90791 Add-on CPT Codes for Time Based Billing If the diagnostic interview lasts longer than 90 minutes, please use the following CPT codes to designate added time: Add-On CPT Code +99354 — An additional 30-45 minutes of time Use 90791 + 99354 if your session is between 90 and 120 minutes (1.5 to 2 hours)
Full Answer
How much does Medicare reimburse for diagnostic interviews?
The following diagnostic interview reimbursement rates set by the Center for Medicare Services: CPT Code 90791 Reimbursement Rate (2021): $180.75 — Psychiatric diagnostic interview performed by a licensed mental health provider for 20 to 90 minutes in length.
How many times can you do a psychiatric diagnostic interview?
A. Psychiatric Diagnostic Interview Examination (90791, 90792) A psychiatric diagnostic evaluation or a psychiatric diagnostic evaluation with medical services can be conducted once, at the onset of an illness or suspected illness.
What is the CPT code for mental health?
CPT Code 90791 Reimbursement Rate (2021): $180.75 — Psychiatric diagnostic interview performed by a licensed mental health provider for 20 to 90 minutes in length. CPT Code 90791 Reimbursement Rate (2020): $145.44. CPT Code 90792 Reimbursement Rate (2021): $201.68
Can a psychiatric evaluation be completed multiple times in one day?
In some cases, for various reasons, psychiatric evaluations (CPT® codes 90791/90792) are completed in multiple sessions that occur on different days. In this situation, the DOS that should be reported on the claim is the DOS on which the service (based on CPT® code description) concluded.
Does 90791 have a time limit?
The Centers for Medicare Services have specific requirements that require CPT Code 90791 to be at least 16 minutes and not more than 90 minutes in the designated session time, with 60-minutes being the typical standard.
How many times can 90791 be billed?
How Frequently Can 90791 Be Billed for a Client? This depends on the insurance and the plan and if you're not sure, call the insurance. Typically Medicare and Medicaid plans allow 90791 once per client per provider per year. Other plans will allow as frequently as once per 6 months.
Does Medicare pay for 90791?
Required Session Components for Code 90791 According to Medicare, each session billed with code 90791 must include the following (or have the following characteristics): Elicitation of a complete medical and psychiatric history. Mental status examination.
What is a CPT 90791 Psyc DX interview XM?
According to the CPT manual, 90791 is an “integrated biopsychosocial assessment, including history, mental status, and recommendations.” The manual goes on to say that the evaluation may include “communication with family or other sources and review and ordering of diagnostic studies.”
What is the CPT time rule?
When only one service is provided in a day, providers should not bill for services performed for less than 8 minutes. For any single timed CPT code in the same day measured in 15 minute units, providers bill a single 15-minute unit for treatment greater than or equal to 8 minutes through and including 22 minutes.
Can 90791 and 90832 be billed together?
Behavioral health assessment/evaluation and psychotherapy Do not bill CPT codes 90791-90792 and 90832- 90838. These codes are not billable on the same date to the same member by the same provider.
How many times a year can you bill 90792?
When billing for Medicare, CMS will allow only one claim of 90791 or 90792 in a year. However, in some cases, depending on the medical necessity, Medicare might allow reimbursement for more than one unit of 90791 or 90792.
Is 90792 a time based code?
CPT Code 90792 Time Length Providers require at minimum 60 minutes up to 120 minutes of time to render an exhaustive diagnostic interview and examination of their mental health clients in order to code procedure code 90792.
What is the difference between CPT 90791 and 90792?
There are two codes for psychiatric diagnostic evaluation. 90791 is used by psychologists, social workers and other licensed behavioral health professional and 90792 is used by psychiatrists and psychiatric nurse practitioners and physician assistants, because it includes medical services.
Does 90791 require a modifier?
You can use an HO modifier with all of the standard procedure codes for mental health. 90791, 90834, 90837, etc.
How long is a 90832 session?
16–37 minutesKey facts for utilizing psychotherapy codesCPT CodeTotal Duration of Psychotherapy Session9083216–37 minutes9083438–52 minutes9083753 or more minutes90846, 9084726 or more minutes
Who can bill for CPT code 99484?
The BHI codes (99492, 99493,99494, and 99484) can be billed (directly reported) by physicians and non- physician practitioners whose scope of practice includes evaluation & management (E/M) services and who have a statutory benefit for independently reporting services to Medicare.
How long is CPT 90791?
The Centers for Medicare Services (CMS.gov) requires CPT code 90791 to be 16 minutes in length at minimum and 90 minutes of length at maximum before using an add-on CPT code to designate session time. ( Source) At TheraThink, we recommend our providers spend at least 60 minutes performing an intake session. If a provider does need help billing ...
