Accurate CPT code 90791 billing is important for mental health practices, including psychiatry, psychology, and social work. This guide provides a complete overview of 90791, including documentation requirements, reimbursement common errors, and best practices for medical billers.
Understand that this code ensures compliant claims, reduces denials, and improves revenue cycle management for behavioral health services.
CPT 90791 is a psychiatric diagnostic evaluation without medical management. This code is used for an initial assessment to evaluate a patient’s mental health.
Including psychiatric history, mental status examination, and treatment recommendations.
Official CPT definition: “Psychiatric diagnostic evaluation without medical services.”
Key takeaway: CPT 90791 is appropriate for initial evaluations where no medical management is provided. For sessions involving medication, CPT 90792 should be used instead.
Time Requirements:
Proper use ensures compliance and reduces claim denials due to incorrect service coding.
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Understanding the difference between CPT 90791 and psychotherapy or psychiatric evaluation codes is critical for medical billers.
Code | Description | Typical Duration | Used For |
90791 | Diagnostic evaluation (no meds) | 60 min | Initial psychiatric assessment |
90792 | Diagnostic evaluation (with meds) | 60 min | Psychiatric evaluation with medication |
90832 | Psychotherapy | 16–37 min | Short therapy session |
90834 | Psychotherapy | 38–52 min | Standard psychotherapy session |
90837 | Psychotherapy | 53+ min | Extended therapy session |
Misusing 90791 instead of 90792 is a common cause of claim denials.
Proper documentation ensures insurance compliance and successful reimbursement. Required elements for CPT 90791 include:
CPT 90791 is widely reimbursed but varies by payer:
Accurate coding and documentation are crucial for proper behavioral health billing.
Medical billers often face the following issues with 90791 CPT claims:
Pro tip: Always verify payer-specific requirements to avoid claim denials.
CPT 90791 is a key code for psychiatric diagnostic evaluations that do not involve medical management. Medical billers must understand documentation requirements and session duration. Payer rules and differences from related codes like 90792, 90832, 90834, and 90837 to prevent claim denials and ensure accurate reimbursement.
Outsourcing behavioral health billing to experts helps maintain compliance. Improve payment speed and allow providers to focus on quality patient care rather than coding errors.
Used for an initial psychiatric diagnostic evaluation without medical management.
Licensed mental health professionals, including psychologists, LCSWs, and counselors.
90792 includes medical management (e.g., prescribing medication). 90791 does not.
Normally session of this code 60 minutes.
Yes, when medically necessary and fully documented.
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