Psychiatric Evaluation Cost in West Virginia
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
West Virginia Medicare physician rate (2026)
-3.2% vs nationalSingle statewide locality.
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 West Virginia
Run a ZIP lookup for your part of West Virginia, whether Morgantown, Charleston, Huntington, Wheeling, the Eastern Panhandle near Martinsburg, or the southern coalfields.
What psychiatric evaluation costs at hospitals near you
Everything above is a national average. The hospital you pick in West Virginia 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 West Virginia the office and hospital physician lines for this CPT differ by $31.35.
National vs West Virginia
Where West Virginia ranks for this CPT
Psychiatric Evaluation and how West Virginia is priced
West Virginia is one statewide payment locality with geographic indices among the lowest in the eastern United States, so its published Medicare rates apply identically from the Eastern Panhandle to the southern coalfields. The uniform pricing spans a state whose mountainous terrain makes actual travel to care unusually difficult relative to straight-line distances. CMS's work index floor supports the state's low-cost profile. Morgantown, Charleston, and Huntington all bill against the same geographic factors.
The state's care concentrates around its academic medical centers in Morgantown and Huntington and the capital-region hospitals in Charleston, each serving long mountain catchments. West Virginia's population is among the oldest and highest-need in the country, and hospital finances have been fragile in many counties. Eastern Panhandle residents commonly use Maryland or Virginia providers, and northern residents look to Pittsburgh.
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 West Virginia
Psychiatric Evaluation in other states
Psychiatric Evaluation in West Virginia: questions
West Virginia is a single Medicare locality for this fee schedule. The 2026 physician rate for CPT 90791 is $167.82 in an office and $136.47 in a hospital, statewide. A ZIP lookup still confirms the locality mapping.
Not on the physician fee schedule. West Virginia uses one locality, so the Medicare physician rate is the same from one end of the state to the other. What still changes is site of service (office vs hospital) and any facility fee the hospital bills on its own claim.
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 West Virginia. Medigap may cover that 20%. This is not the hospital facility fee.
No. $167.82 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. West Virginia ranks #4 of 51 states on the physician line (3% below the national office rate of $173.35).