How much does Medicare pay for CPT 90792?

Medicare allowed an average of $163.13 per service and paid $123.95 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $405.98, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 90792?

Psychiatric diagnostic evaluation with medical services. It was billed 473,012 times to 451,856 Medicare beneficiaries by 8,503 providers in 2024.

Does 90792 pay differently in an office than a hospital?

Yes. The allowed amount averaged $171.78 in an office setting and $155.31 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 90792 most?

Nurse Practitioner, with 243,305 services from 3,809 clinicians. Next are Psychiatry, Physician Assistant, Geriatric Psychiatry.

CPT 90792

Psychiatric diagnostic evaluation with medical services

$163.13Medicare-allowed amount per service, averaged across 473,012 services

Providers submitted

$405.98

Asking price, not received

Medicare allowed

$163.13

The fee schedule figure

Medicare paid

$123.95

Balance is patient coinsurance

Providers submitted an average of $405.98 for this code and Medicare allowed $163.13 — 2.5× 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 $123.95 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $171.78
Hospital / facility: $155.31

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. 224,822 services were billed in an office setting and 248,190 in a facility.

Services: 473,012
Beneficiaries: 451,856
Providers billing it: 8,503
Total allowed: $77,162,448

What Medicare pays for CPT 90792

Across 473,012 services billed by 8,503 providers to 451,856 beneficiaries, Medicare allowed an average of $163.13 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 90792

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	243,305	235,413	$151.58	3,809
Psychiatry	193,212	181,821	$178.50	4,141
Physician Assistant	24,455	23,409	$150.45	338
Geriatric Psychiatry	3,883	3,805	$183.90	58
Certified Clinical Nurse Specialist	2,332	2,270	$151.79	51
Neuropsychiatry	2,191	1,961	$183.08	14
Neurology	965	903	$182.09	12
Family Practice	916	742	$177.46	18
Internal Medicine	667	546	$182.52	21
General Practice	394	372	$176.31	11
Pain Management	90	88	$174.21	3
Hospitalist	87	76	$170.44	3
Addiction Medicine	82	77	$169.77	3
Licensed Clinical Social Worker	75	71	$137.57	4
Plastic and Reconstructive Surgery	68	19	$192.91	1

90792 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
New York	53,145	$182.53	$131.15	686
Florida	52,643	$156.90	$120.40	657
California	44,540	$167.38	$125.73	664
New Jersey	38,177	$163.19	$119.07	443
Texas	29,145	$161.47	$124.47	471
Illinois	22,230	$166.69	$125.53	429
Ohio	20,696	$151.43	$117.54	373
North Carolina	17,572	$153.22	$119.31	365
Tennessee	14,841	$147.59	$117.24	218
Virginia	14,829	$159.92	$120.81	235
Pennsylvania	14,443	$167.46	$126.56	345
Massachusetts	13,220	$167.36	$123.30	350
Michigan	12,414	$166.31	$127.25	228
Maryland	10,557	$163.96	$119.41	256
Georgia	10,266	$158.21	$122.45	192
Louisiana	7,503	$155.38	$120.63	130
Kentucky	6,707	$153.67	$119.48	135
Missouri	6,404	$162.83	$124.77	144
Wisconsin	6,114	$159.24	$123.54	180
South Carolina	5,945	$155.53	$123.04	129
Arizona	5,548	$159.09	$121.54	164
Washington	5,123	$165.06	$122.35	136
Alabama	4,891	$152.72	$122.90	80
Arkansas	4,562	$151.50	$120.17	128
Indiana	4,432	$148.74	$117.31	103
Delaware	4,215	$162.13	$129.20	37
Connecticut	4,016	$175.02	$128.97	108
Iowa	3,760	$154.19	$119.71	104
Mississippi	3,710	$152.73	$118.10	77
Kansas	3,408	$159.54	$124.48	73
Nevada	3,344	$169.08	$129.78	73
Rhode Island	2,362	$167.13	$125.26	60
Nebraska	2,361	$160.74	$125.74	70
Colorado	2,164	$165.20	$125.27	77
Oklahoma	2,162	$164.50	$127.63	54
Minnesota	1,987	$162.98	$124.81	72
Maine	1,750	$150.37	$116.03	70
Oregon	1,604	$171.26	$126.11	57
New Mexico	1,416	$158.08	$119.94	44
District of Columbia	1,327	$182.75	$125.80	34
New Hampshire	1,138	$159.32	$122.08	35
Utah	1,056	$163.74	$125.23	43
Montana	1,015	$166.62	$123.99	30
Hawaii	896	$167.03	$124.81	21
West Virginia	698	$167.06	$124.03	26
North Dakota	562	$160.35	$125.68	22
Idaho	559	$157.53	$126.60	21
Vermont	403	$157.03	$120.31	15
South Dakota	397	$163.41	$121.90	9
Alaska	396	$232.77	$126.71	17
Wyoming	245	$168.89	$132.95	9
Puerto Rico	103	$163.40	$125.16	3
U.S. Virgin Islands	11	$162.05	$114.37	1

Related codes

90791Psychiatric diagnostic evaluation$147.36
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.