WPS covers a repeat 90791 after a six-month break in treatment
WPS, the Medicare contractor for six Midwest states, also covers a repeat after a psychiatric hospital stay or a significant change in mental status.
Co-founder, JotPsych
Your Medicare client comes back after months away, and you'll need a code for the first session: 90791, the psychiatric diagnostic evaluation, or a psychotherapy code. Count the months since your client's last visit for the psychiatric condition.
WPS article A57480, revision effective January 1, 2026, sets the number. After a shorter break, the first session back takes a psychotherapy code, unless your client had a psychiatric hospital stay or another case WPS lists.
When WPS covers a repeat 90791
WPS covers 90791 once, at the onset of your client's illness, and the same provider may repeat it after an extended break in treatment. How long is an extended break? About six months, per WPS's psychiatry billing article, A57480.
WPS is the Medicare Administrative Contractor for Iowa, Kansas, Missouri, Nebraska, Indiana, and Michigan. WPS's coverage rules cover one evaluation every six months in an episode of illness. Your note for a repeat in that episode needs the reason.
Other cases that allow a repeat
- Psychiatric hospital stay.
- Significant change in mental status that needs more assessment.
- Sudden or marked change in mental status, in a client with a known neurological disorder or dementia.
- Second opinion, or a clearer diagnosis to rule out other psychiatric or neurological conditions.
Last seen for depression: 4 months ago
No hospital stay, no change in mental status
Last seen for depression: 8 months ago
Returns for treatment
Client two's break passed six months, and client one's didn't. A psychiatric hospital stay in those four months would allow a 90791 for client one too.
What to do at the first session back
- Find the date of your client's last visit for the condition. Count from that visit. Don't count from your intake.
- Write the reason in your note. Give the months since your client's last visit, or the case that applies, such as a psychiatric hospital stay.
- Don't bill a psychotherapy code on the day you bill 90791. WPS's coverage rules bar 90791 beside a psychotherapy code on the same day.
- Pick the psychotherapy code when no case applies. Match the code to your session's minutes, and write the minutes in your note.
Other Medicare contractors and commercial plans set their own rules, so check theirs before you bill a repeat 90791 outside WPS's six states.
A JotPsych appointment type for repeat evaluations can start each visit from your evaluation template, with 90791 pre-filled.
Book 15 minutes- WPS Government Health Administrators, Billing and Coding: Psychiatry and Psychology Services, article A57480, revision effective January 1, 2026: Article Text, II, Psychiatric Diagnostic Interview Examination (90791, 90792). Read October 5, 2026.
- WPS Government Health Administrators, local coverage determination L34616, Psychiatry and Psychology Services, revision effective October 30, 2025: Psychiatric Diagnostic Evaluation (once a day, not with a psychotherapy code on the same day, and documentation when reported more than once per episode of illness). Read October 5, 2026.