What your 90792 actually pays: Medicare's 2026 rate for the prescriber intake

Same new-patient visit, a different code, meaningfully more money, when a prescriber does the intake and the medical elements are actually there. Medicare pays 90792 nearly $29 more than 90791 in 2026, and some practices leave that gap on the table by habit.

The code, and the sibling it gets confused with

CPT code 90792 is the psychiatric diagnostic evaluation with medical services: the same comprehensive new-patient intake as 90791, plus the medical work only a prescriber can do, reviewing medical history relevant to psychiatric treatment, a relevant physical or mental status exam with medical elements, and an initial medication plan. Only a psychiatrist, psychiatric mental health nurse practitioner (PMHNP), or other prescriber can bill it. A therapist doing an intake bills 90791; a PMHNP doing the same category of visit, with medication decisions included, should usually bill 90792 instead.

The two codes are easy to conflate because they describe the same appointment slot on a schedule. The difference is entirely in what happened during the visit and what the note documents. An intake that reviews current medications, discusses a starting regimen, and reflects genuine medical decision-making supports 90792. An intake that is purely diagnostic and historical, with medication decisions deferred to a later visit, is 90791 even when a prescriber is the one doing it.

What Medicare pays in 2026

Medicare pays $202.08 nationally for 90792 in 2026, up from $187.93 in 2025, a 7.5% increase. That is $28.73 more than 2026's 90791 rate of $173.35, for describing the medical component a prescriber's intake usually includes anyway. 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 codes were explicitly exempted from a separate 2.5% efficiency cut applied elsewhere in the same rule.

What commercial payers pay

PayerPrice shows national average commercial rates for 90792 from $173.44 (UnitedHealthcare) to $230.32 (Cigna) as of August 2026. Every major payer in the PayerPrice data pays more for 90792 than for 90791, consistent with Medicare's own pricing logic: the medical component is worth more everywhere, not just under Medicare.

The so-what

A group practice where PMHNPs and psychiatrists do new-patient intakes but the EHR template defaults new-patient visits to 90791, because that was the code the practice's therapists always used, is quietly undercollecting on every single prescriber intake. The fix is not a new workflow. It is a one-time check of what the default actually is.

• Audit your prescriber intake code. Pull the last 20 new-patient visits billed by a prescriber and confirm they went out as 90792, not 90791, whenever the note documents medical decision-making.
• Fix the template, not just the claim. If the default is wrong, every future intake repeats the same loss until someone changes the default itself.