What is the difference between CPT 90791 and 90792?
Like 90791, it is defined as a psychiatric diagnostic evaluation. The only distinction is that 90792 includes medical services done by a physician. This means that only medically licensed professionals, such as a psychiatrist, can bill 90792.
Can you bill for CPT code 90791?
Billing for CPT Code 90791 can be performed by the following licensed mental health professionals: If you have a different license, odds are high you are not eligible to perform a diagnostic evaluation, and as such you are not able to specify a mental health diagnosis for that client.
Does 90791 pay more per session than 90834?
Yes! 90791 almost always pays more per session than 90834 or 90837. The exact payment depends on the credentialing of the provider rendering services and the insurance plan. In our experience, 90791 is typically allowed at +35-75% of the 90834 reimbursement rate and +10-50% of the 90837 reimbursement rate.
Is 90791 an outpatient appointment?
90791 is considered a routine outpatient appointment, so typically no authorization is required. But like any procedure code, exceptions do exist depending on the plan and insurance company. Some insurance companies like United Health Care (UHC) will grant one authorization for 90791 and a separate one for 90834 or 90837 EAP sessions.
Is CPT code 90791 covered by Medicare?
These rates are at the upper level of reimbursement for CPT Code 90791 and because Medicare is picking these rates, they are specifically for LCSWs. If you have a different license that is not a PhD or MD, you should plan on lower rates than this from commercial insurance policies and Medicaid, in general.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Psychiatry and Psychology Services.
ICD-10-CM Codes that Support Medical Necessity
The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related determination.
ICD-10-CM Codes that DO NOT Support Medical Necessity
Severe and profound intellectual disabilities (ICD-10-CM codes F72, F73, and F79) are never covered for psychotherapy services or psychoanalysis (CPT codes 90832-90840, 90845-90849 and 90853). In such cases, rehabilitative, evaluation and management (E/M) codes should be reported.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What is crisis psychotherapy?
Psychotherapy for Crisis. A crisis psychotherapy session requires urgent assessment and history of the crisis state, mental status exam and disposition. To be considered crisis psychotherapy, the presenting problem must be life-threatening or complex and require immediate attention to a patient in high distress.
Does Medicare cover depression screening?
Medicare makes a limited number of screening services available to beneficiaries at no cost. Depression screening: Medicare covers one depression screening per year if the screening is done in a primary care setting (such as a physician’s office) that can provide follow-up treatment and referrals.
Does Medicare cover psychotherapy?
Medicare covers a psychiatric diagnostic interview, inpatient and outpatient psychotherapy services, psychotherapy for crisis situations and psychoanalysis. There are a number of different procedure codes for the various types of psychotherapy (i.e., individual, family, group) and MACs may have LCDs that set certain restrictions ...
Has the code for psychotherapy been revised?
Not all of the psychotherapy codes have been revised. The code numbers and descriptions for psychoanalysis, family psychotherapy (with and without the patient), multifamily group psychotherapy and group psychotherapy did not change in 2013.
Can a psychologist bill Medicare for 90863?
Designed to allow prescribing psychologists to bill for pharmacologic management, code 90863 cannot yet be reported by psychologists when treating Medicare beneficiaries. Medicare, which does not have a separate category for prescribing psychologists, does not recognize prescribing or monitoring medication as part of a psychologist’s scope of practice. Code 90863 is an add-on code that captures prescribing and reviewing medication and must be billed along with a code for a psychotherapy service.
What is Medicare preventive visit?
A one-time “Welcome to Medicare” preventive visit. This visit includes a review of your possible risk factors for depression. A yearly “Wellness” visit. Talk to your doctor or other health care provider about changes in your mental health. They can evaluate your changes year to year.
What is deductible in Medicare?
deductible. The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. applies. If you get your services in a hospital outpatient clinic or hospital outpatient department, you may have to pay an additional. copayment.
What is a health care provider?
health care provider. A person or organization that's licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers. to diagnose or treat your condition.
Do you pay for depression screening?
You pay nothing for your yearly depression screening if your doctor or health care provider accepts assignment. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges.
Most Common Psychiatry CPT Codes
While there are many obscure and obtuse CPT Codes for Psychiatr y, it’s most efficient to learn the most commonly billed psychiatry CPT codes and their corresponding time allotments.
Medicare Reimbursement Rates for Psychiatrists
Medicare pays psychiatrists surprisingly well. Unfortunately, they now require electronic billing, which involves complex online enrollments for completion.
