If you or a loved one needs a mental health assessment, you might come across the 90791 CPT code. This CPT code is used to bill for psychiatric diagnostic evaluations, which are necessary to determine a patient’s mental health condition and recommend a treatment plan.
But what exactly does the 90791 CPT code entail? How does it work, and what are its requirements? In this article, we’ll take a deep dive into this code and provide you with all the information you need to understand it.
What is the Procedure Code 90791?
The CPT 90791 is a billing code used for psychiatric diagnostic evaluations. This code is used when a mental health professional, such as a psychiatrist or psychologist, conducts an initial evaluation of a patient’s mental health condition.
What Does the CPT Code 90791 Include?
The 90791 CPT code includes a comprehensive assessment of a patient’s mental health status. During this assessment, the mental health professional will conduct an interview with the patient, review the patient’s medical and psychiatric history, and evaluate the patient’s mental status.
Some of the specific components included in the procedure 90791 code are:
- A diagnostic interview: The mental health professional will ask the patient questions about their symptoms, medical history, and other factors that may affect their mental health. This interview will help the mental health professional make a diagnosis and develop a treatment plan.
- A mental status exam: The mental health professional will evaluate the patient’s mental status, including their appearance, behavior, mood, and thought processes. This exam can help the mental health professional identify any potential mental health issues.
- A review of the patient’s medical and psychiatric history: The mental health professional will review the patient’s medical and psychiatric history, including any medications they are taking or have taken in the past.
- A discussion of treatment options: Based on the results of the assessment, the mental health professional will discuss potential treatment options with the patient.
Who Can Perform the 90791 CPT Code?
The cpt code 90791 can only be performed by licensed mental health professionals, such as psychiatrists, psychologists, and clinical social workers. These professionals have the training and expertise necessary to conduct a comprehensive psychiatric diagnostic evaluation and develop a treatment based on their findings.
When is the 90791 CPT Code Used?
The 90791 CPT code is used when a patient requires an initial psychiatric diagnostic evaluation. This evaluation may be necessary if the patient is experiencing symptoms of a mental health condition, such as depression, anxiety, or bipolar disorder. It may also be necessary if the patient has a history of mental illness or if they are seeking treatment for a specific mental health concern.
What are the Benefits of the 90791 CPT Code?
There are several benefits to using the 90791 CPT code for mental health assessments:
- Comprehensive assessment: The 90791 CPT code requires a comprehensive assessment of a patient’s mental health status, which can help ensure that any potential mental health issues are identified and treated.
- Accurate diagnosis: The diagnostic interview and mental status exam included in the 90791 CPT code can help mental health professionals make an accurate diagnosis, which is essential for developing an effective treatment plan.
- Treatment planning: The discussion of treatment options included in the 90791 CPT code can help patients and mental health professionals develop a treatment plan that meets the patient’s unique needs.
What are the Requirements for the 90791 CPT Code?
To bill for the procedure code 90791, some certain requirements must be met. These requirements are mention as below:
- The evaluation must be performed by a licensed mental health professional.
- The evaluation must be comprehensive and include a diagnostic interview, a mental status exam, a review of the patient’s medical and psychiatric history, and a discussion of treatment options.
- The evaluation must take place face-to-face with the patient.
- The evaluation must last at least 60 minutes.
- The mental health professional must document the results of the evaluation, including the patient’s diagnosis and treatment plan.
90791 Fee Schedule for 2023
CPT 90791 fee schedule for year 2023 as per CMS guidelines as below
| HCPCS Code | Short Description | Non-Facility Price | Facility Price | Non-Facility Limiting Charge | Facility Limiting Charge |
| 90791 | Psych diagnostic evaluation | $174.86 | $150.80 | $191.03 | $164.75 |
FAQs
Ans. The cost of the CPT code 90791 depending on several factors, including the location of the mental health professional, the type of insurance the patient has, and the complexity of the evaluation. On average, the cost of the CPT code ranges from $150 to $500, but it can be higher or lower depending on the above factors.
Ans. The CPT code 90791 is typically covered by most insurance plans, including Medicaid and Medicare. However, it’s important to check with your insurance provider to determine your coverage and any out-of-pocket costs.
Ans. After the code 90791 is completed, the mental health professional will use the results of the evaluation to develop a treatment plan for the patient. This treatment plan may include therapy, medication, or other interventions to address the patient’s mental health concerns.
Ans. To find a mental health professional who uses the CPT 90791 , you can start by asking your primary care physician for a referral. You can also search for mental health professionals in your area who accept your insurance.
Ans. The CPT 90791 is specifically used for psychiatric diagnostic evaluations. Other CPT codes may be used for different mental health services, such as psychotherapy or medication management.
Conclusion:
The 90791 CPT code is a billing code used for psychiatric diagnostic evaluations. This code requires a comprehensive assessment of a patient’s mental health status, including a diagnostic interview, mental status exam, review of medical and psychiatric history, and discussion of treatment options. It can only be performed by licensed mental health professionals and is typically covered by insurance.
If you or a loved one needs a mental health assessment, understanding the procedure code 90791 can help you navigate the process and ensure that you receive the care you need. Be sure to consult with a mental health professional to determine if a psychiatric diagnostic evaluation is right for you.
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