Summary & Overview
CPT 90792: Psychiatric Diagnostic Evaluation with Medical Services
CPT code 90792 is a critical billing code used for psychiatric diagnostic evaluations that include medical services. This code is widely recognized across the United States and is essential for clinicians who provide comprehensive mental health assessments, integrating both psychiatric and medical expertise. The procedure is most commonly performed in outpatient settings, such as offices, and is a foundational step in the diagnosis and management of mental health disorders.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare, cover this service, reflecting its importance in the delivery of mental health care. The publication provides an overview of payer coverage, clinical context, and related billing codes, offering readers insight into reimbursement benchmarks and policy updates relevant to psychiatric diagnostic procedures.
Readers will learn about the scope of CPT 90792, its role in the evaluation of conditions such as major depressive disorder, generalized anxiety disorder, bipolar disorder, adjustment disorders, and schizophrenia. The summary also highlights common modifiers, associated provider taxonomies, and related CPT codes, equipping stakeholders with a comprehensive understanding of the billing and clinical landscape for psychiatric diagnostic evaluations with medical services.
CPT Code Overview
CPT 90792 represents a psychiatric diagnostic evaluation with medical services. This procedure is typically performed in an outpatient setting, such as a physician's office, and involves a comprehensive assessment of a patient's mental health, including both psychiatric and medical components. The service is classified under Other Psychiatric Diagnostic Procedures, and is essential for establishing an accurate diagnosis and developing an appropriate treatment plan for individuals presenting with mental health concerns.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient psychiatric clinic with symptoms such as persistent sadness, anxiety, or mood instability. The provider, who may be a psychiatry physician, psychologist, or mental health counselor, conducts a comprehensive psychiatric diagnostic evaluation that includes both psychiatric assessment and medical services. This evaluation may involve reviewing the patient's medical history, performing a mental status examination, assessing for medical conditions that could impact psychiatric symptoms, and formulating a diagnosis and treatment plan. The procedure is typically performed in an office setting and may be used for patients with conditions such as major depressive disorder, generalized anxiety disorder, bipolar disorder, adjustment disorder, or schizophrenia.
Coding Specifications
- Modifier
+90785: Indicates interactive complexity, such as communication with third parties or involvement of legal guardians. Used in addition to the primary procedure code when the evaluation requires additional time or resources due to complexity.
| Provider Taxonomy Code | Specialty Name |
|---|---|
2084P0800X | Psychiatry Physician |
103T00000X | Psychologist |
101YM0800X | Mental Health Counselor |
- Psychiatry Physician: Medical doctors specializing in psychiatric care.
- Psychologist: Providers specializing in psychological assessment and therapy.
- Mental Health Counselor: Licensed professionals providing mental health counseling.
Related Diagnoses
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F32.9- Major depressive disorder, single episode, unspecified- Relevant for patients presenting with depressive symptoms requiring psychiatric evaluation.
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F41.1- Generalized anxiety disorder- Used when patients exhibit persistent anxiety and worry, necessitating diagnostic assessment.
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F31.9- Bipolar disorder, unspecified- Applied for patients with mood instability or suspected bipolar disorder during evaluation.
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F43.23- Adjustment disorder with mixed anxiety and depressed mood- For patients experiencing stress-related symptoms with both anxiety and depression.
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F20.9- Schizophrenia, unspecified- Used for patients with psychotic symptoms or suspected schizophrenia, requiring comprehensive psychiatric and medical evaluation.
Related CPT Codes
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90791- Psychiatric diagnostic evaluation (without medical services)- Used for psychiatric diagnostic evaluations that do not include medical services. Often an alternative to
90792when no medical component is required.
- Used for psychiatric diagnostic evaluations that do not include medical services. Often an alternative to
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90832- Psychotherapy services (Psychotherapy, 30 minutes with patient)- Used for brief psychotherapy sessions following the diagnostic evaluation. May be used in conjunction with
90792for ongoing treatment.
- Used for brief psychotherapy sessions following the diagnostic evaluation. May be used in conjunction with
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90834- Psychotherapy services (Psychotherapy, 45 minutes with patient)- Used for standard-length psychotherapy sessions. Commonly follows the initial evaluation for continued care.
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90837- Psychotherapy services (Psychotherapy, 60 minutes with patient)- Used for extended psychotherapy sessions. May be used for patients requiring more intensive therapy after the diagnostic evaluation.
These codes are often used together in a clinical workflow, with 90792 for the initial evaluation and the psychotherapy codes for subsequent treatment. 90791 is an alternative when medical services are not provided.
National Reimbursement Benchmarks
For CPT code 90792, the national mean rate for Medicare is $207.60, while the BUCA (average commercial) mean rate is $213.11. Commercial payers such as Cigna and UnitedHealth Group show higher mean rates, with Cigna at $254.11 and UnitedHealth Group at $234.01, compared to Medicare.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies significantly across payers. Medicare exhibits the tightest range at $12.00, indicating relatively consistent rates nationally. In contrast, Cigna has the widest dispersion at $140.00, reflecting substantial variability in commercial reimbursement. Other commercial payers like UnitedHealth Group and BUCA also show broader ranges, at $128.00 and $88.14 respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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