90792 intake do's and don'ts for prescribers
Medicare's 2026 national rate for 90792 is $171.77 for nurse practitioners, $24.42 more than for 90791. The medical assessment in the intake note sets the code.
Head of Growth and Operations, JotPsych
Does your intake template bill every new patient as 90791, even after you do a medical assessment? Write the medical assessment in the note, and bill those intakes as 90792.
Write the medical assessment in the note
Record each physical exam element you check
Note any prescription or lab order
Treating a prescription as required for 90792
Letting the template pick the code
Billing 90792 with no medical assessment
Do's and don'ts based on First Coast's coverage policy L33252, which covers Medicare claims in Florida, Puerto Rico, and the U.S. Virgin Islands. Elsewhere, check your own Medicare contractor's coverage policy.
What separates the two codes
In First Coast's coverage policy L33252, both codes include a history, a psychiatric history, a complete mental status exam, and a tentative diagnosis. 90792 adds a medical assessment, with "other physical examination elements as indicated." 90791 doesn't.
What to write in a 90792 note
Write the medical assessment in the note.
Name what you assessed. The policy calls 90792 "an integrated biopsychosocial and medical assessment."
Record each physical exam element you check.
List each element you check, such as blood pressure or weight. Write what you found beside each one.
Note any prescription or lab order.
The 90792 evaluation "may include" a prescription and the "review and ordering of laboratory or other diagnostic studies." Write down each one you make.
What to avoid
Don't treat a prescription as required for 90792.
You don't have to prescribe. Without a prescription, an intake still bills as 90792 when the note shows the medical assessment.
Don't let the template pick the code.
Open your intake template. Check which code it sets by default. Then choose the code from what each note shows.
Don't bill 90792 without the medical assessment.
The policy's 90791 already includes "a complete medical history." That history alone doesn't make an intake a 90792.
| Payer | 90791 | 90792 | Difference |
|---|---|---|---|
| Medicare, nurse practitioners | $147.35 | $171.77 | $24.42 |
| Medicare, physicians | $173.35 | $202.08 | $28.73 |
| Blue Cross/Anthem | $184.47 | $210.44 | $25.97 |
| UnitedHealthcare | $160.15 | $173.44 | $13.29 |
| Aetna | $164.22 | $183.80 | $19.58 |
| Cigna | $205.36 | $230.32 | $24.96 |
Medicare's figures are its 2026 national rates, with nurse practitioners at 85% of the physician rate, per CMS booklet MLN1986542 (March 2026); the commercial figures are PayerPrice national averages, August 2026, one per payer with no split by clinician type. Each payer here pays more for 90792 than for 90791, so an intake billed as 90791 when the note supports 90792 is paid less at each one.
Look up your area's 90791 and 90792 rates in CMS's fee schedule search, since each area's rate differs from the national rate. For a nurse practitioner, the rate is 85% of the amount the search shows. Then compare each payer's contracted rate for both codes with PayerPrice's national 90792 and 90791 averages.
JotAudit in JotPsych checks each intake note before you sign and suggests the code the note supports.
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.
- First Coast Service Options, the Medicare contractor for Florida, Puerto Rico, and the U.S. Virgin Islands, Local Coverage Determination L33252: Psychiatric Diagnostic Evaluation and Psychotherapy Services, version 29, effective July 1, 2020, read October 2, 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.
- 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 90792 Fee Schedule by Payer: national payer-file averages, verified August 2026.
- PayerPrice, CPT 90791 Fee Schedule by Payer: national payer-file averages, verified August 2026.