Summary & Overview
CPT 90885: Psychiatric Record Review to Inform Diagnosis and Treatment
CPT code 90885 denotes a clinician-performed review of a patient’s medical records specifically to support a psychiatric evaluation, diagnosis, and treatment planning. Nationally, this code captures a discrete, non-face-to-face clinical activity that helps clinicians synthesize prior documentation before or during psychiatric assessment, and it affects billing, coding compliance, and documentation practices across behavioral health settings. Key payers commonly involved in coverage and reimbursement considerations include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. This publication explains what CPT code 90885 represents, where and how it is typically used, and why it matters for psychiatry and behavioral health operations. Readers will find concise benchmarks for utilization and coverage concepts, summaries of relevant policy themes affecting record-review services, and clinical context that clarifies when this code may be applicable. The content is aimed at coding professionals, practice managers, and behavioral health clinicians seeking a clear, national-level reference on the service definition, typical sites of service, and payer landscape. Data not available in the input is clearly identified where applicable.
Billing Code Overview
CPT code 90885 describes a record review performed by a clinician to evaluate existing medical records related to a psychiatric evaluation, supporting diagnosis and development of a treatment plan. This service typically involves review of prior psychiatric notes, laboratory results, consult reports, and other clinical documentation to inform the current psychiatric assessment.
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Service type: Clinical record review for psychiatric evaluation
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Typical site of service: Outpatient behavioral health settings, psychiatric clinics, hospital outpatient departments, and telehealth/remote chart review contexts
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Clinical & Coding Specifications
Clinical Context
A 34-year-old adult referred to outpatient psychiatry after an emergency department visit for acute anxiety and suicidal ideation. The psychiatrist did not perform a face-to-face evaluation but is asked to review hospital records, prior outpatient notes, laboratory results, and crisis-treatment summaries to assist with diagnostic formulation and the outpatient treatment plan. The clinician accesses the electronic medical record, reviews prior psychiatric evaluations, medication trials, psychotherapy notes, substance-use history, and risk assessments. After record review, the psychiatrist documents findings, diagnostic impressions, medication recommendations, and a plan for follow-up or need for urgent in-person evaluation. Billing for this service uses 90885 when the provider’s review of existing records directly contributes to establishing diagnosis and treatment recommendations without a new psychiatric face-to-face encounter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when only the psychiatrist’s professional work is billed and the facility bills technical components separately. |
52 |