90792 – Behavioral Health Assessment / Diagnostic Service
CPT code 90792 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90792
?
90792 is a CPT code designated for the psychiatric diagnostic evaluation with medical services, typically utilized in the context of comprehensive assessment services. This entry delves into the clinical applications, documentation requirements, and payer considerations associated with this code. It is crucial for providers to ensure that clinical notes are aligned with evidence-based practices while clearly outlining treatment goals, interventions employed, and measurable patient progress. When the billing is time-based, it is imperative to document start and stop times accurately to substantiate the duration of the billed service.
Documentation Tips
When billing for services utilizing the 90792 code, it is essential to thoroughly document both start and stop times if the service is time-based. Include comprehensive details on the therapeutic modality or assessment instrument applied, the clinical focus of the session, patient responses, and a clear plan for follow-up. For any scored instruments, maintain copies of the completed evaluation tools. When conducting telehealth sessions, ensure that consent is documented alongside details about the technology platform used. Employ consistent documentation structures, such as the SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan) formats, to enhance audit readiness and demonstrate compliance with payer requirements.
At a Glance
- Service Type: Assessment
- Use Case: Diagnostic / Testing
- Typical Setting: Outpatient clinic, inpatient setting, or telehealth (as per payer policy)
- Billing Unit: Per session or per assessment instrument (dependent on service rendered)
- Common Pairings: 90791, 96127, various psychotherapy codes
Billing Examples
Consider a clinician who administers the Beck Depression Inventory (BDI) as part of a comprehensive assessment for a new patient presenting with depressive symptoms. The clinician records the patient’s responses to each item and files the scored instrument as part of the clinical documentation. In another scenario, a psychologist conducts a standardized neuropsychological assessment, which includes administering, scoring, and interpreting various cognitive tests. The workflows associated with these assessments justify the use of CPT code 90792, as they provide a detailed overview of the patient’s mental health status and inform subsequent treatment planning.
Compliance Guidelines
- Confirm payer coverage policies and authorization requirements prior to billing to avoid claim denials.
- Ensure documentation reflects medical necessity and is appropriately linked to ICD-10 diagnoses that justify the service rendered.
- Utilize correct modifiers as needed (e.g., modifier 95 for telehealth services) to comply with payer regulations.
- Avoid upcoding practices — select codes that accurately represent the documented time and level of service provided.
- Implement regular audits of billing practices to reduce claim denials and enhance the quality of clinical documentation.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F32.9
- F41.1
- R45.0
- Z13.89
- F90.0
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
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Q1: What is this code used for?
A: The 90792 code is used for psychiatric diagnostic evaluations where medical services are provided. It is important for documentation to clearly support the nature and extent of the billed service.
Q2: Can it be billed via telehealth?
A: Yes, many payers allow billing for telehealth services under this code, provided the service is synchronous, and proper consent and modifiers are documented in accordance with payer policies.
Q3: What documentation will payers request?
A: Payers typically require detailed documentation including time spent, therapeutic techniques or assessment instruments utilized, patient responses, and a clear link to a covered ICD-10 diagnosis.
Q4: Can this be billed with other services?
A: Yes, when billing for multiple services, it is essential to document distinct times and the rationale for each service. Consider using add-on codes or the E/M (Evaluation and Management) separation rules where applicable.
Q5: Common denial reasons?
A: Claims may be denied due to missing time documentation, insufficient evidence of medical necessity, incorrect modifier usage, or billing outside of frequency limits established by payers.
