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The CPT® Code 90792 refers to a comprehensive psychiatric diagnostic evaluation that includes medical services. This procedure is essential for establishing a thorough understanding of a patient's mental health status and medical history. During this evaluation, the psychiatrist conducts a detailed psychiatric diagnostic interview, which encompasses gathering a complete medical and psychiatric history from the patient. This process involves performing a mental status examination, which assesses various aspects of the patient's psychological functioning. The psychiatrist may also order laboratory tests and other diagnostic studies, interpreting the results to inform the diagnostic process. Communication with other sources, such as family members or previous healthcare providers, is also a critical component of this evaluation, as it helps to gather additional insights into the patient's condition. The psychiatrist uses this information to establish a tentative diagnosis and to evaluate the patient's capacity to benefit from psychotherapy. The extent of the mental status examination may vary based on the patient's specific condition and needs. During the evaluation, the psychiatrist looks for signs of psychopathology, which can manifest in various ways, including the patient's appearance, attitude, behavior, speech patterns, emotional responses, mood, thought content, perceptions, and cognitive functions. This diagnostic interview is typically conducted when the psychiatrist first sees a patient but may also be repeated for new episodes of illness or in cases of re-admission due to complications. It is important to note that if the psychiatric diagnostic evaluation is performed without accompanying medical services, the appropriate code to report is 90791. However, when medical services are provided alongside the psychiatric diagnostic evaluation, the correct code to use is 90792.
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The psychiatric diagnostic evaluation with medical services, represented by CPT® Code 90792, is indicated for various situations where a comprehensive assessment of a patient's mental health and medical history is necessary. This evaluation is typically performed when a patient presents with symptoms that may indicate a psychiatric disorder or when there is a need to reassess a patient's mental health status due to a new episode of illness or complications arising from a previous condition. The following are specific indications for this procedure:
The procedure for CPT® Code 90792 involves several critical steps that ensure a thorough psychiatric diagnostic evaluation with medical services. Each step is designed to gather essential information about the patient's mental and physical health.
After the completion of the psychiatric diagnostic evaluation with medical services, the patient may be provided with a treatment plan based on the findings of the evaluation. This plan may include recommendations for psychotherapy, medication management, or further diagnostic testing if needed. The psychiatrist will typically schedule follow-up appointments to monitor the patient's progress and adjust the treatment plan as necessary. It is essential for the patient to adhere to the recommended follow-up care to ensure optimal outcomes and address any emerging issues promptly.
| Short Descr | PSYCH DIAG EVAL W/MED SRVCS | Medium Descr | PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES | Long Descr | Psychiatric diagnostic evaluation with medical services | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GT | Via interactive audio and video telecommunication systems | SA | Nurse practitioner rendering service in collaboration with a physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | CR | Catastrophe/disaster related | AF | Specialty physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | FQ | The service was furnished using audio-only communication technology | GZ | Item or service expected to be denied as not reasonable and necessary | AJ | Clinical social worker | 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. | ET | Emergency services | GA | Waiver of liability statement issued as required by payer policy, individual case | Q2 | Demonstration procedure/service | 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. | UC | Medicaid level of care 12, as defined by each state | 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 | AM | Physician, team member service | 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 | FR | The supervising practitioner was present through two-way, audio/video communication technology | FS | Split (or shared) evaluation and management visit | GQ | Via asynchronous telecommunications system | UB | Medicaid level of care 11, as defined by each state | 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 | 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) | HB | Adult program, non geriatric | 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. | 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 | 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. | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | U2 | Medicaid level of care 2, as defined by each state | U7 | Medicaid level of care 7, as defined by each state | UA | Medicaid level of care 10, as defined by each state | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | TD | Rn | U4 | Medicaid level of care 4, as defined by each state | AH | Clinical psychologist | HF | Substance abuse program | KX | Requirements specified in the medical policy have been met | AI | Principal physician of record | GJ | "opt out" physician or practitioner emergency or urgent service | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | U6 | Medicaid level of care 6, as defined by each state | 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. | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 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. | A1 | Dressing for one wound | AG | Primary physician | 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 | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | G0 | Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke | GB | Claim being re-submitted for payment because it is no longer covered under a global payment demonstration | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | 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 | H9 | Court-ordered | HA | Child/adolescent program | HE | Mental health program | HK | Specialized mental health programs for high-risk populations | HL | Intern | HN | Bachelors degree level | HO | Masters degree level | HP | Doctoral level | HW | Funded by state mental health agency | LT | Left side (used to identify procedures performed on the left side of the body) | 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 | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q3 | Live kidney donor surgery and related services | 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 | SC | Medically necessary service or supply | SY | Persons who are in close contact with member of high-risk population (use only with codes for immunization) | TG | Complex/high tech level of care | TH | Obstetrical treatment/services, prenatal or postpartum | 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 | UD | Medicaid level of care 13, as defined by each state | UF | Services provided in the morning | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 2021-01-01 | Note | Guidelines changed. |
| 2013-01-01 | Added | Added |
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