A CPT code 90792 psychiatric diagnostic evaluation is an in-depth assessment that combines a detailed psychiatric evaluation with medical services. It allows the clinician to understand the patient’s mental health and arrive at a diagnosis and treatment plan, which includes medication management.
Unlike CPT 90791, which covers a psychiatric evaluation without medical services, 90792 includes the medical assessment needed for a more complete approach to care. At RPMCCM Health, our experienced providers guarantee that each CPT code 90792 psychiatric diagnostic evaluation is thorough, patient-focused, and tailored to your needs.
What Is CPT Code 90792?
CPT Code 90792 refers to a comprehensive mental health evaluation that includes medical services. It enables clinicians to identify psychiatric disorders, assess the need for treatment, and determine the most suitable medication options, while emphasizing a holistic approach to patient care, as well as clear diagnosis and medication treatment planning.
Who can perform it:
- Psychiatrists
- Licensed medical providers with prescribing authority
When it is used:
- Initial diagnostic assessments for new patients
- Evaluations requiring medication management
- Complex psychiatric cases needing integrated medical input
CPT 90792, a psychiatric diagnostic evaluation, serves as the foundation for individualized care, enabling providers to create treatment plans that incorporate aspects of both psychiatric and medical care. The use of mental and medical evaluations provides a comprehensive and organized approach to meeting patients’ mental health needs.
Key Components of a 90792 Evaluation
A comprehensive CPT code 90792 psychiatric diagnostic evaluation generally includes the following practices:
Patient History and Presenting Concerns
- Review of current symptoms and mental health history
- Social, family, and occupational background
- Identification of any risk factors affecting mental health
Mental Status Examination
- Observation of behavior, mood, thought processes, and cognitive function
- Assessment of psychiatric symptoms and overall mental state
Medical Evaluation and Medication Considerations
- Physical health review relevant to psychiatric treatment
- Medication history and assessment for potential pharmacologic interventions
- Identification of medical conditions impacting psychiatric care
Treatment Recommendations and Care Planning
- Personalized treatment plan including therapy, medication, or both
- Coordination with other healthcare providers as needed
- Guidance for follow-up and ongoing care
90792 Billing Requirements
Understanding the 90792 billing requirements is as crucial for providers as it is for the patients. With proper billing, you can achieve compliance with insurance rules, accurate reimbursement, and reduced risk of claim denials. Not to mention, knowing who can bill, session length, and coverage details can help both parties navigate the process with confidence and efficiency. Key billing requirements include:
- Insurance coverage — Often covered by private insurance and Medicare when 90792 billing requirements are necessary.
- Eligible providers — Psychiatrists or other qualified medical providers.
- Session length — Typically 60–90 minutes; billing must reflect actual time spent.
- Billing restrictions — Usually, only one CPT 90792 psychiatric diagnostic evaluation can be billed per patient per day.
Understanding these guidelines helps ensure that the procedure stays smooth, with fewer administrative errors and proper documentation. For official guidance, consult CMS.gov for up-to-date rules.
Documentation Rules for CPT 90792
It is essential to ensure that the documentation for CPT 90792 is accurate to support compliance, facilitate claim payment, and accurately document the service, thereby preventing claim denials.
Complete documentation provides the medical necessity for the evaluation and promotes transparency between the provider and patient. Additionally, the insurer should address continuity of care and future treatment planning.
Required documentation includes:
- Detailed patient history and presenting concerns
- Clinical findings from mental status and medical exams
- Clear treatment plan with recommendations
- Compliance with local and federal regulations
The best practice is to document thoroughly, concisely, and accurately. Properly following 90792 documentation rules can help protect against claim denials, while also improving the quality of patient care, guaranteeing compliance, and providing an accurate record for future clinical decisions.
90791 vs 90792: Understanding the Difference
When comparing 90791 vs. 90792 CPT codes, one key consideration is that both offer psychiatric diagnostic evaluations. The differentiation aspect, being 90792, includes medical services such as medication evaluation.
Knowing the distinction can help providers make accurate bills and make sure patients receive the right level of care as needed.
| Feature | CPT 90791 | CPT 90792 |
| Psychiatric evaluation | Yes | Yes |
| Medical services included | No | Yes |
| Medication assessment | No | Yes |
| Typical use | Initial evaluation | Initial evaluation requiring medical input |
In short, if a medical evaluation or medicated assessment is included in a psychiatric evaluation, 90792 would be the correct code. If the evaluation is psychiatric only, with no medical service involved, 90791 would be used. Both of these codes assure proper billing and care direction documentation.
Frequently Asked Questions (FAQ)
Can 90792 be billed more than once?
Usually, 90792 is billed only once per patient per day, except in rare, documented circumstances.
How long is a 90792 evaluation?
Typically 60–90 minutes, depending on complexity and patient needs.
Which providers can bill 90792?
Psychiatrists and qualified medical providers with prescribing authority.
Is 90792 covered by insurance or Medicare?
Often, yes, when deemed medically necessary. Coverage varies, so check your plan.
Why Choose RPMCCM Health for Psychiatric Evaluations?
At RPMCCM Health, we combine medical and behavioral health expertise to provide a comprehensive CPT code 90792 psychiatric diagnostic evaluation.
With our approach, we aim to make sure that each patient receives thorough, personalized care. Combining expert assessment with attention to individual needs for accurate diagnosis, effective treatment planning, and improved mental health outcomes. Our approach includes:
- Experienced psychiatrists and licensed providers
- Personalized, patient-focused assessments
- Integrated treatment planning for optimal outcomes
By focusing on both medical and psychiatric care, we deliver evaluations that are thorough, compassionate, and reliable. We ensure that our patients can feel confident in knowing their treatment plans are well-informed, coordinated, and designed to support lasting mental health and overall well-being.
Schedule Your CPT 90792 Evaluation
Looking for a comprehensive psychiatric evaluation that includes medical services? Schedule your CPT 90792 psychiatric diagnostic evaluation today with RPMCCM Health. Our experienced providers offer thorough, patient-focused assessments to guide accurate diagnosis and personalized treatment planning. Take the first step toward effective mental health care and begin your journey to improved well-being.
