CPT Code 90792: Billing Guide with Reimbursement Rates [2020]

CPT Code 90792 can be hard to understand.  How long does a medical assessment and diagnostic interview last?

What’s required to bill procedure code 90792? What are the reimbursement rates for 90792 and what are the license level requirements?

Our Definitive Guide to CPT Code 90792 will teach you how to understand when to bill 90792, what license you need, when to use procedure code 90791, and what criteria is required to perform a psychiatric diagnosis interview and evaluation.

If you’d prefer to offload this work to someone else, consider seeking guidance through our billing service we provide exclusively to behavioral health providers.  But if you’re brave, read on..

cpt code 90792 descriptionCPT Code 90792 Definition

CPT Code 90792 description:  Psychiatric Diagnosis Interview Examination (PDE) performed by a licensed mental health provider.

According to CMS.gov, CPT Code 90792 requires:

  • Elicitation of complete medical and psychiatric history (including past, family, social)
  • Mental status examination
  • Establishment of an initial diagnosis
  • Evaluation of the patient’s ability and capacity to respond to treatment
  • Initial plan of treatment
  • Reported once per day and not on the same day as an Evaluation and Management services performed by the same provider for the same client (99202-99205, 99212-99215)
  • Covered once at the outset of an illness

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Elsewhere, Noridian Medicare defines 90792 as a Psychiatric Diagnostic Evaluation (PDE) with medical services.

CPT 90792 adds a medical assessment or physical exam component to the evaluation of the client, limiting the licenses able to bill 90792.

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cpt code 90792 requirementsDiagnostic Interview Coding Criteria

The coding criteria for the diagnosis evaluation of a mental health concern or illness by a psychiatrist depends on meeting the procedural requires specific to code 90792.

By performing a medical history, examination, initial diagnosis, responsiveness to treatment, and treatment plan, you are meeting the procedural requirements to bill 90792 as a licensed medical clinician.  

If you are not performing a medical evaluation as you would when coding 90792 (because you are not licensed to do so), please use CPT Code 90791 for your claims.  This applies to all non-MD mental health providers.

If you are performing a neuropsychological examination, testing, or doing screening, please read our Definitive Guide to Mental Health CPT Codes and review codes in the 96XXX range in our guide.

Mind bloggled?  We can help.

CPT Code 90792 Time Length

The diagnostic evaluation is not coded by duration of time, so please note the requirements for your intake session depend on performing services, not a duration of visit.

Providers require at minimum 60 minutes up to 120 minutes of time to render an exhaustive diagnostic interview and examination of their mental health clients in order to code procedure code 90792.

cpt code 90792 reimbursement rate

CPT Code 90792 Reimbursement Rate

This procedure code does have a higher license level requirement than billing code 90791, as it includes a medical assessment component to treatment.

Medicare reimburses Psychiatrists at a higher rate as a result.

Medicare 2020 90792 Reimbursement Rate:  $160.96

(Source)

90792 License Level Requirements

Unlike CPT Code 90791, 90792 requires performing a medical assessment and therefore can only be performed by licensed medical professionals.

You must obtain an MD as a licensed physician or medical doctor to be able to bill for 90792.  Only psychiatrists and physicians are able to bill CPT code 90792.

CPT Code 90792 Add On Codes

Consider using the following Add-on CPT Codes when billing for your diagnostic interview and evaluation:

  • 90785 – Interactive Complexity
  • 90833 – 30 minute psychotherapy add-on. Example: Psychiatrist evaluates medication response, then has 30 minute session.
  • 90836 – 45 minute psychotherapy add-on. Example: Clinical Nurse Specialist evaluates medication response, then has 45 minute session.
  • 90863 – Pharmacologic Management after therapy.
  • 99050 – Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
  • 99051 – Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.

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Unsure which codes to use when?  Our billing service specializes in utilizing the most accurate add-on and modifiers with your routine codes to ensure your claims are safely maximized.

90792 Billing Modifiers

If your practice is approved to bill 90792 coordinated with other licensed mental health clinicians in a group, please consider using the following 90792 modifiers when coding for your clinicians:

  • AJ – Clinical Social Worker (LCSW)
  • AF – Psychiatrist (MD)
  • AH – Clinical Psychologist or Doctorate Level Degree (PsyD or PhD)
  • HP – Clinical Psychologist or Doctorate Level Degree (PsyD or PhD)

(Source)

How to Bill 90792

Billing for your intake session is easy enough: add it to line 24 on your CMS-1500 form.  You can review an image version of that here:

cpt code 90792 on cms 1500

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