Understanding your mental health is the first step toward receiving effective, personalized care. The CPT code 90791 psychiatric diagnostic evaluation is an important process to help clinicians evaluate your mental health needs, provide a diagnosis, and design a customized treatment plan.
At RPMCCM Health, our experienced providers guarantee every psychiatric diagnostic evaluation is thorough, patient-focused, and tailored to your unique needs.
What Is CPT Code 90791?
CPT code 90791 is a psychiatric diagnostic evaluation formulated to evaluate a patient’s overall mental health. It is performed by qualified professionals (psychiatrists, psychologists, and licensed clinical social workers) and consists of a thorough review and assessment of mental health history and symptoms to determine risk factors for informed care.
This process is typically performed for new patients, during initial visits, or when a significant change is made in treatment. CPT code 90791 psychiatric diagnostic evaluation, assists clinicians in producing recommendations that a patient may benefit from for therapy, medications, or other interventions.
This procedure helps guarantee that every patient receives an individualized, effective model of care and treatment planning for mental health.
Key Features of CPT 90791
Purpose of the Evaluation
The main goal of CPT 90791 psychiatric diagnostic evaluation, is to initiate a comprehensive evaluation of a patient’s mental health. This procedure includes:
- Formulating an accurate diagnosis
- Developing a personalized treatment plan
- Performing a risk assessment to ensure patient safety
What Patients Can Expect During the Session
During the evaluation, you can expect a structured discussion with the clinician about your mental health history, current symptoms, and psychosocial assessment factors. The clinician may use questionnaires and a mental status exam to explore the entire picture. This is a collaborative and patient-centered session where you get to feel supported and informed.
Difference Between Medical Management and Psychotherapy Focus
CPT 90791 addresses general diagnostic assessment and treatment planning only. Not psychotherapy sessions, which offer ongoing treatment, 90791 does not include medical management services, also known as medication management, in which the provider may prescribe medication. The distinction supports both patient understanding and insurance billing.
Billing Guidelines for 90791
Understanding 90791 billing guidelines is critical for guaranteeing proper insurance coverage and effective session planning. Key points include:
- Insurance and Medicare Coverage — Most major insurance plans, including Medicare, will reimburse psychiatric intake CPT 90791, specifically for first-time evaluations for patients. Please check with your plan, as coverage differs by plan.
- Timings and Length of Session — This is generally billed for the first evaluation of a client. The length of the session may vary due to the complexity of the patient’s mental health issues and the thoroughness of the evaluation, as stated in the CPT guidelines.
- Who Can Bill — CPT 90791 can only be billed by licensed professionals, such as psychiatrists, psychologists, or licensed clinical social workers.
Following these 90791 billing guidelines helps ensure accurate billing, reduces claim denials, and supports proper insurance reimbursement.
Documentation Requirements for CPT 90791
Proper documentation is a must to achieve regulatory, clinical, and billing compliance. CPT 90791 documentation requirements include a written summary of the patient’s detailed history, examination findings that encompass a thorough mental status examination, a diagnosis resulting from the evaluation, and a treatment plan to guide next steps.
A recommended process includes maintaining sufficient records, documenting services promptly, and making sure all pertinent information is reported.
Furthermore, proper CPT 90791 documentation requirements prevent claim denials and contribute to continuity of care and communication between health care providers, and allow for the provision of safe, efficient, and appropriately coordinated mental health care for patients.
90791 vs 90792: What’s the Difference?
Prior to breaking down the difference between 90791 vs 90792, it is important to know that both codes relate to psychiatric evaluations; however, it’s equally necessary to understand their distinctions for accurate billing and patient care. Key Differences Include:
| Code | Narration |
| 90791 | Psychiatric diagnostic evaluation without medical management. Focuses solely on assessment, diagnosis, and treatment planning. |
| 90792 | Psychiatric diagnostic evaluation, including medical evaluation and management. Includes prescribing or adjusting medications alongside diagnostic assessment. |
In short, 90791 can purely be used for diagnostic assessments, whereas 90792 can be used when medication management is involved. Understanding the difference between 90791 vs 90792 can help providers deliver appropriate care, confirm insurance compliance, and prevent billing errors.
Frequently Asked Questions (FAQ)
How long does a 90791 evaluation take?
Generally, a CPT 90791 session lasts between 45-75 minutes, depending on the complexity of the patient’s mental health needs.
Can 90791 be billed more than once?
It is usually billed for new patient evaluations or significant changes in treatment. Repeat billing requires clinical justification.
What’s included in a psychiatric diagnostic evaluation?
The evaluation includes a detailed mental health history, mental status examination, risk assessment, diagnosis, and treatment recommendations.
Do patients need a referral for 90791?
Referral requirements vary by insurance provider. Check with your insurer or RPMCCM Health to confirm.
Why Choose RPMCCM Health for Psychiatric Evaluations?
RPMCCM Health is committed to providing high-quality, patient-centered psychiatric evaluations. Each evaluation is tailored to the specific needs of each person to grasp the understanding of mental health concerns fully.
Our team of licensed providers, who specialize in behavioral health and diagnostics, will provide you with consultation and supervision. Moreover, we focus on individualized care and follow-up, whilst making sure that every treatment plan is manageable, actionable, and designed to help the patient achieve some level of improvement in their mental health.
Ready to Take the First Step?
Make your first move in understanding and improving your mental health today. Contact RPMCCM Health to book your CPT code 90791 psychiatric diagnostic evaluation. Our experienced and considerate team is here to walk you through the process with individualized care while offering support along the way in your mental health journey.
