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The CPT® Code 90785 refers to "Interactive complexity," which is an add-on code used in conjunction with primary psychiatric services. This code is applicable when the treatment provided to a patient involves significant communication challenges that complicate the encounter. Such challenges may arise from various factors, including the patient's inability to communicate effectively due to developmental or mental impairments, or the presence of additional individuals involved in the patient's care, such as parents, guardians, or representatives from state agencies and schools. Furthermore, language barriers that necessitate the use of interpreters or other communication aids can also contribute to interactive complexity. The use of this code is essential for accurately reflecting the increased difficulty in communication during psychiatric evaluations, individual psychotherapy sessions, or group therapy. To justify the use of code 90785, it is crucial for the provider to document at least one complicating factor related to communication, which may include maladaptive communication behaviors, emotional or behavioral issues from caregivers that impact the patient's treatment, or the need for specialized communication tools. This detailed documentation ensures that the complexities of the encounter are recognized and appropriately coded for reimbursement purposes.
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The use of CPT® Code 90785 is indicated in situations where communication difficulties significantly complicate the psychiatric treatment of a patient. These indications may include:
The procedure for reporting CPT® Code 90785 involves the following steps:
After the procedure, it is important to continue monitoring the patient's communication abilities and the effectiveness of the treatment plan. Providers should remain aware of any ongoing communication challenges that may arise and adjust the treatment approach as necessary. Documentation of the patient's progress and any changes in their communication status should be maintained to support future coding and billing efforts. Additionally, if further sessions are required that involve similar complexities, the provider should be prepared to report code 90785 again, ensuring that all relevant communication factors are documented for each encounter.
| Short Descr | PSYTX COMPLEX INTERACTIVE | Medium Descr | PSYCHOTHERAPY COMPLEX INTERACTIVE | Long Descr | Interactive complexity (List separately in addition to the code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Packaged into APC Rates | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5B - Specialist - psychiatry | MUE | 3 | CCS Clinical Classification | 218 - Psychological and psychiatric evaluation and therapy |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 90791 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychiatric diagnostic evaluation | 90792 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychiatric diagnostic evaluation with medical services | 90832 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychotherapy, 30 minutes with patient | 90833 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | 90834 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychotherapy, 45 minutes with patient | 90836 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | 90837 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychotherapy, 60 minutes with patient | 90838 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | 90853 | Telehealth Service (Medicare) MPFS Status: Active Code APC Q3 PUB 100 CPT Assistant Article Group psychotherapy (other than of a multiple-family group) |
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GW | Service not related to the hospice patient's terminal condition | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | AJ | Clinical social worker | FQ | The service was furnished using audio-only communication technology | AH | Clinical psychologist | GA | Waiver of liability statement issued as required by payer policy, individual case | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | SA | Nurse practitioner rendering service in collaboration with a physician | U4 | Medicaid level of care 4, as defined by each state | HN | Bachelors degree level | HO | Masters degree level | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | AM | Physician, team member service | SF | Second opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance) | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | GC | This service has been performed in part by a resident under the direction of a teaching physician | HF | Substance abuse program | UA | Medicaid level of care 10, as defined by each state | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | AF | Specialty physician | FR | The supervising practitioner was present through two-way, audio/video communication technology | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | FS | Split (or shared) evaluation and management visit | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GJ | "opt out" physician or practitioner emergency or urgent service | GQ | Via asynchronous telecommunications system | GR | This service was performed in whole or in part by a resident in a department of veterans affairs medical center or clinic, supervised in accordance with va policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | HB | Adult program, non geriatric | HE | Mental health program | HP | Doctoral level | KX | Requirements specified in the medical policy have been met | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q2 | Demonstration procedure/service | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | TD | Rn | TU | Special payment rate, overtime | U1 | Medicaid level of care 1, as defined by each state | U2 | Medicaid level of care 2, as defined by each state | U3 | Medicaid level of care 3, as defined by each state | U6 | Medicaid level of care 6, as defined by each state | U7 | Medicaid level of care 7, as defined by each state | UB | Medicaid level of care 11, as defined by each state | UD | Medicaid level of care 13, as defined by each state | UH | Services provided in the evening | V3 | Demonstration modifier 3 |
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| 2021-01-01 | Note | Guidelines changed. |
| 2013-01-01 | Added | Added |
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