Psychiatric Evaluation

Paying for a Psychiatric Evaluation: Insurance, Superbills and Good-Faith Estimates

By Dr. Stacey Forbes, DNP, APRN, PMHNP-BC · Updated October 12, 2026

The cost of a psychiatric evaluation depends less on the visit than on how you pay for it: through an insurance plan, directly with a superbill for out-of-network reimbursement, or with health savings dollars. Each route has its own vocabulary, and the forms rarely explain it. This guide translates the billing codes, shows which questions to ask your insurer, explains what the federal good-faith estimate rule gives self-pay patients, and sets out how Willow & Stone handles payment in Texas and the other states it serves.

The two billing codes: 90791 and 90792

Insurers do not pay for “a first appointment”; they pay for a coded service. A psychiatric evaluation uses one of two CPT codes, which CMS lists together under “psychiatric diagnostic evaluation” in its mental health coverage booklet:

The difference is the medical component. A 90792 visit can include things such as reviewing and making decisions about medication or ordering lab tests, alongside the full psychiatric interview. Neither code is tied to a fixed number of minutes, which is why a 90-minute evaluation and a shorter one can carry the same code.

Why this matters to you: when you call your insurer, asking “is CPT 90792 covered for an outpatient visit, and what do I owe?” gets a far more useful answer than “do you cover psychiatry?” If you will be paying directly and submitting a superbill, the same code appears on it.

Texas insurance versus direct pay in the other states

How you pay at Willow & Stone depends on where you are located during care.

• Texas patients: Willow & Stone accepts insurance for patients in Texas. Coverage depends on the specific plan, so confirm with the office before the first visit. Your share is then set by your plan’s copay, deductible and coinsurance for outpatient mental health care.
• New Mexico, Florida, Alaska, Arizona and Colorado: care is direct-pay. You pay the practice, and you can ask for a superbill to submit to your own insurer for possible out-of-network reimbursement.

No prices are listed here because fees are shared individually before you book; the pricing page explains the visit types and how the fee model works. If you are weighing the two routes in general, cash-pay versus insurance psychiatry sets out the trade-offs.

Questions to ask your insurer before you book

Whether you will use your plan directly in Texas or submit a superbill from another state, one phone call before the evaluation saves surprises later. Have your member card and the codes above in front of you, and ask:

1. Do I have outpatient mental health benefits, and are they in-network only or also out-of-network?
2. Is CPT 90792 (and 90791) covered, and is a referral or prior authorization required?
3. What is my deductible, and how much of it is already met this year?
4. For out-of-network care, what percentage do you reimburse, and of what amount? Plans often reimburse a share of their own “allowed amount”, not of the bill.
5. How do I submit a superbill, and is there a deadline after the date of service?
6. Are telehealth visits covered the same way as office visits?

Write down the date, the representative’s name and a reference number. If a claim is later processed differently, those notes are what you appeal with.

Superbills, briefly

A superbill is an itemized receipt built for an insurer. It carries what a claim needs: the clinician’s details and NPI number, the date of service, a diagnosis code, the CPT code and the amount paid. You submit it yourself, and the insurer reimburses you according to your out-of-network benefits, if you have them.

Two things are worth knowing before the first visit. A superbill includes a diagnosis code, because insurers require one to process any claim. And reimbursement is never guaranteed: it depends entirely on your plan. Our superbill guide covers the step-by-step process.

Using an HSA or FSA

Health savings accounts and flexible spending arrangements pay for qualified medical expenses. IRS Publication 969 ties HSA-qualified expenses to “medical care” as defined in the tax code, and IRS Publication 502, which lists what counts as medical care, states plainly that you can include amounts you pay for psychiatric care. The same publication includes amounts paid to a psychologist for medical care and laboratory fees that are part of medical care.

There are limits. Publication 502 says you generally cannot include the cost of nutritional supplements, vitamins or herbal supplements, with a narrow exception, so supplements recommended in a treatment plan may not qualify. And an expense paid from an HSA or FSA cannot also be claimed as an itemized deduction.

Your plan administrator has the final word on what your account will reimburse, and some ask for documentation such as an itemized receipt. A superbill or receipt from the visit usually serves that purpose.

Your right to a good-faith estimate

The No Surprises Act gave people who are not using insurance a right to know expected charges in advance. Under the federal rule (45 CFR 149.610), “uninsured or self-pay” includes people who have coverage but choose not to submit a claim, so it covers direct-pay patients with a superbill too.

For recurring care, such as a series of follow-ups, one estimate can cover up to 12 months, after which a new one is required. Each estimate covers a single provider or facility, so a lab you are referred to gives its own.

If the final bill from a provider is at least $400 more than that provider’s estimate, a separate rule (45 CFR 149.620) lets you start a patient-provider dispute process within 120 calendar days of receiving the bill. Keep the estimate: CMS notes that you cannot dispute a bill without it.

Labs and other costs outside the visit

If your evaluation leads to lab recommendations, the testing is performed and billed by the laboratory, not by the practice. Some tests are covered by insurance and some are not; specialty panels and pharmacogenomic tests vary the most. Ask the lab for its price or check your coverage before the sample is collected. For pharmacogenomic testing specifically, see whether GeneSight is covered by insurance.

Medication costs are separate as well and depend on your pharmacy benefit. If cost would stop you from filling a prescription, say so at the visit; there are often equally reasonable options at different prices.

For an overview of everything the evaluation includes before you start comparing costs, see the integrative psychiatric evaluation page.

Common Questions

Sources & Further Reading

• CMS — Medicare & Mental Health Coverage (MLN1986542, March 2026)
• IRS — Publication 502, Medical and Dental Expenses
• IRS — Publication 969, Health Savings Accounts and Other Tax-Favored Health Plans
• CMS — Your right to a good faith estimate
• eCFR — 45 CFR 149.610, Good faith estimates for uninsured (or self-pay) individuals
• eCFR — 45 CFR 149.620, Patient-provider dispute resolution

This article is general education, not a diagnosis or advice for your situation. Only a clinician who has evaluated you can diagnose a condition or recommend treatment.