CPT code 90792 Billing Guide and Reimbursement Update

Understanding CPT Code 90792 is essential for mental health providers who perform psychiatric clinical evaluations with medical services. This guide explains how to use 90792, which differs from 90791 in terms of required credentials, reimbursement rate, and major billing guidelines.

What is CPT Code 90792?

CPT code 90792 is used for a psychiatric clinical evaluation with medical services offered by a licensed medical professional. Unlike CPT code 90791, which is for non-medical mental health evaluation, 90792 includes a medical assessment component.

According to CMS guidelines, CPT code 90792 is required

A complete medical and psychiatric history (including past, family, and social history)
Advanced exercise registered nurse (APRN) or physician assistant (PAS) (in some states, if allowed by law)
Non-medical mental health professionals, such as licensed clinical social workers (LCSW) or licensed professional consultants (LPCs), should be used instead of CPT code 90791.

Who Can Bill CPT Code 90792?

Since 90792 includes a medical assessment, only licensed medical professionals can bill for it. This includes:

Psychiatrists (MDs, DOs)
Physicians performing psychiatric evaluations
Advanced Practice Registered Nurses (APRNs) or Physician Assistants (PAs) (in some states, if permitted by law)

Non-medical mental health professionals, such as licensed clinical social workers (LCSWs) or licensed professional counselors (LPCs), must use CPT Code 90791 instead.

CPT code 90792 required time

Unlike psychiatry codes, 90792 are not based on time, but on the completion of specific service components. However, most providers spend 60 to 120 minutes in making a comprehensive clinical evaluation.

CPT Code 90792 Reimbursement Rates (2025)

Reimbursement rates for CPT Code 90792 fluctuate annually. Here’s how the rate has changed:

2025: $185.18
2024: $190.57
2023: $196.55
2022: $218.90
2021: $201.68
2020: $160.96

Medicaid Sample Reimbursement Rates (2025):

Mississippi: $134.42
New Jersey: $325.00

Add-On CPT Codes for 90792

Providers often bill additional codes alongside 90792 for enhanced reimbursement:

90785 – Interactive complexity (for challenging cases, such as language barriers or trauma victims)
90833 – 30-minute psychotherapy add-on (e.g., psychiatrist evaluates medication, then conducts therapy)
90836 – 45-minute psychotherapy add-on
90863 – Pharmacologic management (for ongoing medication management after evaluation)
99050 – After-hours services (emergency or weekend appointments)
99051 – Evening, weekend, or holiday services

Billing Modifiers for CPT Code 90792

When billing 90792 alongside other medical services or in coordination with other mental health professionals, consider using these modifiers:

AJ – Clinical Social Worker (LCSW)
AF – Psychiatrist (MD)
AH – Clinical Psychologist (PhD or PsyD)
HP – Doctorate-level Clinical Psychologist

How to Bill 90792?

To ensure accurate billing, list CPT Code 90792 on line 24 of the CMS-1500 form. If using add-on codes or modifiers, ensure proper documentation to prevent claim denials.

Final Thoughts

Psychiatric clinical evaluation requires careful attention to CPT coding rules, licensing requirements, and reimbursement rates for billing. Using accurate add-on codes and modifiers can maximize reimbursement when ensuring compliance.

If managing billing in-house is heavy, Expressmbs specializes in mental health billing to ensure that your claims are processed correctly and reimbursed at the highest rates. For more help with the mental health CPT code, go to our broad guide for behavior health billing.

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