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 |