| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $153.75 |
| Typical Billed Amount What providers commonly charge | $200 – $500 |
| Potential Markup How much more you might pay vs. Medicare rate | 225% above Medicare |
What CPT Code 90791 Means
CPT code 90791 represents a psychiatric diagnostic evaluation - essentially your initial mental health assessment. This comprehensive appointment typically lasts 60-90 minutes and involves a thorough discussion of your mental health history, current symptoms, and life circumstances.
During this evaluation, your psychiatrist, psychologist, or other qualified mental health professional will ask detailed questions about your symptoms, family history, medications, and how your mental health affects your daily life. They may also conduct mental status examinations and risk assessments.
This code is different from regular therapy sessions because it's specifically for diagnostic purposes. Your provider uses this time to understand your condition and create an appropriate treatment plan, which might include therapy, medication, or other interventions.
How Billing Works for Psychiatric Evaluations
When you see CPT code 90791 on your medical bill, you're being charged for your psychiatric diagnostic evaluation. The Medicare reimbursement rate for this service is $153.75, but you'll typically see charges ranging from $200 to $500 depending on your provider and location.
If you have insurance, your plan will likely cover a portion of this cost after you meet any applicable deductible. Many insurance plans recognize the importance of mental health services and provide good coverage for diagnostic evaluations. However, you may still be responsible for a copay or coinsurance amount.
The final amount you owe depends on your insurance benefits, whether your provider is in-network, and if you've met your annual deductible. Always check with your insurance company beforehand to understand your expected out-of-pocket costs.
Verifying Your Psychiatric Evaluation Charges
To check if you were billed correctly for CPT code 90791, first confirm that you actually received a comprehensive psychiatric evaluation, not just a regular therapy session. This initial diagnostic appointment should have been longer and more detailed than typical follow-up visits.
Compare the charged amount to the typical range of $200-$500. If your bill seems unusually high, contact your provider's billing department to ask for an itemized explanation. Make sure you weren't accidentally charged for additional services you didn't receive.
If you believe there's an error, don't hesitate to question it. Common billing mistakes include being charged for the wrong type of appointment or being billed for services that should have been included in the evaluation. Keep detailed records of your appointments and any communications with billing staff to help resolve any discrepancies.