The #1 AI-powered therapy

notes – done in seconds

Try for free

The #1 AI-powered therapy notes – done in seconds

Try for free

This blog is brought to you by YUNG Sidekick –

the #1 AI-powered therapy notes – done in seconds

This blog is brought to you by YUNG Sidekick — the #1 AI-powered therapy notes – done in seconds

Try for free – no credit card required

Back to blog

90792 CPT Code: A Complete Guide for Mental Health Professionals

Stanley Efrem

Mar 4, 2025

The 90792 CPT code gives mental health providers a Medicare reimbursement rate of $196.55 in 2023. Licensed professionals like psychiatrists and nurse practitioners must conduct detailed assessments that last 60-120 minutes. This code is designed for psychiatric diagnostic evaluations with medical services.

Your diagnostic evaluation needs a complete medical and psychiatric history, mental status examination, original diagnosis, and treatment plan development. The 90792 code covers medical assessment components, unlike the 90791 code that non-MD providers use. This piece will help you understand the requirements, documentation needs, and billing procedures that maximize your reimbursement and ensure compliance.

Understanding the 90792 CPT Code Basics

Licensed medical professionals use the 90792 CPT code to perform psychiatric diagnostic evaluations with medical services. This detailed assessment combines biopsychosocial and medical components that make it different from standard mental health evaluations [1].

Psychiatrists, psychiatric nurse practitioners, and physician assistants can use this code [2]. These professionals must complete detailed evaluations that cover several key elements. They collect complete medical and psychiatric histories, including past, family, and social information. They perform detailed mental status examinations and create original diagnoses based on current DSM criteria [3].

Practitioners must evaluate the patient's ability to respond to treatment. They create customized treatment plans that address each patient's unique mental health needs [3]. The medical part lets providers prescribe medications, do physical examinations, and order laboratory or diagnostic studies [1].

Providers mostly use this code when an illness starts or while evaluating a new client. All the same, they might need repeat evaluations in specific cases. These cases include long breaks in treatment, psychiatric hospital admissions, or major changes in mental status that need more assessment [4].

The main difference between codes 90791 and 90792 stands out clearly. Both codes represent psychiatric diagnostic evaluations, but 90792 has medical services while 90791 doesn't [5]. This medical component explains why 90792 comes with higher reimbursement rates [3].

A detailed assessment usually takes 60 to 120 minutes [6]. The code doesn't specify time requirements, but providers need enough time to complete all work properly.

Medicare guidelines let providers use either 90792 or appropriate Evaluation and Management (E/M) codes for original evaluations [7]. When providers bill both an E/M service and psychiatric evaluation on the same day, the services must remain separate and distinct. They should add modifier-25 to the E/M code and list it first on claim forms, followed by the psychiatric evaluation code [8].

Documentation Requirements for 90792

Documentation serves as the life-blood of getting reimbursed for the 90792 CPT code. Medical records must show each patient's complete name and service dates on every page [9]. A provider's signature, credentials, and clear documentation remain mandatory [9].

Psychiatric diagnostic evaluation documentation needs to cover several key elements. The records should include a complete medical and psychiatric history that looks at past experiences, family background, and social factors [10]. Your documentation must show a detailed mental status examination reviewing the patient's current psychological state [10].

Clinical notes should establish a diagnosis based on assessment findings [10]. These notes must also show how you reviewed the patient's response potential to treatment since this guides care decisions [10].

Treatment plan records deserve special focus. Each patient's documentation needs specific details about participation and behavior patterns [11]. Note that copying similar notes between different patients creates compliance issues [11].

Time documentation gives providers two options: they can record start and stop times or note the total duration [9]. Providers need 60-120 minutes to complete these evaluations fully, making precise time records crucial [6].

Medicare patients require special attention to regional Medicare carrier's Local Coverage Determination (LCD) policies that may have unique documentation needs [12]. Medicare typically pays for one evaluation yearly for institutionalized patients, unless medical necessity supports more assessments [7].

Documentation must capture any prescribed medications or ordered laboratory studies [13]. The records should also show any discussions with family members or other sources that helped form your evaluation [13].

