How much does Medicare pay for CPT 90791?

Medicare allowed an average of $147.36 per service and paid $112.46 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $304.93, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90791?

Psychiatric diagnostic evaluation. It was billed 531,319 times to 505,986 Medicare beneficiaries by 11,400 providers in 2024.

Does 90791 pay differently in an office than a hospital?

Yes. The allowed amount averaged $149.55 in an office setting and $143.02 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 90791 most?

Psychologist, Clinical, with 328,467 services from 4,463 clinicians. Next are Licensed Clinical Social Worker, Licensed Professional Counselor, Psychiatry.

CPT 90791

Psychiatric diagnostic evaluation

$147.36Medicare-allowed amount per service, averaged across 531,319 services

Providers submitted

$304.93

Asking price, not received

Medicare allowed

$147.36

The fee schedule figure

Medicare paid

$112.46

Balance is patient coinsurance

Providers submitted an average of $304.93 for this code and Medicare allowed $147.36 — 2.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $112.46 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $149.55
Hospital / facility: $143.02

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 352,943 services were billed in an office setting and 178,376 in a facility.

Services: 531,319
Beneficiaries: 505,986
Providers billing it: 11,400
Total allowed: $78,295,168

What Medicare pays for CPT 90791

Across 531,319 services billed by 11,400 providers to 505,986 beneficiaries, Medicare allowed an average of $147.36 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 90791

Specialty	Services	Beneficiaries	Avg allowed	Providers
Psychologist, Clinical	328,467	312,449	$159.84	4,463
Licensed Clinical Social Worker	138,963	133,471	$123.73	4,871
Licensed Professional Counselor	30,079	29,373	$122.76	1,104
Psychiatry	16,072	14,195	$156.64	437
Nurse Practitioner	9,188	8,184	$135.68	277
Marriage and Family Therapist	5,643	5,556	$123.24	155
Physician Assistant	503	486	$132.13	18
Neurology	452	450	$170.55	9
Certified Clinical Nurse Specialist	387	382	$140.06	17
Neuropsychiatry	323	314	$148.92	3
Geriatric Psychiatry	230	229	$156.61	5
Emergency Medicine	173	102	$160.52	1
Unknown Supplier/Provider Specialty	163	162	$161.39	8
Internal Medicine	128	112	$170.09	8
Family Practice	126	111	$164.49	5

90791 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	65,130	$160.48	$120.58	881
Florida	52,465	$148.29	$113.57	980
Texas	47,096	$142.91	$114.21	644
New York	44,726	$157.39	$114.02	785
New Jersey	37,524	$150.36	$109.76	524
Pennsylvania	28,888	$147.42	$112.11	523
Illinois	20,448	$148.58	$111.39	588
Massachusetts	18,154	$145.08	$106.56	510
North Carolina	16,040	$134.64	$104.00	445
Maryland	15,512	$147.80	$109.49	338
Michigan	14,599	$148.49	$113.36	366
Ohio	12,422	$139.34	$108.26	404
Indiana	12,152	$137.76	$109.06	260
Arizona	12,068	$146.39	$116.20	204
Connecticut	10,425	$145.01	$106.93	240
Virginia	10,314	$143.35	$107.65	278
Georgia	10,002	$139.31	$106.81	240
Tennessee	9,035	$142.94	$114.80	154
Minnesota	6,716	$143.24	$106.92	301
Kentucky	5,721	$131.92	$103.38	125
South Carolina	5,565	$138.68	$108.74	163
Missouri	5,465	$139.45	$108.68	153
Colorado	5,164	$146.74	$111.32	200
Oklahoma	5,093	$139.84	$108.70	120
Arkansas	4,963	$131.85	$108.01	105
Washington	4,674	$149.87	$110.31	162
Oregon	4,476	$147.82	$108.27	172
Kansas	3,870	$143.62	$110.06	116
Wisconsin	3,778	$140.90	$110.43	151
Delaware	3,275	$157.29	$120.57	75
Louisiana	3,181	$138.46	$107.08	94
Iowa	3,063	$131.03	$100.97	123
Alabama	2,938	$135.01	$105.54	74
Nevada	2,930	$144.00	$110.58	75
Rhode Island	2,770	$137.74	$101.78	79
Utah	2,605	$140.98	$107.75	91
New Hampshire	2,015	$142.10	$105.21	70
New Mexico	1,741	$146.04	$107.51	70
Idaho	1,611	$131.43	$102.38	62
Mississippi	1,586	$135.05	$111.14	44
Maine	1,551	$117.91	$87.32	64
West Virginia	1,508	$141.94	$109.75	45
Nebraska	1,277	$137.39	$104.62	50
South Dakota	1,104	$137.92	$105.12	32
Vermont	989	$133.90	$99.22	39
North Dakota	889	$143.06	$105.87	33
District of Columbia	866	$138.68	$97.11	30
Wyoming	796	$136.63	$98.60	30
Montana	771	$130.04	$100.03	39
Alaska	498	$189.39	$108.14	21
Hawaii	438	$145.31	$107.89	17
Puerto Rico	323	$152.13	$117.16	6
ZZ	55	$142.29	$115.23	1
U.S. Virgin Islands	30	$168.66	$125.59	2
XX	13	$117.30	$82.63	1
AP	11	$130.24	$91.85	1

Related codes

90792Psychiatric diagnostic evaluation$163.13
90785Psychiatric services complicated by communication factor$12.70
90732Pneumococcal vaccine$128.28
90715Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older$37.48
90714Diphtheria and tetanus vaccine (7 years or older)$27.84
90739Hepatitis b vaccine (hepb)$155.49
90746Hepatitis b vaccine$67.61
90756Influenza vaccine$31.36

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.