What Is CPT Code 90791?

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• What Is CPT Code 90791

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What Is CPT Code 90791
The CPT Code 90791 is used for psychiatric
diagnostic evaluations without medical services.
It was created in 2013, along with 90792, to
replace the former psychiatric diagnostic
evaluation codes 90801 and 90802. This code is
flexible in that it can be used by clinical
psychologists, licensed professional counselors,
licensed marriage and family therapists, and
licensed clinical social workers, in addition to
psychiatrists. CPT Code 90791 represents
integrated biopsychosocial assessment, including
history, mental status, and recommendations. Cod
e 90792 was created at the same time as code
90701, and these two codes are often the source
of confusion for many practitioners. The only
real difference between the two codes is that
code 90792 includes medical services such as
writing a prescription. For this reason, only
psychiatrists and other medical professionals can
use code 90792. This code has multiple benefits,
this code can be used to reimburses more than
other common mental health CPT service codes like
90834 (individual psychotherapy, 45 minutes) and
90837 (individual psychotherapy, 60 minutes). And
typically, no preauthorization is required
(although some plans do require preauthorization,
so be sure to check individual payer guidelines).
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What Is CPT Code 90791
Is 90791 covered by Medicare? Medicare will pay
for only one 90791 per year for institutionalized
patients unless medical necessity can be
established for others. when a patient is
referred with an organic diagnosis and a mental
health diagnosis is established, the mental
health diagnosis should be billed. Requirements
to Use Code 90791 CPT code 90791 covers such a
broad array of assessments, its quite flexible
and is a popular choice. However, there are some
rules that limit its use, and you can encounter
problems getting reimbursed if you dont know
these requirements. First, although some payers
allow providers to bill this code every six
month, most will only reimburse the code once per
year per client. This is why code 90791 is
typically used for initial assessments and yearly
progress evaluations. Part of the regulations
governing the use of code 90791 are related to
what the session must include. According to
Medicare, each session billed with code 90791
must include the following (or have the following
characteristics)
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What Is CPT Code 90791

• Elicitation of a complete medical and psychiatric
  history
• Mental status examination
• Evaluation of the patients ability and capacity
  to respond to treatment
• Initial plan of treatment
• Reported once per day
• Not reported say day as E/M service performed by
  the same provider
• Covered at the outset
• Most private payers follow the same requirements
  as Medicare. Each payer is unique, however, so
  its a good idea to check with each clients
  insurer to see what their requirements are before
  you plan to use this code.
• Required Documentation for Code 90791
• Medicare also has specific documentation rules
  associated with code 90791, and again, most
  payers share these requirements. Heres what your
  documentation should include.

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What Is CPT Code 90791

• Exact time record
• Modalities and frequency
• Clinical notes that summarize
• Diagnosis
• Symptoms
• Functional status
• Focused mental status examination
• Treatment plan, prognosis, and progress
• Name, signature, and credentials of the person
  providing the service
• A therapy practice needs several things in order
  to be healthy and sustainable. While billing
  isnt typically considered an exciting topic,
  its one of the most important elements of
  building a strong foundation for your practice.
  And knowing your CPT codes is an essential part
  of getting reimbursed accurately for the services
  you provide. Code 90791 is an important code that
  youll want to use when applicable due to its
  benefits.