your history, symptoms, and goals to establish a diagnosis and treatment plan. It usually runs 60 to 90 minutes, longer than ordinary therapy sessions, and happens in an office or by telehealth. This version of the evaluation does not include medical services like prescribing, which distinguishes it from its sister code 90792.
What Affects the Cost
- –Many therapists and some psychiatrists do not accept insurance at all, making this a cash purchase at whatever the clinician charges.
- –Clinician credentials drive price: psychiatrists charge more than psychologists, who charge more than masters-level therapists, for the same code.
- –In-network negotiated rates are often far below the clinician's list price, so network status changes the cost more than almost anything else.
- –Telehealth platforms sometimes price intake evaluations differently from their ongoing session rates.
- –Out-of-network plans may reimburse a percentage of an allowed amount well below what the clinician actually charged, leaving you the gap.
How It Is Billed
CPT 90791 is billed once at the start of care, occasionally again if you return after a long gap or need re-evaluation; ongoing sessions then bill under psychotherapy codes like 90834 or 90837. It cannot be billed by the same clinician on the same day as a psychotherapy service. Because no medical services are included, prescription management is absent from this code; if medication evaluation happens, 90792 is the correct code instead.
Insurance & Coverage Notes
Mental health parity law requires plans to cover behavioral health on terms no more restrictive than medical care, so this evaluation is covered in network like a specialist visit; the practical problem is network adequacy, since many behavioral health clinicians are out of network. If you cannot find an in-network provider with reasonable availability, some plans grant network-gap exceptions paying out-of-network clinicians at in-network rates; ask for one in writing. Telehealth coverage for this code is now standard on most plans.
Questions to Ask Before Booking
- 1.Are you in network with my plan, and if not, what is your rate for this evaluation?
- 2.Will ongoing sessions be billed at a different rate than this intake?
- 3.If I need medication, will you refer me for a separate 90792 evaluation with a prescriber, at what cost?
- 4.Does my plan offer a network-gap exception if no in-network therapist is available soon?
- 5.Do you provide superbills I can submit for out-of-network reimbursement?
Psychiatric Evaluation (CPT 90791): questions
Under 2026 Medicare rates, a psychiatric evaluation in a doctor's office costs about $173 nationally, with no separate facility fee. In a facility the total is up to about $319 at a hospital outpatient department, because the facility is paid its own rate on top of the physician. A ZIP code adjusts every figure to your area.
Medicare uses a different practice-expense RVU in a facility. For CPT 90791 that produces an office rate of $173.35 and a hospital physician rate of $137.28 (a $36.07 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
A psychiatric diagnostic evaluation is the comprehensive first appointment with a mental health professional, typically a psychologist, therapist, or psychiatrist, covering your history, symptoms, and goals to establish a diagnosis and treatment plan. It usually runs 60 to 90 minutes, longer than ordinary therapy sessions, and happens in an office or by telehealth. This version of the evaluation does not include medical services like prescribing, which distinguishes it from its sister code 90792. CMS bills it as “Psych diagnostic evaluation.”
In a doctor's office, $173.35 is Medicare's whole national payment: it covers the physician, the room and the supplies, with no separate facility fee. In a hospital outpatient department the physician is paid about $137.28 and the hospital adds its own facility payment, bringing the total to up to about $319. Services billed under other codes, such as lab work, are extra. Private-plan allowed amounts are often higher than Medicare; your deductible and coinsurance still apply.
For cash-pay surgery shopping, use this CPT as the Medicare floor when you compare written quotes. How cash-price shopping works.