Licensed mental health professionals use the 90792 CPT code as a tool for conducting thorough psychiatric diagnostic examinations.
The code involves a structured interview process that includes a thorough review of the patient’s medical and psychiatric history, a detailed mental status examination, and the development of an initial treatment plan.
90792 CPT Code Explained
The 90792 CPT code refers to the Psychiatric Diagnostic Interview Examination (PDE), which is performed by a licensed mental health provider.
This evaluation involves gathering a full medical and psychiatric history, conducting a mental status examination, establishing an initial diagnosis, and evaluating the patient’s ability to respond to treatment.
Components of the evaluation include:
- Elicitation of a complete medical and psychiatric history
- A thorough mental status examination assessing cognitive abilities, mood, insight, judgment, and overall presentation
- Establishment of an initial diagnosis using the current Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria
- Evaluation of the patient’s capacity to respond to treatment
- Development of an initial treatment plan
90792 CPT code is reported once per day and cannot be used on the same day as an Evaluation and Management service (CPT codes 99202-99205, 99212-99215) performed by the same provider for the same client.
The 90792 code is typically covered once at the onset of an illness, ensuring a standardized framework for conducting comprehensive psychiatric assessments that lead to accurate diagnosis and effective care planning.
CPT 90792 assists mental health practitioners in customizing treatment plans to meet the unique mental health needs of each patient by including comprehensive interviewing and mental state evaluation.
CPT Code 90792 Add-On Codes
Consider incorporating the following add-on CPT codes into your 90792 billings:
- 90785 – Interactive Complexity. This code is used for cases involving complex communication, such as patients with significant psychiatric symptoms.
- 90833 – 30-Minute Psychotherapy Add-On. Use this code when, after evaluating medication response, a 30-minute psychotherapy session is conducted (e.g., by a psychiatrist).
- 90836 – 45-Minute Psychotherapy Add-On. For situations where, after evaluating medication response, a 45-minute psychotherapy session is completed (e.g., by a clinical nurse specialist).
- 90863 – Pharmacologic Management. Use for the management of medications following psychotherapy.
- 99050 – After-Hours Services. For services provided in the office during times outside of regular office hours or when the office is closed.
- 99051 – Evening, Weekend, or Holiday Services. This code applies to services provided during scheduled evening, weekend, or holiday hours.
Time Requirements of the 90792 CPT Code
90792 CPT code is not based on the duration of the session but rather on the completion of the required services. The focus is on the thoroughness of the diagnostic evaluation, including the psychiatric interview, mental status examination, and formulation of an initial diagnosis and treatment plan.
Typically, providers allocate between 60 to 120 minutes to conduct a comprehensive diagnostic interview and examination necessary to meet the criteria for billing 90792 CPT code.
The important thing is to make sure that all required components of the evaluation are fulfilled, regardless of the specific length of time.
What are the Coding Criteria for the 90792 CPT Code?
The coding criteria for a psychiatric diagnostic evaluation depend on adherence to the specific procedural requirements outlined for the 90792 CPT code.
To appropriately bill for CPT code 90792, licensed medical clinicians must conduct a comprehensive medical history, and a mental status examination, establish an initial diagnosis, assess the patient’s responsiveness to treatment, and develop a treatment plan.
If you are not conducting a medical evaluation, as required for 90792 (typically because you are not licensed to perform medical evaluations), you should use CPT code 90791, which applies to non-MD mental health providers.
Reimbursement Rate for 90792 CPT Code
The 90792 CPT code offers a higher reimbursement rate compared to 90791, primarily due to the inclusion of a medical assessment, which requires a higher level of licensure, often performed by psychiatrists.
Current Medicare reimbursement for 90792 is $190.57, however in 2023, Medicare reimbursed psychiatrists $196.55 for conducting a psychiatric diagnostic interview, which typically lasts between 20 to 90 minutes.
In previous years, the rates have fluctuated, with $218.90 in 2022, $201.68 in 2021, and $160.96 in 2020.
Simplify Your 90792 Billing Process with Medical Claims Billings
Maximize your revenue and minimize your stress by partnering with Medical Claims Billing. Our team has experience managing the specifics of CPT codes (such as 90792, 90791, 90832, etc.) so you can be sure that your psychiatric examinations will be accurately and promptly reimbursed.
Don’t let billing challenges hold you back from providing exceptional care. Let us handle the paperwork while you concentrate on making a positive impact on mental health!
