Primary Care Coding Alert

Question: How often is it possible to bill 90791 and/or 90792 per Medicare guidelines?

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Answer: CPT^® codes 90791 (Psychiatric diagnostic evaluation) and 90792 (Psychiatric diagnostic evaluation with medical services) describe two different services where your provider collects information about a patient’s present and past behavior and obtains a past family, medical, and social history for a diagnostic evaluation of that patient in the case of 90791, and adds medical services, such as a physical exam and medication administration and management, to that behavioral evaluation in the case of 90792.

According to Medicare Local Coverage Determination (LCD) L31887, the services can be “reported once per day and NOT on the same day as an E/M [evaluation and management] service performed by the same individual for the same patient” and are “covered once at the outset of an illness or suspected illness” (Source: https://downloads.cms.gov/medicare-coverage-database/lcd_attachments/31887_33/Outpatient_Psych_Fact_Sheet09.18.14.pdf). However, checking with your payer will definitely be a good idea before billing for the services.