| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $172.41 |
| Typical Billed Amount What providers commonly charge | $225 – $550 |
| Potential Markup How much more you might pay vs. Medicare rate | 219% above Medicare |
What CPT 90792 Means and When It's Used
CPT code 90792 represents a "psychiatric diagnostic evaluation with medical services." In simple terms, this means you're receiving a thorough mental health assessment from a medical professional who can prescribe medications - typically a psychiatrist, psychiatric nurse practitioner, or other qualified medical provider.
This code is most commonly used during your first appointment when the doctor needs to understand your mental health history, current symptoms, and determine if medication might be helpful. The evaluation usually lasts 60-90 minutes and includes discussing your symptoms, medical history, family history, and current medications.
The key difference with this code is that it's billed by medical doctors or nurse practitioners who have prescribing authority. If you see a therapist or counselor who cannot prescribe medications, they would use a different code (90791) instead.
What to Expect on Your Medical Bill
When you see CPT code 90792 on your bill, you can expect charges typically ranging from $225 to $550, depending on your location and the specific practice. Medicare reimburses providers $172.41 for this service, though you may pay more if you have a Medicare supplement plan or see a provider who doesn't accept Medicare assignment.
On your explanation of benefits or medical bill, you'll see this listed as "psychiatric diagnostic evaluation with medical services" or similar wording. Some bills might show it simply as "psych eval" or "psychiatric consultation." The date of service should match your appointment date.
If you have insurance, your out-of-pocket cost will depend on your specific plan benefits, deductible, and whether you've met your annual deductible. Many insurance plans cover mental health services, but you may still have a copay or need to pay a percentage after your deductible is met.
How to Verify Your Bill is Correct
To check if you were billed correctly for CPT 90792, first confirm that you actually received a psychiatric evaluation from a medical provider who can prescribe medications. If you saw a therapist, social worker, or counselor who cannot prescribe medications, the correct code should be 90791 instead.
Verify that the date of service matches your actual appointment date and that you only see this code billed once per evaluation session. If you see multiple 90792 codes for the same date, this could be an error unless you had separate evaluations with different providers.
If your bill seems incorrect or unusually high (significantly above the $225-$550 typical range), contact your provider's billing department first. Ask them to explain the charges and verify the correct code was used. If you're still concerned, contact your insurance company to discuss the claim. Keep records of all your communications and don't ignore bills while resolving billing questions.