How to use CPT code 90791
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.
Billing and coding
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.
CPT code 90792 description
Code 90792 represents an intake assessment performed by a provider who is qualified to administer medical services, like prescribing medication. It’s referred to as a “psychiatric diagnostic evaluation,” to distinguish it from a similar intake session performed by a counselor, therapist, or social worker.
This is is how the American Medical Association defines 90792 in the official CPT codebook:
Psychiatric diagnostic evaluation (with medical services)
Psychiatric diagnostic evaluation with medical services is an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations.
The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies.
Because this code includes a medical assessment, insurance payers limit the licenses able to bill 90792. In behavioral health, code can be used by:
- Psychiatrists (MD)
- Psychiatric Nurse Practitioners (NP)
- Clinical psychologists (PhD or PsyD)
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.
Billing made easy with Headway
Working with insurance can be confusing at times. Headway has developed easy and simple tools to help you stay compliant, handle claims quickly, and operate your practice with confidence.
With Headway handling your billing, you’ll get paid every two weeks and have renewed space to focus on helping your clients.
CPT code 90792 time frame
The code 90792 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.
CPT code 90791 reimbursement rates
Reimbursement rates for sessions billed with 90792 will vary depending on the plan, your contract, your location, and your license type.
How often can CPT code 90792 be billed for one client?
Most payers will only reimburse 90792 once per year, per client.
Code 90792 cannot be reported on the same day as an evaluation and management service for the same patient, so medical providers will need to choose which code best applies to the nature of the care.
Code 90792 cannot also be billed on the same day as psychotherapy services (including for crisis).
What’s the difference between 90792 and 90791?
Code 90792 is used for an intake assessment for care that includes medical services, such as ordering diagnostic work or prescribing medication. For this reason, 90792 can only be billed by a qualified medical clinician like a psychiatrist or nurse practitioner.
Psychiatrists and nurse practitioners may instead choose to bill medical services under evaluation and management codes (E/M), such as 99202–99205 and 99212–99215.
In contrast, code 90791 is used to represent an intake assessment for care that does not include medical services, and is typically the code billed for intake assessments conducted by licensed clinical social workers, professional counselors, or marriage and family therapists.
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.
Billing and coding
View all resourcesHow to use CPT code 90791
How to use CPT code 90837
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.
How to use CPT code 90834
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.
