WPS covers a repeat 90791 after a six-month break in treatment
Medicare contractor Wisconsin Physicians Service (WPS) also covers a repeat after an inpatient psychiatric admission or a significant change in mental status.
Co-founder, JotPsych
When a Medicare client comes back after months away, 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.
When WPS covers a repeat 90791
Covered once, at the onset of the illness.
Covered again for the provider who billed the first evaluation, after an extended break in treatment: about 6 months since the last visit for the psychiatric condition.
Covered again for that provider after an inpatient psychiatric admission or a significant change in mental status that needs more assessment.
WPS article A57480, revision effective January 1, 2026, sets the 6 months. After a shorter break, the first session back takes a psychotherapy code, unless another case WPS lists applies.
Does WPS handle Medicare where you practice? WPS is the Medicare Administrative Contractor for Iowa, Kansas, Missouri, Nebraska, Indiana, and Michigan, per WPS's psychiatry billing article, A57480.
Other cases that allow a repeat
WPS also covers a repeat for a client with a previously established neurological disorder or dementia in two cases.
- Sudden or marked change in mental status.
- Second opinion or clearer diagnosis, when necessary to rule out additional psychiatric or neurological conditions, which may be treatable.
Last seen for depression: 4 months ago
No inpatient psychiatric admission, 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. An inpatient psychiatric admission 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.
- Check for about six months since that visit, or another case WPS lists. Ask your client about any inpatient psychiatric admission since that visit.
- Bill 90791 with the reason in your note, or a psychotherapy code with the minutes. Found a case? Give the months since your client's last visit, or the case that applies. Found none? Match the psychotherapy code to your session's minutes, and write the minutes in your note.
- 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.
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.