How to use CPT code 90792
Because 90792 can only be billed by psychiatrists and nurse practitioners, it’s a less commonly used code for intake assessments, but has many of the same expectations.
Code 90791 is officially deemed a “diagnostic evaluation,” but you might know it better as an initial assessment. It typically happens in your first session with a client.
Code 90791 represents your initial assessment of your client. It’s the session where you gather information about the clients symptoms in order to establish a diagnosis and formulate their treatment plan.
This is is how the American Medical Association defines 90791 in the official CPT codebook:
Psychiatric diagnostic evaluation (without medical services)
Psychiatric diagnostic evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations.
The evaluation may include communication with family or other sources and review and ordering of diagnostic studies.
This code is most frequently used by:
Your documentation for this code should include all the standard elements of an intake note, including:
Complete documentation for 90791 should include both the intake note and your full assessment, whether you choose to conduct a general bio-psycho-social assessment, or a diagnostic-specific assessment like PHQ-9 for depression, GAD 7 for anxiety, or the Alcohol Use Disorders Identification Test (AUDIT-C) for substance abuse.
“The actual assessment can be structured or non structured, whatever the style of the therapist is,” says Innocent Turner, LCSW, Headway’s Clinical Quality and Strategy Manager. “But if you only submit the intake note, that causes a lot of denials, because the note will refer to an assessment that isn’t there.”
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
The code 90791 is not associated with any specific time component. But an intake session is usually 45 minutes, by most clinical standards, due to the complexity of conducting a full assessment.
Reimbursement rates for sessions billed with 90791 will vary depending on the plan, your contract, your location, and your license type.
Most payers will only reimburse 90791 once per year, per client.
Code 90791 cannot be reported on the same day as an evaluation and management service for the same patient, or on the same day as psychotherapy services (including for crisis).
Code 90791 is used to represent an intake assessment for care that does not include medical services.
In contrast, code 90792 is used for an intake assessment for care that does include medical services, such as ordering diagnostic work or prescribing medications. For this reason, 90792 can only be billed by a qualified licensed provider like a psychiatrist or nurse practitioner.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Because 90792 can only be billed by psychiatrists and nurse practitioners, it’s a less commonly used code for intake assessments, but has many of the same expectations.
The 90837 CPT code is often understood to be the standard of a therapy session among providers. However, insurers have a tendency to flag 90837 more frequently than other codes.
The “45 minute” session is a core element of mental health care, so it’s vital that every provider knows how to apply the 90834 code to their work.