CPT® Code 90792 is used to report an initial psychiatric diagnostic evaluation that includes medical services. This code is typically billed by psychiatrists or other qualified healthcare professionals who can provide both mental health assessment and medical evaluation (such as medication review, physical health considerations, or ordering labs).
Definition
Psychiatric diagnostic evaluation with medical services. This service includes:
- A mental status exam
- A review of medical and psychiatric history
- Diagnostic formulation
- Development of a treatment plan
- Medical assessment (such as ordering labs or initiating medications)
Time Duration
While CPT 90792 is not time-based, sessions typically range from 60 to 90 minutes, depending on the patient's complexity. Providers should ensure thorough documentation of the evaluation and any medical services rendered.
Who Can Bill 90792?
This code is appropriate for:
- Psychiatrists
- Nurse practitioners
- Physician assistants
- Other qualified mental health professionals with medical credentials
It is not appropriate for non-medical therapists (e.g., psychologists or social workers who do not prescribe or assess medical issues)—they would use CPT 90791 instead.
Billing Considerations
- Do not bill CPT 90792 in conjunction with E/M codes on the same day.
- Document the inclusion of medical decision-making (e.g., prescribing meds, evaluating physical health) to justify use of CPT 90792 over CPT 90791.
- Only one psychiatric diagnostic evaluation (CPT 90791 or CPT 90792) is generally reimbursed per provider, per patient, unless medical necessity supports another.
Using CPT 90792 in OptiMantra
OptiMantra, an integrated EHR and practice management system used by many holistic and mental health clinics, supports documentation and billing for CPT 90792. Providers can:
- Use built-in psychiatric intake templates
- Document medical decision-making and assessments
- Seamlessly generate superbills or CMS-1500 claims with correct CPT codes
- Track appointments and ensure compliance with insurance billing requirements
Providers using OptiMantra should ensure the appropriate charting fields for medical services (e.g., vital signs, medications, lab orders) are filled to justify CPT 90792 during audits or claims reviews.
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