Table of Contents Hide
- What is the purpose of using code 90791?
- Who can bill for CPT code 90791?
- Does CPT code 90791 require prior authorization from insurance companies?
- What modifier is needed for 90791?
This guide will help you understand the billing and invoicing processes associated with mental health operations using the CPT code 90791.
What is the purpose of using code 90791?
Diagnostic examination with medical services 90791 diagnoses mental health issues. Medical billing and coding use it to represent the initial psychiatric evaluation, which includes a complete patient history, mental status check, and diagnosis and treatment plan.
CPT 90791 code is reserved for basic, minimal, and uncomplicated healthcare encounters with established patients.
It should not be used for complex, new patient visits, procedures, or situations requiring more significant medical decision-making, time, or the presence of a physician or qualified healthcare professional.
Who can bill for CPT code 90791?
Licensed mental health professionals qualified to conduct psychiatric diagnostic examinations and create treatment regimens frequently charge CPT code 90791. Some examples of specialists who can legally bill the code are as follows:
Medical professionals with many years of experience and knowledge.
Professional psychologists with the training and experience to evaluate mental health.
Licensed Clinical Social Workers (LCSWs):
Clinical social workers who are licensed and trained to provide mental health services, including diagnostic evaluations.
Licensed Professional Counselors (LPCs):
Psychologically trained counselors who assess and plan treatment.
- Physician assistants and nurse practitioners:
Nurse practitioners and physician assistants may conduct psychiatric examinations and submit claims using the CPT code 90791 in select states and under specific conditions.
Also read: What is 97110 CPT code description?
Does CPT code 90791 require prior authorization from insurance companies?
It depends on the insurance company and the specific policy. Some insurance companies may require prior authorization for CPT code 90791, while others may not. It is important to check with the insurance company and verify their specific requirements.
What documentation is required when submitting a claim with CPT code 90791?
When submitting a claim with CPT code 90791, the following documentation is typically required:
- Patient Information:
Patient’s full name and date of birth.
Patient’s address and contact information.
Insurance information (if applicable), including the policy number and group number.
- Provider Information:
Information about the healthcare provider conducting the evaluation, including their name, credentials, and contact information.
- Referring Provider Information (if applicable):
Details about the referring provider if the patient was referred for the evaluation.
- Chief Complaint:
Concise patient’s mental health concern for evaluation.
Comprehensive patient history:
- Medical history
- Psychiatric history
- Substance use history
- Family history
- Past treatments (if any)
Initial diagnosis or provisional diagnosis is based on the assessment.
What modifier is needed for 90791?
Modifiers are usually unnecessary when using 90791, which refers to an initial mental evaluation. However, they can be necessary in different situations, depending on the particulars of those circumstances or the payer’s or insurance provider’s demands.
Can CPT code 90791 be used for follow-up visits or only for initial evaluations?
Before wrapping up, we should know the limitations of this code and whether it can be used for purposes other than initial evaluations. Per our research, 90791 is not typically used for follow-up or subsequent visits with the same patient.
Different CPT codes, such as those that depict psychiatric diagnostic interviews, medication management, or psychotherapy, would be used to describe and bill for the services delivered during those ongoing treatment sessions for follow-up appointments or routine visits. This distinct separation of initial assessments from follow-up visits makes it easier to ensure correct billing and fair reimbursements for mental health services.