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The CPT® Code 90791 is designated for a psychiatric diagnostic evaluation, which is a comprehensive assessment conducted by a psychiatrist. This evaluation encompasses a thorough collection of the patient's medical and psychiatric history, alongside a detailed mental status examination. During this process, the psychiatrist may order laboratory tests and other diagnostic studies, interpreting the results as part of the evaluation. Additionally, the psychiatrist engages in communication with other relevant sources or informants to gather further insights into the patient's condition. The primary objective of this evaluation is to establish a tentative diagnosis and assess the patient's capacity to benefit from psychotherapy treatment. The extent of the mental status examination is tailored to the patient's specific condition, with the psychiatrist observing various indicators of psychopathology, including the patient's appearance, attitude, behavior, speech patterns, emotional responses, mood, thought content, perceptions, and occasionally cognitive functions. This diagnostic interview is typically performed during the initial consultation with the patient but may also be repeated for new episodes of illness or upon re-admission to inpatient care due to complications. It is important to note that when the psychiatric diagnostic evaluation is conducted independently, the appropriate code to report is 90791. In cases where medical services are provided alongside the psychiatric evaluation, the correct code to use is 90792.
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The psychiatric diagnostic evaluation represented by CPT® Code 90791 is indicated for various situations where a comprehensive assessment of a patient's mental health is necessary. This includes:
The procedure for conducting a psychiatric diagnostic evaluation involves several key steps, which are detailed as follows:
After the psychiatric diagnostic evaluation is completed, the psychiatrist will typically discuss the findings with the patient, outlining the tentative diagnosis and potential treatment options. The patient may be advised on the next steps, which could include psychotherapy, medication management, or further diagnostic evaluations if needed. Follow-up appointments may be scheduled to monitor the patient's progress and adjust the treatment plan as necessary. It is essential for the psychiatrist to document all findings and recommendations thoroughly to ensure continuity of care and compliance with medical record-keeping standards.
| Short Descr | PSYCH DIAGNOSTIC EVALUATION | Medium Descr | PSYCHIATRIC DIAGNOSTIC EVALUATION | Long Descr | Psychiatric diagnostic evaluation | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | 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 | Codes That May Be Paid Through a Composite APC | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5B - Specialist - psychiatry | MUE | 1 | CCS Clinical Classification | 218 - Psychological and psychiatric evaluation and therapy |
This is a primary code that can be used with these additional add-on codes.
| 90785 | Telehealth Service (Medicare) Addon Code Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC N Interactive complexity (List separately in addition to the code for primary procedure) |
| 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. | AH | Clinical psychologist | AJ | Clinical social worker | GT | Via interactive audio and video telecommunication systems | GW | Service not related to the hospice patient's terminal condition | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 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 | HO | Masters degree level | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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. | 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 | CR | Catastrophe/disaster related | FQ | The service was furnished using audio-only communication technology | Q2 | Demonstration procedure/service | GZ | Item or service expected to be denied as not reasonable and necessary | 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. | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | HN | Bachelors degree level | GC | This service has been performed in part by a resident under the direction of a teaching physician | HB | Adult program, non geriatric | KX | Requirements specified in the medical policy have been met | GA | Waiver of liability statement issued as required by payer policy, individual case | FR | The supervising practitioner was present through two-way, audio/video communication technology | GJ | "opt out" physician or practitioner emergency or urgent service | U4 | Medicaid level of care 4, as defined by each state | 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) | UC | Medicaid level of care 12, as defined by each state | SA | Nurse practitioner rendering service in collaboration with a physician | HP | Doctoral level | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | HF | Substance abuse program | SF | Second opinion ordered by a professional review organization (pro) per section 9401, p.l. 99-272 (100% reimbursement - no medicare deductible or coinsurance) | TG | Complex/high tech level of care | UD | Medicaid level of care 13, as defined by each state | AF | Specialty physician | HW | Funded by state mental health agency | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | UB | Medicaid level of care 11, as defined by each state | FS | Split (or shared) evaluation and management visit | GQ | Via asynchronous telecommunications system | 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 | Q5 | Service furnished under a reciprocal billing 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 | U2 | Medicaid level of care 2, as defined by each state | UA | Medicaid level of care 10, as defined by each state | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 27 | Multiple outpatient hospital e/m encounters on the same date: for hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct e/m encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department e/m code(s). this modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (eg, hospital emergency department, clinic). note: this modifier is not to be used for physician reporting of multiple e/m services performed by the same physician on the same date. for physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital emergency department, clinic), see evaluation and management, emergency department, or preventive medicine services codes. | 32 | Mandated services: services related to mandated consultation and/or related services (eg, third party payer, governmental, legislative or regulatory requirement) may be identified by adding modifier 32 to the basic procedure. | 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. | 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. | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | A1 | Dressing for one wound | AG | Primary physician | AI | Principal physician of record | AK | Non participating physician | AM | Physician, team member service | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | ER | Items and services furnished by a provider-based, off-campus emergency department | ET | Emergency services | G0 | Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke | G2 | Most recent urr reading of 60 to 64.9 | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GF | Non-physician (e.g. nurse practitioner (np), certified registered nurse anesthetist (crna), certified registered nurse (crn), clinical nurse specialist (cns), physician assistant (pa)) services in a critical access hospital | GX | Notice of liability issued, voluntary under payer policy | H9 | Court-ordered | HA | Child/adolescent program | HE | Mental health program | HH | Integrated mental health/substance abuse program | HJ | Employee assistance program | HK | Specialized mental health programs for high-risk populations | HL | Intern | 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 | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PT | Colorectal cancer screening test; converted to diagnostic test or other procedure | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | QW | Clia waived test | SC | Medically necessary service or supply | SW | Services provided by a certified diabetic educator | TD | Rn | TN | Rural/outside providers' customary service area | TS | Follow-up service | TV | Special payment rates, holidays/weekends | U1 | Medicaid level of care 1, as defined by each state | U3 | Medicaid level of care 3, as defined by each state | U5 | Medicaid level of care 5, 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 | U8 | Medicaid level of care 8, as defined by each state | UF | Services provided in the morning | UH | Services provided in the evening | V1 | Demonstration modifier 1 | V2 | Demonstration modifier 2 | V3 | Demonstration modifier 3 | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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