Official New York Medicaid FFS for CPT 90791 (Psychiatric diagnostic evaluation) is $177.67 (facility $60.38) from eMedNY Physician, effective 2026-07-01, verified 2026-09-10. CY 2026 Medicare non-facility PFS is $170.93 to $190.53 across 5 CMS localities. Source: CMS RVU26D, October 2026 release and the official New York fee schedule. Not an MCO or commercial rate. The published UnitedHealthcare (Optum Behavioral Health) median is $150.00; the middle 80% of published UHC rates run from $95.00 to $239.87 (file dated 2026-09-01, counted by provider practice state). See what UnitedHealthcare pays in New York.
Last updated
Last verified 2026-09-10. Medicare effective 2026-10-01. New York Medicaid FFS effective 2026-07-01 (eMedNY Physician).
| Locality | Medicare non-facility | Medicare facility | Medicaid FFS | Commercial | Source |
|---|---|---|---|---|---|
Manhattan | $189.15 | $147.23 | $177.67 | $150.00 | CMS MPFS |
NYC Suburbs/Long Island | $190.53 | $147.64 | $177.67 | $150.00 | CMS MPFS |
Poughkpsie/N NYC Suburbs | $183.48 | $143.98 | $177.67 | $150.00 | CMS MPFS |
Queens | $189.94 | $147.30 | $177.67 | $150.00 | CMS MPFS |
Rest Of New York | $170.93 | $136.66 | $177.67 | $150.00 | CMS MPFS |
Compare an offered CPT 90791 rate in New York 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 New York (median $150.00).
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Questions
What is the New York Medicaid FFS amount for CPT 90791?
Official New York Medicaid FFS is $177.67 (facility $60.38) from eMedNY Physician, effective 2026-07-01, last verified 2026-09-10.
What is the 2026 Medicare rate for CPT 90791 in New York?
For CPT 90791 (Psychiatric diagnostic evaluation) in New York, the CY 2026 Medicare non-facility Physician Fee Schedule amount is $170.93 to $190.53 across 5 CMS localities. Source: CMS RVU26D, October 2026 release, conversion factor 33.4009, effective 2026-10-01.
How does New York Medicaid FFS compare to Medicare for CPT 90791?
New York Medicaid FFS is $177.67; Medicare non-facility PFS is $170.93 to $190.53. These are different programs. The Medicaid cell is official fee-for-service only, not an MCO or commercial contracted rate. Source: https://www.emedny.org/ProviderManuals/Physician/.
What is the UnitedHealthcare commercial median for CPT 90791 in New York?
UnitedHealthcare Optum Health Behavioral Services (OHBS) professional median is $150.00 (10th percentile $95.00, 90th percentile $239.87; 339 rate rows; 14,669 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 New York CPT 90791 amount a Medicaid MCO or commercial contracted rate?
Medicaid FFS ($177.67) is fee-for-service, not MCO. The commercial column is UnitedHealthcare median ($150.00 median) when loaded; Aetna and Anthem stay Coming soon.