Summary & Overview
CPT 90791: Psychiatric Diagnostic Evaluation
CPT code 90791 represents the initial psychiatric evaluation, a critical service in mental health care that enables providers to diagnose and develop treatment plans for patients presenting with psychiatric symptoms. This code is widely recognized and reimbursed by major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The psychiatric evaluation is typically conducted in an office setting and is essential for establishing a clinical baseline for conditions such as major depressive disorder, generalized anxiety disorder, bipolar disorder, and schizophrenia.
This publication provides a comprehensive overview of 90791, including payer coverage, clinical context, and related billing codes. Readers will gain insight into national benchmarks, policy updates, and the role of psychiatric evaluations in the broader landscape of mental health services. The analysis also highlights common modifiers and associated provider taxonomies, offering clarity on documentation and billing practices. By understanding the scope and significance of 90791, stakeholders can better navigate the complexities of psychiatric service reimbursement and clinical workflow.
CPT Code Overview
CPT code 90791 is used for a comprehensive psychiatric evaluation performed by a provider to assess and diagnose mental health conditions. This service is classified under psychiatry/psychological evaluation and typically takes place in an office setting (Place of Service 11). The evaluation involves gathering a detailed history, conducting a mental status examination, and formulating a diagnostic impression to guide further treatment planning. This code is foundational in mental health care, serving as the initial step in identifying and addressing psychiatric disorders.
Clinical & Coding Specifications
Clinical Context
A patient presents to a psychiatric provider's office (Place of Service 11) for an initial evaluation due to symptoms such as persistent sadness, anxiety, or behavioral changes. The provider, who may be a psychiatrist, psychologist, or mental health counselor, conducts a comprehensive psychiatric assessment to determine the patient's mental health status and establish a diagnosis. This evaluation may include a review of medical, psychiatric, and social history, mental status examination, and discussion of presenting concerns. The goal is to identify conditions such as major depressive disorder, generalized anxiety disorder, adjustment disorder, bipolar disorder, or schizophrenia, and to formulate a treatment plan.
Coding Specifications
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Modifiers:
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Modifier
25: Used when a significant, separately identifiable evaluation and management service is performed by the same provider on the same day as another procedure or service. -
Modifier
59: Indicates a distinct procedural service, used when procedures or services are not normally reported together but are appropriate under the circumstances.
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Provider Taxonomies:
Taxonomy Code Specialty Name