Billing and coding

How to use CPT code 90792

Because 90792 can only be billed by psychiatrists and nurse practitioners, it’s a less commonly used code for intake assessments, but has many of the same expectations.

CPT code 90792 description

Code 90792 represents an intake assessment performed by a provider who is qualified to administer medical services, like prescribing medication. It’s referred to as a “psychiatric diagnostic evaluation,” to distinguish it from a similar intake session performed by a counselor, therapist, or social worker.

This is how the American Medical Association defines 90792 in the official CPT codebook:

CPT code 90792: Psychiatric diagnostic evaluation (with medical services)

Psychiatric diagnostic evaluation with medical services is an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations. The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies.

Because this code includes a medical assessment, insurance payers limit the licenses able to bill 90792. In behavioral health, the code is most often used by providers with prescriptive authority, such as:

  • Psychiatrists (MD)
  • Psychiatric Nurse Practitioners (NP)

Your documentation for this code should include all the standard elements of an intake note, including:

  • Session details: Including patient name and date of birth on every page, start and stop times, date, and place of service
  • History of present illness
  • Review of systems
  • Biopsychosocial assessment
  • Mental status exam (at least 5 elements)
  • Risk assessment
  • Documentation of any laboratory testing or diagnostic studies, with results and interpretation.
  • Diagnosis and functional status
  • Initial recommended course of treatment, including prescribing of medications and plan for next session
  • Name, credentials and signature of the provider who completed the assessment within 72 hours of service.

It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.

CPT code 90792 time frame

The code 90792 is not associated with any specific time component, but clinicians often spend 45 minutes or more conducting a full assessment.

CPT code 90792 reimbursement rates

Reimbursement rates for sessions billed with 90792 will vary depending on the plan, your contract, your location, and your license type. Headway providers enjoy enhanced reimbursement rates, thanks to Headway’s partnerships with many of the nation’s top insurance plans.

How often can CPT code 90792 be billed for one client?

Most payers will reimburse 90792 once every 6 months per client.

Code 90792 cannot be reported on the same day as an evaluation and management service for the same patient, so medical providers will need to choose which code best applies to the nature of the care.

Code 90792 cannot also be billed on the same day as psychotherapy services ( including for crisis).

Use code 90785 in conjunction with 90792 when the diagnostic evaluation includes interactive complexity services.

What’s the difference between 90792 and 90791?

Code 90792 is used for an intake assessment for care that includes medical services, such as ordering diagnostic work or prescribing medication. For this reason, 90792 can only be billed by a qualified medical clinician like a psychiatrist or nurse practitioner.

Psychiatrists and nurse practitioners may instead choose to bill medical services under evaluation and management codes (E/M), such as 99202 through 99205 and 99212 through 99215.

In contrast, code 90791 is used to represent an intake assessment for care that does not include medical services, and is typically the code billed for intake assessments conducted by licensed clinical social workers, professional counselors, or marriage and family therapists.

The add-on code that can be used with CPT code 90792

Code 90792 may appear alongside one other CPT code. Code 90785 is used for sessions that involve interactive complexity. Here’s more information about how to use 90785 for interactive complexity.

Common mistakes when billing CPT code 90792

CPT code 90792 is often confused with code 90791. Code 90792 should only be used for evaluations that also include medical services, and as such may only be used by qualified providers such as psychiatrists and nurse practitioners.

Other common mistakes include failing to submit enough documentation to support the use of code 90792. Make sure to thoroughly document the session details, patient history, assessments and diagnostics that took place, and your diagnosis and treatment plan. Headway’s documentation templates ensure that none of these crucial details slip through the cracks.

Remember, too, that CPT code 90792 is typically reimbursed only once per year, per patient and should not be used repeatedly.

This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.