What your 90791 actually pays: Medicare's 2026 rate, by payer
Every new patient starts with an intake. Medicare's rate for the psychiatric diagnostic evaluation rose only 3.9% for 2026, the smallest increase in this code family, while commercial payers show the widest spread of any code we have checked.
Sources: [1] CMS, PFS Relative Value Files, RVU25A (released 2025-01-10) and RVU26A (released 2025-12-29) <<a href="https://www.cms.gov/medicare/payment/fee-schedules/physician/pfs-relative-value-files">cms.gov</a>> [2] PayerPrice, CPT 90791 Fee Schedule by Payer (national payer-file aggregation, verified August 2026) <<a href="https://payerprice.com/rates/90791-CPT-fee-schedule">payerprice.com</a>> A contract still priced at the 2025 rate pays this gap short on every claim with a 2026 date of service, and nothing flags the shortfall unless someone checks the remit against the current rate.
The code, and why it is the front door
CPT code 90791 is the psychiatric diagnostic evaluation without medical services: a comprehensive intake covering history, mental status exam, and an initial treatment plan. It is not restricted to prescribers. A therapist, psychologist, licensed clinical social worker (LCSW), or psychiatric mental health nurse practitioner (PMHNP) can all bill it for a new patient's first visit. It typically runs 60 minutes and sets the diagnosis and plan that every later visit builds on.
What Medicare pays in 2026
Medicare pays $173.35 nationally for 90791 in 2026, up from $166.91 in 2025, a 3.9% increase, the smallest percentage gain of any code in this series. The number underneath that move is the Medicare conversion factor, a single dollar multiplier that CMS applies to every code on the physician fee schedule. It fell for five straight years, from a peak of $36.09 in 2020 to $32.35 in 2025, before this year's rule reversed course: $33.40 for 2026, a 3.26% increase. Behavioral health services were explicitly exempted from a separate 2.5% efficiency cut CMS applied elsewhere in the same rule, which kept 90791 from losing ground even in a year when its own increase ran below the conversion factor alone would predict for some comparable codes.
The 2025 rate itself was a correction. In 2024, 90791 briefly reached $195.46 nationally before falling 14.6% to $166.91 in 2025 as CMS adjusted the code's valuation. 2026's increase to $173.35 recovers part of that, but the code has not returned to its 2024 level.
What commercial payers pay
PayerPrice shows the widest commercial spread of any code in this family: from $160.15 (UnitedHealthcare) to $205.36 (Cigna) nationally, a difference of $45.21 per intake, as of August 2026. BCBS/Anthem pays $184.47, above the Medicare rate; UnitedHealthcare and Aetna both pay below it. A practice with a UnitedHealthcare-heavy commercial panel is collecting meaningfully less per intake than one with a Cigna-heavy panel, even before accounting for individual contract terms.
The so-what
- Check which code your intakes actually bill as. If your prescribers are billing every new-patient intake as 90791 rather than 90792 (the version with medical services, which pays more and is available whenever a prescriber's intake includes the medical elements it usually does), confirm that is a deliberate choice, not an EHR default nobody revisited.
- Weight your commercial panel with the spread in mind. A $45 gap per intake between your best and worst commercial payer compounds fast across every new patient a growing practice brings in.
JotPsych flags when a documented intake supports 90792 instead of 90791, so a prescriber's first visit with a new patient gets billed at the level the visit actually was.
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