CPT 90791
Global XXX ActivePsych diagnostic evaluation
CPT 90791 Billing & Documentation Guide
CPT code 90791 (Psych diagnostic evaluation) is classified under Psychiatry with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.84, a non-facility practice expense RVU of 1.33, and a malpractice RVU of 0.02, a total non-facility RVU of 5.19 and facility RVU of 4.11. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $177.82, though rates vary from $166.76 to $240.07 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90791, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 90791 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 90791 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 90791
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.84 | 3.84 |
| Practice Expense RVU | 1.33 | 0.25 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 5.19 | 4.11 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90791
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $185.78 | $143.1 | $179.49 - $206.78 | 29 |
| Florida | $174.13 | $137.94 | $171.73 - $176.19 | 3 |
| Georgia | $171.63 | $137.22 | $168.68 - $174.58 | 2 |
| Illinois | $172.91 | $138.06 | $169.86 - $175.96 | 4 |
| Michigan | $170.91 | $137.04 | $169.57 - $172.25 | 2 |
| North Carolina | $170.13 | $136.48 | $170.13 - $170.13 | 1 |
| New York | $184.81 | $144.56 | $170.93 - $190.53 | 5 |
| Ohio | $169.49 | $136.56 | $169.49 - $169.49 | 1 |
| Pennsylvania | $173.64 | $138.31 | $169.67 - $177.61 | 2 |
| Texas | $173.32 | $137.81 | $169.31 - $176.11 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 90791
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90791 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0360T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0361T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0362T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0362T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0363T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0364T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0365T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0366T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0367T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 90791
What does CPT code 90791 mean? +
CPT code 90791 represents: Psych diagnostic evaluation. It's in the Psychiatry category with a global period of XXX.
What is the Medicare reimbursement for CPT 90791? +
The 2026 Medicare national average non-facility payment for CPT 90791 is $177.82. Rates range from $166.76 to $240.07 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90791? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 90791? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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