90791 CPT code Guides for initial Psychiatric Evaluation

The CPT code 90791 is nominated for psychiatric clinical evaluation without medical services. This is mainly used for intake appointments where licensed professionals conduct a widespread assessment of a patient’s mental health.

These assessments include reviewing medical history, examining mental state, and preparing treatment plans.

Who can bill CPT Code 90791?

Clinical social worker (lcsw)

Licensed professional consultant (LPC)

Marriage and Family Physicians (LMFT)

Clinical psychologist

Some states have restrictions on which professionals can bill 90791 CPT codes, so it’s essential to check local guidelines.

When to Use CPT Code 90791

CPT 90791 is used for new patient intake sessions and comprehensive psychiatric evaluations. It is appropriate for:

New clients seeking mental health treatment.
Annual reassessments for Medicare and Medicaid patients.
Initial evaluations for psychiatric treatment plans.

The typical session length for 90791 CPT codes is 60 minutes, but it can range from 16 to 90 minutes based on patient needs.

Documentation Requirements for 90791

Accurate documentation is critical to ensure insurance reimbursement and compliance. Providers must include:

Comprehensive mental health history
Mental status examination
Diagnosis and treatment plan
Session duration and any additional assessments performed
Functional status and symptoms that establish medical necessity

Failure to document properly can lead to claim denials, affecting reimbursement.

2025 Reimbursement Rates for CPT Code 90791

For 2025, reimbursement rates for CPT Code 90791 are as follows:

Medicare Rate: Updated based on CMS guidelines
Private Insurance: Varies depending on the provider and state regulations
90849 (Multiple-family group psychotherapy):
- Medicare Payment: $41.09
- Private Insurance: $37.52

These rates are subject to annual adjustments based on CMS and private insurer updates.

Billing Frequency for CPT Code 90791

Understanding the limitations on billing frequency helps prevent denials:

Medicare/Medicaid: Once per patient per provider annually
Institutionalized Patients (Medicare): Once per year
Private Insurance: Some plans allow billing every six months

Exceeding the allowed billing frequency can result in claim rejections and financial losses

Difference between CPT Code 90791 and 90792

Aspect	CPT Code 90791	CPT Code 90792
Focus	Psychiatric evaluations without medical interventions	Includes medical services (e.g., prescriptions)
Eligible Providers	Licensed therapists, psychologists	Psychiatrists, medical doctors
Medical Services	Not included	Includes physical exams, prescriptions

Mental Health Evaluation & Management (E/M) Codes

E/M codes are used in conjunction with psychotherapy by authorized prescribers, psychiatrists, and MDs. These codes allow providers to bill for medical evaluations alongside psychotherapy services.
Coding E/M is more complex, requiring detailed documentation and compliance with strict guidelines. However, it often results in higher reimbursement rates than standard psychiatric evaluation codes.
There are also E/M codes used without psychotherapy, making them suitable for providers focusing on medication management and psychiatric follow-ups.

Add-On CPT Codes for Extended Sessions

For evaluations exceeding 90 minutes, add-on CPT codes may be required. Providers should consult insurance guidelines to ensure proper billing.

Common Billing Errors for 90791

Incorrect documentation leading to claim denials
Misuse of CPT codes such as confusing 90791 with 90792 CPT codes
Lack of authorization when required by certain insurance providers

Final thoughts

CPT code 90791 plays an important role in mental health assessment, ensuring proper clinical evaluation for new patients. Accurate documentation, understanding reimbursement rates, and using AI-powered billing solutions can increase practice efficiency and financial stability.

For trouble-free billing, consider outsourcing for a professional medical billing service or integrating the AI-assisted coding tool in your practice.

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