What Is CPT 90792?
CPT 90792 represents a psychiatric diagnostic evaluation with medical services.
CMS distinguishes 90792 from 90791, which represents a psychiatric diagnostic evaluation without medical services.
90791 vs 90792
The distinction is not simply the provider's job title.
The code should reflect the service actually performed and the applicable coding requirements.
90791
Psychiatric diagnostic evaluation without medical services.
90792
Psychiatric diagnostic evaluation with medical services.
Who Can Bill 90792?
Provider eligibility depends on applicable Medicare, Medicaid, commercial payer and state requirements.
Do not assume that every behavioral-health provider can bill 90792 simply because they provide psychiatric services.
Provider enrollment and scope-of-practice requirements should be verified.
Documentation
The medical record should support the psychiatric diagnostic evaluation and medical services provided.
Depending on payer requirements, documentation may address:
- History
- Examination/assessment
- Diagnosis
- Medical decision-making
- Treatment plan
- Medication-related services where applicable
- Medical necessity
Common 90792 Billing Problems
Wrong Evaluation Code
A provider may select 90792 when the service doesn't meet the applicable requirements.
Provider Enrollment
Claims can be affected by provider enrollment or credentialing issues.
Authorization
Some plans may impose authorization or utilization-management requirements.
Duplicate Evaluations
Repeated diagnostic evaluations may receive additional scrutiny depending on the circumstances.
Billing 90792 Correctly
The billing team should verify:
- Provider
- Payer
- Patient eligibility
- Date of service
- CPT
- Diagnosis
- POS
- Authorization
- Documentation
- Filing requirements
[Talk to a Mental Health Billing Specialist]