In the complex world of healthcare billing and psychiatric services, understanding specific CPT codes is crucial for both providers and patients. CPT code 90791 plays a vital role in mental health assessments, guiding clinicians in documenting and billing for initial psychiatric evaluations. This code ensures that patients receive thorough assessments while allowing providers to accurately communicate services to insurers. In this comprehensive guide, we break down everything you need to know about CPT 90791, from its definition to usage, differences with other codes, and best practices for accurate billing.
Short Answer: What is CPT Code 90791?
CPT code 90791 refers to an initial psychiatric diagnostic evaluation performed by a qualified mental health provider such as a psychiatrist or psychologist. Unlike therapy session codes, 90791 is used for comprehensive assessments of a patient’s mental health, including history, current symptoms, and treatment planning.
This code is critical in medical billing because it documents the initial evaluation for insurance purposes, ensuring the provider is reimbursed correctly. It also plays a pivotal role in mental health services, forming the foundation for all subsequent treatment plans.
Detailed Explanation of CPT Code 90791
Overview of CPT Codes
Current Procedural Terminology (CPT) codes are a standardized system used in the United States to document medical services and procedures. Managed by the American Medical Association (AMA), CPT codes ensure consistent communication between providers, patients, and insurance companies. They are essential for:
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Accurate billing and reimbursement
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Standardized documentation of patient care
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Compliance with healthcare regulations
Specifics of CPT Code 90791
CPT 90791 is specifically for initial psychiatric evaluations without medical services. Unlike 90792, which includes medical evaluation and prescription considerations, 90791 focuses purely on mental health assessment.
Who can perform it?
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Psychiatrists
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Psychologists
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Licensed clinical social workers (LCSWs)
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Other qualified mental health professionals
When is it used?
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At the start of mental health treatment
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To assess a new patient’s psychiatric history and current concerns
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To develop a tailored treatment plan
Services Covered Under CPT 90791
The services included in a 90791 evaluation are comprehensive and thorough:
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Assessment of mental health history – Including past diagnoses, treatments, and family mental health history.
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Evaluation of current symptoms – Depression, anxiety, mood disorders, or other psychiatric conditions.
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Development of a treatment plan – Recommendations for therapy, medication, or further assessments.
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Risk assessment and clinical decision-making – Evaluating risks such as suicidal ideation or behavioral concerns.
How CPT Code 90791 is Used
A systematic approach ensures both effective care and proper documentation.
Step 1 – Patient Intake
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Collect personal and medical history
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Review previous psychiatric evaluations, medications, and hospitalizations
Step 2 – Clinical Interview
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Conduct a mental status examination assessing appearance, behavior, thought processes, and mood
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Discuss symptoms, life stressors, and current concerns
Step 3 – Risk Assessment
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Evaluate potential suicidal or homicidal risk
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Identify safety concerns and immediate interventions if necessary
Step 4 – Treatment Planning
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Develop short- and long-term treatment goals
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Recommend therapy, lifestyle modifications, or psychiatric medications
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Discuss follow-up appointments and referrals
Step 5 – Documentation for Billing
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Accurately document all observations, assessments, and recommendations
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Ensure compliance with insurance and legal standards for billing CPT 90791
CPT Code 90791 vs. Other Psychiatric CPT Codes
Understanding the distinctions between similar codes prevents billing errors and ensures compliance.
CPT 90791 vs. 90792
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90791: Initial evaluation without medical services
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90792: Initial evaluation with medical services, including medication management
CPT 90791 vs. Therapy Codes (90832, 90834, 90837)
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90791 is for evaluation only
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Therapy codes are ongoing treatment sessions for individual or group psychotherapy
CPT 90791 vs. Re-Evaluation Codes
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90791 is for first-time evaluations
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Re-evaluation codes (e.g., 90833) are used for follow-up assessments
Comparison Table:
| CPT Code | Service Type | Typical Duration | Provider | Notes |
|---|---|---|---|---|
| 90791 | Initial Psychiatric Evaluation | 45–60 min | Psychiatrist, Psychologist | No medical service included |
| 90792 | Initial Psychiatric Evaluation with Medical Services | 45–60 min | Psychiatrist | Includes medical assessment and prescriptions |
| 90834 | Psychotherapy, Individual | 45 min | Any licensed therapist | Follow-up therapy session |
Common Questions About CPT Code 90791 (FAQs)
1. Who can bill CPT code 90791?
Only licensed mental health providers such as psychiatrists, psychologists, and certain therapists.
2. How long does a 90791 session typically last?
Generally, 45–60 minutes.
3. Does insurance cover CPT 90791?
Yes, most insurance plans cover it, but coverage may vary based on provider and plan.
4. What is the difference between 90791 and 90792?
90791 does not include medical evaluation or medication management; 90792 does.
5. Can a therapist bill 90791 for telehealth?
Yes, telehealth billing is allowed if local regulations and insurance policies permit.
6. How to document CPT 90791 properly?
Include comprehensive assessment notes, history, mental status examination, risk assessment, and treatment plan.
7. Can 90791 be billed multiple times for the same patient?
Typically no; it is intended for the initial evaluation.
8. Are there common mistakes to avoid when billing CPT 90791?
Yes, such as confusing it with therapy codes, inadequate documentation, and not differentiating from 90792.
Key Considerations and Best Practices for CPT Code 90791
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Accurate documentation: Keep detailed notes for billing and legal purposes.
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Avoid billing errors: Ensure correct code selection to prevent denials.
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Insurance compliance: Understand payer-specific requirements for coverage.
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Clinical thoroughness: Conduct a comprehensive psychiatric evaluation to inform effective treatment plans.
Conclusion
CPT code 90791 is a cornerstone in psychiatric assessment and billing. It ensures patients receive comprehensive evaluations while enabling providers to document and bill correctly. Contact AAAMB to understand the differences between 90791, therapy codes, and re-evaluation codes, clinicians can maintain compliance, optimize patient care, and maximize insurance reimbursements. Proper use of CPT 90791 not only facilitates accurate billing but also strengthens the foundation of quality mental health services.