Psychiatric Evaluation Cost in California
Psych diagnostic evaluation
$319Hospital outpatient total2026 Medicare, physician + facility- ✓Your ZIP's wage-adjusted hospital and surgery centre 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
California Medicare physician rate (2026)
+7.2% vs nationalAverage of 29 localities. Office range $179.49–$206.78.
What the whole procedure costs
The rate above is the physician’s fee on its own. The facility bills separately, and for most procedures the facility is the larger half of the bill. These 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.
Your ZIP in California
A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
What psychiatric evaluation costs at hospitals near you
Everything above is a national average. The hospital you pick in California 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.
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 centre 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. In California the office and hospital physician lines for this CPT differ by $42.68.
National vs California
Where California ranks for this CPT
CPT 90791 by California locality
| Locality | Office |
|---|---|
| san jose-sunnyvale-santa clara (san benito cnty) | $206.78 |
| san jose-sunnyvale-santa clara (santa clara cnty) | $206.69 |
| san francisco-oakland-berkeley (marin cnty) | $203.39 |
| san francisco-oakland-berkeley (san francisco/san mateo/alameda/contra costa cnty) | $203.36 |
| napa | $195.23 |
| vallejo | $195.20 |
| santa rosa-petaluma | $187.02 |
| los angeles-long beach-anaheim (los angeles/orange cnty) | $186.51 |
| san diego-chula vista-carlsbad | $185.60 |
| santa cruz-watsonville | $185.29 |
| sacramento-roseville-folsom | $184.90 |
| oxnard-thousand oaks-ventura | $184.78 |
| salinas | $184.08 |
| santa maria-santa barbara | $184.01 |
| san luis obispo-paso robles | $181.40 |
| riverside-san bernardino-ontario | $179.83 |
| bakersfield | $179.79 |
| chico | $179.49 |
| el centro | $179.49 |
| fresno | $179.49 |
| hanford-corcoran | $179.49 |
| madera | $179.49 |
| merced | $179.49 |
| modesto | $179.49 |
| redding | $179.49 |
| stockton | $179.49 |
| visalia | $179.49 |
| yuba city | $179.49 |
| rest of california | $179.49 |
PE GPCI ranges from 1.096 to 1.442 in California. That index is why the same CPT is not one price statewide.
Psychiatric Evaluation and how California is priced
California is the most finely divided state in the Medicare fee schedule, with roughly thirty payment localities drawn around metropolitan statistical areas after CMS reformed the state's locality map. The San Francisco Bay Area carries some of the highest geographic adjustments in the nation, with San Francisco, San Jose, and the East Bay each priced separately, while Los Angeles, Orange County, San Diego, and Sacramento have their own localities at somewhat lower levels. Rural and inland counties fall into lower-cost localities, so the same procedure can carry meaningfully different Medicare-approved amounts within a single day's drive. No other state shows this much in-state variation on the fee schedule itself.
California's markets differ sharply: the Bay Area combines high wages with heavily consolidated hospital systems, Los Angeles offers enormous choice across a sprawling region, and the Central Valley and far north face genuine access shortages. Where you are treated within the state matters more here than almost anywhere else in the country. Academic medical centers in the Bay Area, Los Angeles, San Diego, and Sacramento handle much of the complex referral care.
This procedure: 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 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.
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?
Other featured procedures in California
Psychiatric Evaluation in other states
Psychiatric Evaluation in California: questions
The 2026 Medicare physician office rate for CPT 90791 averages $185.78 across 29 California localities, from $179.49 in CHICO to $206.78 in SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY). The hospital physician rate averages $143.10. Enter a ZIP for the exact locality.
Yes. CMS splits California into 29 payment localities. For this CPT the office physician fee spans $27.29 from the lowest to highest locality. A ZIP-level lookup matters more in California than in any other state; compare your area, whether that is the Bay Area, Los Angeles, San Diego, Sacramento, the Central Valley, or the rural north.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $37 for the office physician line or $29 for the hospital physician line in California. Medigap may cover that 20%. This is not the hospital facility fee.
No. $185.78 is only the physician's share. Adding Medicare's facility payment brings the total to about $319 in a hospital outpatient department. Anesthesia, pathology and other codes billed the same day are extra. California ranks #49 of 51 states on the physician line (7% above the national office rate of $173.35).