The code cannot be billed with an Evaluation and Management (E/M) service on the same day by the same provider [10]. Your documentation must clearly show these as separate services when provided on different days [14].

Getting Paid: Billing and Reimbursement

Medicare reimbursement rates for the 90792 CPT code have changed quite a bit over the last several years. The rates started at $160.96 in 2020 [3] and jumped to $201.68 in 2021 [3]. They peaked at $218.90 in 2022 [3] and now sit at $196.55 in 2023 [4].

Each state has its own Medicaid reimbursement rate. To name just one example, Mississippi pays $134.42 [6] while New Jersey offers a higher rate of $325.00 [6]. These differences make it vital to check your state's fee schedule before providing services.

Here are the steps you need for proper reimbursement:

Complete the CMS-1500 form accurately
Enter the 90792 code on line 24
Submit claims to appropriate payers
Keep detailed documentation [4]

Most insurance companies let you bill this code once every six months per client [15]. So, you need to track service dates carefully to keep billing practices compliant. Medicare usually allows one evaluation yearly, unless medical necessity requires more.

Commercial insurance rates vary substantially between companies [8]. Some commercial rates might be 5% lower than Medicaid rates [8]. Talking with colleagues about local payer rates is a great way to get insights into reimbursement patterns.

Here's what you need to know about accurate billing:

The 90792 code can't be reported with evaluation and management services for the same patient on the same day [15]
You can't use this code with psychotherapy services, including crisis intervention [15]
Don't bill interactive complexity services (90785) if patients can't communicate by any means [5]

Check individual payer policies and fee schedules often to get the best reimbursement. Every insurance company has specific rules about documentation and claim submissions [4]. Mental health providers who follow these protocols ensure they get paid properly for their complete psychiatric evaluations.

Medicare now requires electronic billing [8]. Though this adds complexity, Medicare's reimbursement rates for psychiatric services remain competitive [8]. Understanding these billing details helps make the reimbursement process smoother and keeps practice revenue steady.

Conclusion

Mental health professionals need to understand CPT code 90792 to provide psychiatric diagnostic evaluations with medical services. This code offers higher reimbursement rates, with Medicare paying $196.55 in 2023. Your success with this code depends on meeting specific requirements.

You must document everything properly when using this code. Each evaluation should include a complete medical and psychiatric history, detailed mental status exam, and a clear treatment plan. Note that unlike code 90791, medical components like medication management and lab studies are part of your scope with 90792.

Payer reimbursement rates vary by a lot. Medicare's rates have changed over the last several years, and Medicaid's rates differ in each state. Commercial insurance companies set their own rates. You should stay updated with payer policies and fee schedules to maximize your practice's revenue.

Proper documentation and compliance with billing requirements will give you fair compensation for psychiatric diagnostic evaluations. The process might seem complex, but becoming skilled at these elements lets you focus on quality patient care while getting fair payment for your services.

FAQs

Who is authorized to use the 90792 CPT code?

Licensed medical professionals such as psychiatrists, psychiatric nurse practitioners, and physician assistants can use the 90792 CPT code. This code is specifically for psychiatric diagnostic evaluations that include medical services.

What distinguishes the 90792 CPT code from the 90791 code?

The main difference is that 90792 includes medical services, while 90791 does not. The 90792 code requires a medical assessment and can only be used by licensed medical professionals, whereas 90791 is for initial diagnostic interviews without medical services.

How long does a typical 90792 evaluation take?

A comprehensive assessment using the 90792 code typically requires between 60 to 120 minutes. This allows for a thorough evaluation including medical and psychiatric history, mental status examination, diagnosis, and treatment planning.

What are the key documentation requirements for the 90792 code?

Essential documentation includes patient identification details, comprehensive medical and psychiatric history, detailed mental status examination, initial diagnosis, treatment plan, and any medical components such as medication prescriptions or laboratory studies ordered.

How often can the 90792 code be billed for a patient?

Most insurance payers allow billing this code once every six months per client. Medicare typically covers one evaluation per year, unless there's a documented medical necessity for additional assessments. It's important to check specific payer policies for exact frequency allowances.