Psychiatric Evaluation Cost in Missouri
Psych diagnostic evaluation
Missouri Medicare physician rate (2026)
-2.1% vs nationalAverage of 3 localities. Office range $167.20–$171.22.
Your ZIP in Missouri
Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
What this number is
The figures on this page are 2026 Medicare physician allowed amounts for a specific CPT code: the professional fee, adjusted by geographic practice-cost indices. They are not a hospital chargemaster price, not your insurer's contracted rate, and not a quote. Hospital facility fees, anesthesia, implants, imaging reads, and pathology are billed separately when they apply. In Missouri the office and hospital physician lines for this CPT differ by $33.10.
National vs Missouri
Where Missouri ranks for this CPT
CPT 90791 by Missouri locality
| Locality | Office |
|---|---|
| metropolitan st. louis | $171.22 |
| metropolitan kansas city | $170.63 |
| rest of missouri | $167.20 |
PE GPCI ranges from 0.862 to 0.952 in Missouri. That index is why the same CPT is not one price statewide.
Psychiatric Evaluation and how Missouri is priced
Missouri is a three-locality state: metropolitan St. Louis and metropolitan Kansas City are each priced separately, and everywhere else falls into a rest-of-state locality with lower geographic adjustments. Both metro localities approve higher amounts than outstate Missouri, and the Kansas City locality applies only to the Missouri side of that metro, since the Kansas side prices under Kansas's statewide locality. Springfield, Columbia, and the rural counties all share rest-of-state factors. The metro-versus-outstate gap is the main pricing story here.
St. Louis and Kansas City hold the state's academic medical centers and most of its specialty depth, drawing patients from far beyond Missouri's borders, including southern Illinois and eastern Kansas. Outstate Missouri is served by regional hubs in Springfield, Columbia, and Cape Girardeau, with the Ozarks and Bootheel among the harder places to reach specialty care. Rural hospital viability has been a persistent concern across the state.
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 Missouri
Psychiatric Evaluation in other states
Psychiatric Evaluation in Missouri: questions
How much does psychiatric evaluation cost in Missouri?
The 2026 Medicare physician office rate for CPT 90791 averages $169.68 across 3 Missouri localities, from $167.20 in REST OF MISSOURI to $171.22 in METROPOLITAN ST. LOUIS. The hospital physician rate averages $136.58. Enter a ZIP for the exact locality.
Does the rate change inside Missouri?
Yes. CMS splits Missouri into 3 payment localities. For this CPT the office physician fee spans $4.02 from the lowest to highest locality. Enter a ZIP code to see which Missouri locality covers you: metro St. Louis, metro Kansas City, or rest-of-state areas like Springfield, Columbia, Joplin, and the Bootheel.
What will a Medicare patient owe for the physician fee?
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $34 for the office physician line or $27 for the hospital physician line in Missouri. Medigap may cover that 20%. This is not the hospital facility fee.
Is this the full psychiatric evaluation bill in Missouri?
No. $169.68 is the Medicare physician allowed amount for CPT 90791. Anesthesia, facility fees, implants, and other CPT codes billed the same day are extra. Missouri ranks #14 of 51 states on this physician line (2% below the national office rate of $173.35).