Wiki 90791 --Help

[mariaher921]

How many times can 90791 be billed? I have read threads from 2014.. but I wanted to know if its been updated. We have LCSW working and I don't know if they have a limit of billing it, because they are billing it more than often, per patient. I can find no information on CMS.. if anyone is familiar with this, any help would be appreciated. Thank you.

 

[MrLittlefoot]

The private payer I work for only pays one. Looking at the Medicare Unlikely Edit list updated for 10/1/18, CMS also only allows this to be billed once per day. Download the practitioner service list to see all of the MUE edits. https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html
This isn't a time based code, if you meet the criteria for a psychiatric diagnostic exam, you can bill the single unit to request reimbursement for it, regardless of how much time it took to meet all the necessary elements.

 

[ckeeney]

Most payers we work with have limits on how often this service may be provided. The exception, sometimes, is if there is a significant change in the patient and then you would have to appeal with documentation. Medicare, for example, allows one every 6 months. You would have to check payer policies on this code.