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Medicare Physician Fee Schedule · Q3 2026 release

CPT 90792 in Columbus, OH 15202-00

Psychiatric diagnostic evaluation with medical services in ZIPs including 43215, 44113, and 45202

90792 2026 C · Columbus, OH flag15202-00 A Active
Allowed amount
$197.12
in a doctor’s own office or clinic

97.5% of the $202.08 national baseline

Medicare payment
$157.70
Patient / secondary
$39.42
Expected total to provider
$197.12

Patient / secondary and expected total to provider assume the Part B annual deductible is already met. If it isn't, the patient owes more than the amount shown here.

Locality-adjusted Physician Fee Schedule pricing

How much does Medicare allow for CPT 90792 in Columbus, OH? Copy link

The Medicare allowed amount is $197.12 in the office (non-facility) setting and $158.09 in a facility, under the Q3 2026 Physician Fee Schedule. The office amount is 2.5% below the national baseline, and the facility amount is 0.8% below the national baseline. This is the fee schedule amount before sequestration and before any deductible or coinsurance is applied — not necessarily what a specific claim pays.

What Medicare locality is Columbus, OH in? Copy link

CMS prices all of Ohio as one Medicare payment locality, so this amount applies statewide, including Cleveland, Cincinnati, Toledo and Akron — not only in Columbus, OH.

Why Columbus, OH differs from the national amount Copy link

Columbus, OH (this locality)
$197.12
National PFS baseline (GPCI 1.000)
$202.08

The national figure is a baseline, not an amount any provider is paid. This locality's geographic practice cost indices scale each RVU component before the conversion factor is applied, which puts Columbus, OH at 2.5% below the national baseline.

Work GPCI
1.000
Practice expense GPCI
0.913
Malpractice GPCI
1.008
2026 conversion factor
$33.4009

Formula and inputs Copy link

The office (non-facility) amount for 90792 in Columbus, OH: each component's RVU times its GPCI, summed, then multiplied by the conversion factor.

RVU and GPCI components of the Columbus, OH allowed amount for 90792
Component RVU × GPCI = Adjusted RVU
Work 4.16 1.000 4.1600
Practice expense 1.72 0.913 1.5704
Malpractice 0.17 1.008 0.1714
Sum of adjusted RVUs 5.9017
× $33.4009 2026 conversion factor $197.12

Facility vs. Office (non-facility) Copy link

In a facility (hospital outpatient or ASC), Columbus, OH allows $158.09 for 90792, versus $197.12 in the office. Only the practice-expense RVU changes with the setting. In a facility, the hospital bills its own fee, so the professional payment is lower. Which setting applies to your place of service.

Participating, non-participating and limiting charge Copy link

All figures are for the office (non-facility) setting in Columbus, OH. The allowed amount is not the program payment — the rows below separate them. See how the limiting charge and sequestration are derived.

Participation and payment-split amounts for 90792 in Columbus, OH
Participating allowed amount The fee schedule amount a participating provider accepts as payment in full. $197.12
Non-participating allowed amount 95% of the participating amount. $187.26
Limiting charge Ceiling a non-participating provider may bill the patient on an unassigned claim — 115% of the non-participating amount. $215.35
Medicare program payment 80% of the allowed amount, once the annual Part B deductible is met. $157.70
Beneficiary coinsurance The remaining 20%. $39.42
Sequestration adjustment Reduces Medicare's share only — never the allowed amount, and never the patient's share. $3.15
Medicare pays after sequestration Program payment net of the sequestration reduction. $154.55

Contracted rate: % of Medicare in Columbus, OH Copy link

Commercial contracts are usually written as a percentage of the Medicare fee schedule. Which Medicare amount they mean is the part that gets misread: a contract benchmarked to the fee schedule prices off this locality's allowed amount — $197.12 in the office (non-facility) setting — not the $202.08 national baseline.

Opens the calculator already set to Columbus, OH and the office (non-facility) setting. It also compares what a payer actually paid against the expected amount. See how to find your contract's actual percentage.

ZIP codes this Columbus, OH rate covers Copy link

The CMS ZIP-to-locality crosswalk maps 1,489 ZIP codes to this payment locality. 90792 prices identically in every one of them.

43001 43002 43003 43004 43005 43006 43007 43008 43009 43010 43011 43013 43014 43015 43016 43017 43018 43019 43021 43022 43023 43025 43026 43027 43028 43029 43030 43031 43032 43033 43035 43036 43037 43040 43041 43044 43045 43046 43047 43048 43050 43054 43055 43056 43058 43060 43061 43062 43064 43065 43066 43067 43068 43069 43070 43071 43072 43073 43074 43076 43077 43078 43080 43081 43082 43083 43084 43085 43086 43093 43098 43099 43101 43102 43103 43105 43106 43107 43109 43110 43111 43112 43113 43115 43116 43117 43119 43123 43125 43126 43127 43128 43130 43135 43136 43137 43138 43140 43142 43143

1,389 more ZIP codes map to this locality. The Columbus, OH locality page lists the full set.

