How to set your 90791 charge for 2026
Four payers' national 90791 averages, which include every clinician type, run $160.15 to $205.36. Medicare never pays above your charge.
Head of Growth and Operations, JotPsych
Blue Cross/Anthem and Cigna average more than Medicare's national psychologist rate for a 90791 intake, and UnitedHealthcare and Aetna average less. Set your charge at or above the highest rate you're paid.
Medicare's figure is its 2026 national rate for physicians and psychologists, from the 2026 fee schedule files; the commercial figures are PayerPrice national averages, August 2026, one per payer with no split by clinician type. Compare your contracted 90791 rate from each payer with that payer's bar.
- List every payer's 90791 rate. For the same intake, Cigna's national average runs $45.21 above UnitedHealthcare's. Use your contracted rate for each commercial payer, not its national average, and add Medicare's 2026 rate for each type of clinician who does your intakes.
- Find Medicare's rates for your area. Look up your area's 90791 rate in Medicare's Physician Fee Schedule look-up tool. Physicians and psychologists get the full fee schedule amount. Nurse practitioners get 85% of that amount. Therapists, meaning clinical social workers, mental health counselors, and marriage and family therapists, get 75% of the psychologist rate.
- Set your charge at or above the highest rate. By law, Medicare pays 80% of the lesser of your charge and its rate. Your patient owes the rest. When your charge is under the psychologist rate, you're paid your charge for a psychologist's intake. Look for the same "lesser of" rule in each commercial contract.
- Check your charge each year. Medicare's national 90791 rates rose 3.9% for 2026, for every clinician type. The 2026 payment rule raised the conversion factor, the dollar amount that turns each code's value into a rate, by 3.26% to $33.40. Medicare released its 2026 rate files on December 29, 2025.
Medicare's rate is the full fee schedule amount for physicians and psychologists, 85% of it for nurse practitioners, and 75% of it for therapists, per CMS booklet MLN1986542 (March 2026) and the 2026 fee schedule files. Set your 90791 charge at or above Medicare's psychologist rate for your area, not the national rate.
Pull your current 90791 charge from your billing settings, and set it beside the highest rate on your list. Is your charge below that rate? Raise it before your next intake claim. Check each commercial rate again when its contract renews.
Enter each payer's 90791 rate in your fee schedule, and JotPsych flags a 90791 billed below that payer's rate.
Book 15 minutes- Centers for Medicare & Medicaid Services (CMS), Physician Fee Schedule Relative Value Files, RVU25A (released 2025-01-10) and RVU26A (released 2025-12-29): national non-facility rates.
- CMS, Search the Physician Fee Schedule, the Physician Fee Schedule look-up tool: payment amounts by code, Medicare administrative contractor, locality, and year, read October 3, 2026.
- PayerPrice, CPT 90791 Fee Schedule by Payer: national payer-file averages, verified August 2026.
- CMS, Medicare Learning Network, Medicare & Mental Health Coverage, booklet MLN1986542, March 2026, pages 13 to 24: physicians and psychologists paid 100% of the fee schedule amount, nurse practitioners 85%, and clinical social workers, marriage and family therapists, and mental health counselors 75% of the psychologist amount.
- 42 U.S.C. 1395l(a)(1), clauses (F), (L), (N), (O), and (FF): Medicare's payment is 80 percent of the lesser of the actual charge and the amount set for each clinician type, read October 2, 2026.
- CMS, Calendar Year 2026 Medicare Physician Fee Schedule Final Rule (CMS-1832-F), fact sheet.