# Billing frequency of CPT 90791 and 90792



## tamaramorrow (Jun 25, 2018)

Good Afternoon,

Can someone please assist me. We are a Behavioral Health Clinic (FQHC). How often can the above CPt's be billed? is it considered an initial visit or subsequent or both? unable to find a specific billing guideline from CMS. Thank you!


----------



## twhite@work (Jun 25, 2018)

*Frequency of 90791 and 90792*

Once per day there is a MUE of 1 with a MIA of 3 which means the code has a date of service edit allowing for it to be billed only once per day
MAI 3: Date of Service Edit: Clinical
MUE MAI "3" indicates a date of service (DOS) edit based on clinical benchmarks. Payers who apply the MUE sum the code's same-DOS units (not counting lines with modifier 55). If the sum exceeds the MUE value, the payer will deny same-DOS lines with that code on the current claim. *MACs may pay excess units upon appeal or may bypass the MUE based on documentation of medical necessity.*
Also Try Medicare LCD L34616 for specific guidelines. 
Since you are a FQHC read this also https://www.cms.gov/Medicare/Medica...Downloads/FQHC-PPS-Specific-Payment-Codes.pdf 
There are some specific codes that represent these code (90791,90792) for a IPPE and Annual Well Visit for Medicare patients G0469-New patient and G0470 Established patient.

Hopes this helps. I used to work for and FQHC and some of the guidelines are specific to FQHC's only and it can make it a little more challenging to find info.


----------

