How Much Does a Psychiatric Evaluation With Medical Services Cost in Pennsylvania?
Psych diag eval w/med srvcs
$202.54In-office total2026 Medicare, Pennsylvania averageUnder 2026 Medicare rates, a psychiatric evaluation with medical services in a doctor's office costs about $203 in Pennsylvania, from $197 in Rest of Pennsylvania to $208 in Metropolitan Philadelphia, with no separate facility fee. In a facility the national total is up to about $341 at a hospital outpatient department, because the facility is paid its own rate on top of the physician.
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- ✓The add-on codes that typically land on the bill
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- ✓Printable PDF download
Pennsylvania Medicare physician rate (2026)
+0.2% vs nationalAverage of 2 localities. Office range $197.05–$208.03.
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.
Your ZIP in Pennsylvania
Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
What psychiatric evaluation with medical services costs at hospitals near you
Everything above is a national average. The hospital you pick in Pennsylvania 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 15001.
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. In Pennsylvania the office and hospital physician lines for this CPT differ by $41.88.
National vs Pennsylvania
Where Pennsylvania ranks for this CPT
CPT 90792 by Pennsylvania locality
| Locality | Office |
|---|---|
| metropolitan philadelphia | $208.03 |
| rest of pennsylvania | $197.05 |
PE GPCI ranges from 0.918 to 1.041 in Pennsylvania. That index is why the same CPT is not one price statewide.
Psychiatric Evaluation With Medical Services and how Pennsylvania is priced
Pennsylvania's fee schedule separates metro Philadelphia from the rest of the state, giving the southeast its own higher-cost locality while Pittsburgh, Harrisburg, Allentown, Erie, and rural Pennsylvania share rest-of-state adjustments. That means the state's second-largest medical market, Pittsburgh, is priced with rural counties rather than with Philadelphia. The Philadelphia locality's premium reflects the metro's wage and rent levels, which lead the state by a wide margin. For patients, the key locality question in Pennsylvania is simply whether care happens in the Philadelphia area.
Philadelphia is one of America's historic centers of academic medicine, dense with teaching hospitals, while Pittsburgh is dominated by a pair of large integrated systems whose rivalry has defined that market for years. The rural middle of the state, sometimes called the T, has far fewer options, and hospital closures there have drawn statewide attention. Residents near the edges use New York, Baltimore, or Ohio providers when convenient.
This procedure: 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 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.
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?
Other featured procedures in Pennsylvania
Psychiatric Evaluation With Medical Services in other states
Psychiatric Evaluation With Medical Services in Pennsylvania: questions
Under 2026 Medicare rates, a psychiatric evaluation with medical services in a doctor's office costs about $203 in Pennsylvania, from $197 in Rest of Pennsylvania to $208 in Metropolitan Philadelphia, with no separate facility fee. In a facility the national total is up to about $341 at a hospital outpatient department, because the facility is paid its own rate on top of the physician. Enter a ZIP for the exact Pennsylvania locality.
Yes. CMS splits Pennsylvania into 2 payment localities. For this CPT the office physician fee spans $10.98 from the lowest to highest locality. Look up your ZIP to see whether metro Philadelphia or rest-of-state pricing applies, from Philadelphia and its collar counties to Pittsburgh, Harrisburg, Allentown, Scranton, Erie, and the rural center.
After the Part B deductible, coinsurance is usually 20% of the allowed amount: about $41 for the office physician line or $32 for the hospital physician line in Pennsylvania. Medigap may cover that 20%. This is not the hospital facility fee.
In a doctor's office, $202.54 is Medicare's whole payment in Pennsylvania: it covers the physician, the room and the supplies, with no separate facility fee. If it is done in a hospital outpatient department instead, the physician is paid about $160.66 and the hospital adds its own facility payment, bringing the national total to up to about $341. Services billed under other codes, such as lab work, are extra. Pennsylvania ranks #35 of 51 states on the office rate (within 2% of the national office rate of $202.08).