Official Indiana Medicaid FFS for CPT 90791 (Psychiatric diagnostic evaluation) is $162.16 (facility $140.09) from IHCP Professional, effective 2026-01-01, verified 2026-09-10. CY 2026 Medicare non-facility PFS is $169.76. Source: CMS RVU26D, October 2026 release and the official Indiana fee schedule. Not an MCO or commercial rate. The published UnitedHealthcare (Optum Behavioral Health) median is $150.08; the middle 80% of published UHC rates run from $110.00 to $230.00 (file dated 2026-09-01, counted by provider practice state). See what UnitedHealthcare pays in Indiana.
Last updated
Last verified 2026-09-10. Medicare effective 2026-10-01. Indiana Medicaid FFS effective 2026-01-01 (IHCP Professional).
| Locality | Medicare non-facility | Medicare facility | Medicaid FFS | Commercial | Source |
|---|---|---|---|---|---|
Indiana | $169.76 | $136.32 | $162.16 | $150.08 | CMS MPFS |
Compare an offered CPT 90791 rate in Indiana on Contract Checker v1.3 (code and state prefilled). When UnitedHealthcare publishes rates for this code and state, the tool also compares your offer to the UHC median and the middle 80% of UHC rates, alongside Medicare and Medicaid FFS. UnitedHealthcare in Indiana (median $150.08).
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Questions
What is the Indiana Medicaid FFS amount for CPT 90791?
Official Indiana Medicaid FFS is $162.16 (facility $140.09) from IHCP Professional, effective 2026-01-01, last verified 2026-09-10.
What is the 2026 Medicare rate for CPT 90791 in Indiana?
For CPT 90791 (Psychiatric diagnostic evaluation) in Indiana, the CY 2026 Medicare non-facility Physician Fee Schedule amount is $169.76 across 1 CMS locality. Source: CMS RVU26D, October 2026 release, conversion factor 33.4009, effective 2026-10-01.
How does Indiana Medicaid FFS compare to Medicare for CPT 90791?
Indiana Medicaid FFS is $162.16; Medicare non-facility PFS is $169.76. These are different programs. The Medicaid cell is official fee-for-service only, not an MCO or commercial contracted rate. Source: https://www.in.gov/medicaid/providers/business-transactions/billing-and-remittance/ihcp-fee-schedules/.
What is the UnitedHealthcare commercial median for CPT 90791 in Indiana?
UnitedHealthcare Optum Health Behavioral Services (OHBS) professional median is $150.08 (10th percentile $110.00, 90th percentile $230.00; 101 rate rows; 3,844 NPIs). Source: 2026-09-01 UnitedHealthcare of Ohio, Inc. Optum-Health-Behavioral-Services in-network-rates.json.gz, source file dated 2026-09-01. Counted by provider practice state. Aetna and Anthem stay Coming soon. Not an MCO rate.
Is this Indiana CPT 90791 amount a Medicaid MCO or commercial contracted rate?
Medicaid FFS ($162.16) is fee-for-service, not MCO. The commercial column is UnitedHealthcare median ($150.08 median) when loaded; Aetna and Anthem stay Coming soon.