Medicaid Reimbursement Rates for Psychiatrists
Medicaid rates vary by state plan, carrier, and plan, so these rates below are a rough guide to compare against Medicare rates.
Commercial Insurance Reimbursement Rates for Psychiatrists
Commercial insurance rates vary dramatically across companies. Some rates are actually lower by 5% than Medicaid rates.
Maximize Your Reimbursement
While it’s useful to know about the reimbursement rates for psych services, what is more important is knowing how to successfully bill these various CPT codes to the appropriate payer, knowing your claims will be paid.
When should CPT codes be used for psychotherapy?
Individual psychotherapy CPT codes should be used only when the focus of treatment involves individual psychotherapy . These CPT codes should not be used as generic psychiatric service CPT codes when other CPT codes such as an evaluation and management (E/M) service or pharmacological codes would be more appropriate.
What is the CPT code for psychological testing?
CPT codes 96101, 96102, 96103, 96105, 96110, and 96111 are appropriate for use when billing for psychological tests. CPT codes 96116, 96118, 96119 and 96120 are appropriate for use when billing for neuropsychological tests. All of the tests under this CPT code range 96101-96120 are indicated as active codes under the physician fee schedule database and are covered if medically necessary.
What is the Medicare Part B deductible?
Regardless of the actual expenses a beneficiary incurs for treatment of mental, psychoneurotic, and personality disorders while the beneficiary is not an inpatient of a hospital at the time such expenses are incurred , the amount of those expenses that may be recognized for Part B deductible and payment purposes is limited to 62.5 percent of the Medicare allowed amount for those services. This limitation is called the outpatient mental health treatment limitation. Expenses for diagnostic services (e.g., psychiatric testing and evaluation to diagnose the patient’s illness) are not subject to this limitation. This limitation applies only to therapeutic services and to services performed to evaluate the progress of a course of treatment for a diagnosed condition (CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 12, §210).
What is the CPT code for speech language pathology?
Occupational therapists and speech language pathologists uses CPT code 96125 when they perform test on patients who have compromised functioning abilities due to acute neurological events such as traumatic brain injury or cerebrovascular accident (CVA) and must undergo assessment to determine if function abilities such as orientation, memory and high-level language function have been compromised and to what extent
What is a psychiatric psychologist?
Psychiatry and Psychology are specialized fields for the diagnosis and treatment of various mental health disorders and/or diseases. References to providers include physicians and non-physicians, such as clinical psychologists, independent psychologists, nurse practitioners, clinical nurse specialists and physician assistances when the services performed are within the scope of their state license and clinical practice/education.
What is CPT code 90862?
CPT code 90862 refers to the in-depth management of psychopharmacologic agents that are potent medications with frequent serious side effects, and represents a very skilled aspect of patient care .
What is the CPT code for a biopsychosocial assessment?
Use of code 90791 is not limited to physicians. The CPT code book says that 90791 includes “an integrated biopsychosocial assessment, including history, mental status, and recommendations.”. There is a separate piece that describes the medical services to make it 90792.
What is a psychiatric evaluation?
Psychiatric Diagnostic Evaluation. A psychiatric diagnostic evaluation is an integrated assessment that includes history, mental status and recommendations. It may include communicating with the family and ordering further diagnostic studies.
What is a 90791 evaluation?
Psychiatric Diagnostic Evaluation without medical services (90791) The evaluation may include communicating with family or other sources, as well as reviewing and ordering non-medical diagnostic studies. Psychiatric Diagnostic Evaluation with medical services (90792) As above (90791), the evaluation may include communicating with family ...
What is the CPT code for a physical therapist?
Physical Therapists (PTs), Occupational Therapists (OTs), and Speech Language Pathologists (SLPs) may perform services represented by CPT codes 96105, 96111 and G0451; under the general supervision of a physician or a CP.
What is mental assessment?
Assessment of mental functioning for individuals with suspected or known mental disorders for purposes of differential diagnosis or treatment planning. Assessment of patient strengths and disabilities for use in treatment planning or management when signs or symptoms of a mental disorder are present.
Can you report a psychotherapy evaluation more than once?
Cannot be reported with a psychotherapy service code on the same day. May only be reported once per day. May be reported more than once for a patient when separate evaluations are conducted with the patient and other informants (i.e., family members, guardians, significant others) on different days.
Is interactive procedure reasonable?
The indication for the assessment should be based on medical necessity and supported in the medical record. Interactive procedures may be necessary and considered reasonable and necessary for patients whose ability to communicate is impaired by expressive or receptive language impairment from various causes.