Psychiatric Evaluation With Medical Services Cost
Psych diag eval w/med srvcs
$202.08In-office total2026 Medicare, nationalUnder 2026 Medicare rates, a psychiatric evaluation with medical services in a doctor's office costs about $202 nationally, with no separate facility fee. In a facility the total is up to about $341 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 with medical services 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 $42.76.
How CMS prices CPT 90792
Work is about 69% of the office total RVU; practice expense is about 28%. 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: $202.08. Hospital (facility) physician rate: $159.32.
Medicare patients typically owe 20% of the allowed amount after the Part B deductible, about $40 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 With Medical Services cost by state
2026 Medicare office rate for CPT 90792, averaged across each state's localities. Open a state for its locality table and full cost breakdown.
What Is Psychiatric Evaluation With Medical Services?
This is the psychiatric diagnostic evaluation performed by a medical provider, a psychiatrist or psychiatric nurse practitioner, that includes medical services: reviewing your health history and medications, considering physical causes of symptoms, and usually prescribing or adjusting psychiatric medication. It typically lasts 45 to 90 minutes as the intake for medication management. Follow-up prescribing visits are then shorter and billed under different codes.
What Affects the Cost
- –Psychiatrists are among the least likely of all physicians to accept insurance, so cash-pay intake fees are common and vary widely by market.
- –This medical evaluation code pays more than the non-medical 90791, and clinician list prices reflect that.
- –Any labs ordered at intake, such as thyroid or metabolic panels before starting medication, are billed separately by the lab.
- –Follow-up medication visits recur monthly or quarterly indefinitely, so the ongoing cadence matters more than the intake price.
- –Private-pay concierge psychiatry practices bundle intakes and follow-ups into membership pricing outside insurance entirely.
How It Is Billed
CPT 90792 covers the intake evaluation with medical services; subsequent medication follow-ups bill as E/M office visits (such as 99213 or 99214), sometimes with a psychotherapy add-on when therapy happens in the same appointment. Labs, pharmacogenomic tests, and prescriptions all generate separate charges from other parties. Like 90791, it is an intake code, not billable at every visit.
Insurance & Coverage Notes
Parity rules make in-network coverage comparable to any medical specialist visit, but psychiatric network directories are notoriously outdated, and finding a prescriber actually taking new patients is the real barrier. Document your search: several failed attempts to find an in-network psychiatrist supports a network-gap exception request paying an out-of-network prescriber at in-network rates. Telehealth psychiatry is broadly covered, and prescribing of non-controlled psychiatric medications by telehealth is routine.
Questions to Ask Before Booking
- 1.Do you take my insurance, and what are your cash rates for the intake and for follow-ups?
- 2.How often will I need follow-up visits, and how are those billed?
- 3.Will you order baseline labs, and where should I have them drawn to stay in network?
- 4.If therapy is recommended alongside medication, do you provide it or refer out?
- 5.Can I request a network-gap exception if no in-network prescriber is available in a reasonable time?
Psychiatric Evaluation With Medical Services (CPT 90792): questions
Under 2026 Medicare rates, a psychiatric evaluation with medical services in a doctor's office costs about $202 nationally, with no separate facility fee. In a facility the total is up to about $341 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 90792 that produces an office rate of $202.08 and a hospital physician rate of $159.32 (a $42.76 gap). The hospital’s own facility charge is extra and often larger than this entire physician line.
This is the psychiatric diagnostic evaluation performed by a medical provider, a psychiatrist or psychiatric nurse practitioner, that includes medical services: reviewing your health history and medications, considering physical causes of symptoms, and usually prescribing or adjusting psychiatric medication. It typically lasts 45 to 90 minutes as the intake for medication management. Follow-up prescribing visits are then shorter and billed under different codes. CMS bills it as “Psych diag eval w/med srvcs.”
In a doctor's office, $202.08 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 $159.32 and the hospital adds its own facility payment, bringing the total to up to about $341. 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.