Resolves the ZIP to its payment locality, so you can confirm whether this amount applies.

90792 in nearby payment localities Copy link

Payment localities in the same region as Columbus, OH, nearest first. Each amount is that locality's own GPCI-adjusted office (non-facility) figure for 90792. Proximity doesn't imply similar pricing — neighbouring localities often differ.

90792 allowed amount in payment localities near Columbus, OH
Metro Allowed amount vs. Columbus, OH
Indianapolis, IN $194.96 -1.1%
Detroit, MI $203.96 +3.5%
Louisville, KY $195.22 -1.0%
Pittsburgh, PA $197.05 —
Chicago, IL $210.69 +6.9%
Buffalo, NY $197.52 +0.2%

Every payment locality nationwide is on the CPT 90792 rate map.

Other codes priced in Columbus, OH Copy link

Office (non-facility) allowed amounts in this same payment locality, Q3 2026.

Other curated codes and their allowed amounts in Columbus, OH
Code Service Columbus, OH vs. national
90834 Standard Therapy Session $111.49 -2.1%
90837 Extended Therapy Session $163.52 -2.1%
90791 Psychiatric Diagnostic Evaluation $169.49 -2.2%
90853 Behavioral health $29.73 -2.2%
99213 Routine Follow-Up Office Visit $90.97 -4.4%
99214 Long Follow-Up Office Visit $129.83 -4.3%
66984 Cataract Surgery $444.90 -3.8%
92014 Full Eye Exam, Returning Patient $120.44 -5.4%
99204 Long New Patient Office Visit $170.25 -4.0%
99212 Brief Follow-Up Office Visit $56.51 -4.9%
99215 Longest Follow-Up Office Visit $184.45 -4.1%
97110 Physical Therapy Exercises $27.87 -4.1%

Common questions Copy link

Which ZIP codes does the Columbus, OH rate for 90792 cover?
The CMS ZIP-to-locality crosswalk maps 1,489 ZIP codes to this payment locality, and every one of them prices 90792 identically. Examples include 43001, 43002, 43003, 43004, 43005, 43006.
Why is the 90792 rate in Columbus, OH different from the national amount?
The national figure is a GPCI 1.000 baseline, not an amount any provider is paid. This locality's geographic practice cost indices — work 1.000, practice expense 0.913, malpractice 1.008 — scale each RVU component before the conversion factor is applied, which is why Columbus, OH allows less than the $202.08 baseline.
Does this 90792 rate apply everywhere in Ohio?
Yes. CMS prices Ohio as a single Medicare payment locality, so the same GPCIs — and the same allowed amount — apply statewide, not only in Columbus, OH. That includes Cleveland, Cincinnati, Toledo and Akron. The city name here is a search-facing label for a statewide payment locality, not a city-specific rate.
What is the facility rate for 90792 in Columbus, OH?
$158.09 in a facility, versus $197.12 in the office (non-facility) setting — a $39.03 difference. Only the practice-expense RVU changes with the setting: in an office the practice carries the overhead, so the professional payment is higher; in a hospital or ASC the facility bills its own fee.
What is the non-participating amount and limiting charge for 90792 in Columbus, OH?
A non-participating provider is paid $187.26 — 95% of the $197.12 participating fee schedule amount. On an unassigned claim the limiting charge caps what the patient can be billed at $215.35, which is 115% of the non-participating amount.
How much of the Columbus, OH 90792 rate does Medicare actually pay?
Medicare pays 80% of the allowed amount ($157.70) once the annual Part B deductible is met, and the beneficiary owes 20% ($39.42). Sequestration reduces Medicare's share by about 2% ($3.15), leaving $154.55. Sequestration never changes the allowed amount itself, which is why it is shown separately here.

Source & method Copy link

Computed from the CMS Medicare Physician Fee Schedule Q3 2026 release : this code's RVUs from the relative value file, multiplied by payment locality 15202-00's GPCIs, then by the 2026 conversion factor of $33.4009. ZIP coverage from the CMS ZIP-to-locality crosswalk, Q3 2026 release . Releases are immutable: an amount retrieved for a past quarter always reflects that PFS release. Coverage and coding correctness are outside this calculation.

Physician relative value file (Q3 2026) · rvu26c-updated-06-30-2026.zip (PPRRVU2026_Jul_nonQPP.csv row 11,467)
Geographic practice cost indices (Q3 2026) · rvu26c-updated-06-30-2026.zip (GPCI2026.csv row 85)
ZIP code to carrier locality crosswalk (Q3 2026) · zip-code-carrier-locality-file-updated-05-13-2026.zip (ZIP5_JUL2026.txt)

Working a claim with an earlier date of service? The calculator prices 90792 in Columbus, OH against the release that governed that date. Past releases need a free account; today's rate does not.

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