CPT code 90792
90792 CPT code is used specifically for psychiatric evaluations. Created by the American Medical Association, Current Procedural Terminology (CPT) codes are a numerical identifier for medical procedures. They are used in over 60 countries and provide a consistent terminology for reporting medical services. Here is what you need to know aboutthe 90792 CPT code.
Summary
- The 90792 CPT code is used for psychiatric diagnostic evaluations with medical services, typically conducted by psychiatrists or psychiatric nurse practitioners. It requires a thorough assessment, including medical history, mental status examination, diagnosis, and treatment planning.
- Medical services requirements for 90792 CPT code can be broad, such as reviewing a patient’s medical history and assessing the need for medication. A physical exam or lab tests are not necessary for billing this code.
- Usage limitations include a maximum of three times per year per patient, usually for initial evaluations or significant clinical changes. It cannot be billed on the same day as certain other evaluation and management services. Enrolling in an insurance billing course for therapists can help providers enhance their knowledge.
- Telehealth compatibility allows providers to bill 90792 for virtual evaluations if conducted via a live, HIPAA-compliant video platform such as TheraPlatform, using the appropriate modifier (95) and place of service code (POS 10).
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What is the 90792 CPT Code?
The formal name for the 90792 CPT code is: “Psychiatric diagnosis evaluation with medical services” and is frequently called the Psychiatric Diagnostic Interview Examination (PDE). This code is typically billed as the initial session between a psychiatrist and a patient.
Who can code 90792?
Only licensed practitioners with a medical degree and specific psychiatric expertise can code the 90792 CPT code. Practically, this means that only two types of mental health professionals can use this code: psychiatrists and psychiatric nurse practitioners. Although similar to a therapy intake evaluation, a therapist without a medical degree cannot bill this code.
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When to code 90792
The following services should be provided to use the 90792 CPT code:
- A complete medical and psychiatric history, including assessment of family and social relationships.
- 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, including immediate next steps. One of the advantages of a thorough evaluation is that it allows for the formation of a comprehensive treatment plan after it is completed.
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What qualifies as medical services for CPT code 90792?
Technically, a 90792 CPT code requires some sort of medical service. But what is a medical service? Is it just being assessed by a medical professional? Do you have to do blood work, conduct a physical, or prescribe medication to use the 90792 CPT code?
In actual practice, providing “medical services” is quite broad. A review of medical history while assessing the need for medication is enough to use a 90792 code. You don’t need to conduct a physical, do blood work, or even prescribe medication, although all of those services may be performed for varying reasons.
Takeaway: As long as a medical professional is conducting the evaluation, you can argue that it is a medical service.
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How long is a psychiatric diagnostic evaluation?
In order to use the 90792 CPT code, the provider must spend 60-120 minutes with the patient. This reflects the number of services completed and the amount of information that needs to be compiled to provide appropriate care.
How often can you use the 90792 CPT code?
The 90792 CPT code has several rules regarding the frequency of its use:
- The 90792 CPT code is usually used once at the outset of treatment with a new provider. It can be used again if the client changes providers. It cannot be used more than three times a year.
Note: If the same provider attempts to use the 90792 CPT code more than once with the same client, they must be prepared for some scrutiny from an insurance company.
Reasons to provide another psychiatric diagnostic evaluation with the same patient may include a significant change in symptoms, situation, or diagnosis.
- Evaluations that are considered medically necessary can be extended for two days and be billed on consecutive days. For example, an evaluation for a child that requires the provider to meet with the child and their parents together and separately.
- The 90792 CPT code can only be reported once per day and not on the same day as an Evaluation and Management service performed by the same provider for the same client (i.e., CPT codes 99202-99205, 99212-99215).
Evaluation and management services are medical services that involve assessing and treating a patient's health, such as a hospital or office visit.
- It cannot be used on the same day the client receives a psychotherapy session from another provider.
Comparing 90791 and 90792
CPT codes 90791 and 90792 are often confused.
They both involve an initial evaluation with a mental health professional. What are the differences?
- Code 90791 is a psychiatric diagnostic evaluation without medical services. It can involve similar components as mentioned for 90792 but without any medical services. In practice, the two evaluations may be almost exactly the same.
- A licensed therapist without a medical degree uses 90791. This includes psychologists, clinical social workers, and licensed professional counselors.
- The CPT code 90792 is usually reimbursed at a higher rate than 90791. This reflects the additional medical services performed and the provider’s education (i.e., psychiatrists are paid more money than non-medical professionals). Reimbursement rates will vary depending on the insurer.
Add-on codes for CPT code 90792
Certain codes can be used in conjunction with 90792 to specify additional services provided during the course of the evaluation.
Common add-on codes for 90792 include:
- 90785: Use code 90785 with 90792 when the diagnostic evaluation includes interactive complexity services. Interactive complexity refers to communication challenges that were present during the evaluation.
Examples include a combative patient or family member, or a non-verbal client who requires specialized equipment to enable communication.
- 90833: Individual psychotherapy, 30 minutes
- 90836: Individual psychotherapy, 45 minutes
- 90863: Pharmacologic management. This usually involves the prescription of medication as a result of the evaluation.
Telehealth for CPT code 90792
It is fair to wonder if you can use the 90792 CPT code if you are performing a psychiatric diagnostic evaluation with medical services online. After all, some medical services (e.g., blood draws) can only be performed in person. The answer is yes.
Psychiatric diagnostic evaluations have been approved for use with telehealth. However, it is important to note that the scope of the evaluation is limited. For example, you will not be able to perform a physical or run tests when the patient isn’t in the same room.
When coding telehealth services, providers need to add the appropriate modifier and place of service code:
- For psychiatric diagnostic evaluations, the appropriate modifier is almost always 95. Modifier 95 is used for telehealth services rendered via real-time interactive audio and video telecommunications systems.
This means that you need to be able to see and hear the person on a live, HIPAA-compliant, telecommunication platform. Needless to say, don’t try to conduct a diagnostic evaluation through text.
- The appropriate place of service code is usually POS 10, which indicates the client is receiving services at their home.
How EHR and practice management software can save you time with insurance billing for therapists
EHRs with integrated billing software and clearing houses, such as TheraPlatform, offer therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
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Resources
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More resources
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References
The American Medical Association (2025). CPT International. https://cpt-international.ama-assn.org
Centers for Medicare and Medicaid Services (2014, June 3). Outpatient psychiatry and psychology services. https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31887_33/Outpatient_Psych_Fact_Sheet09.18.14.pdf
Codify by AAPC. CPT 95, under provider services and ambulatory service center modifiers. https://www.aapc.com/codes/cpt-modifiers/95?srsltid=AfmBOoosNq5Jle-n-ZXV2WGquqXBj4xu4HAI8Hg6DYoPrL93zu8zLF67
