Wiki Psychiatric evaluation with medical service 90792

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Hi
I believe it is 2 a year on differ problems. So let us say patient came in for Paranoia on first visit.Then in 6 months come back for new psych problem of PTSD dx F43.12. But get 20 OP session of beh health a year for Medicare patients which is medically necessary
I hope helped you
Lady T.
 
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TThivierge said:
Hi
I believe it is 2 a year on differ problems. So let us say patient came in for Paranoia on first visit.Then in 6 months come back for new psych problem of PTSD dx F43.12. But get 20 OP session of beh health a year for Medicare patients which is medically necessary
I hope helped you
Lady T.
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Thank you Lady T.
I know that based on Medically Necessary the service can be justified to Medicare.
Specifically, my question is directed to the maximum amount of Psych Eval services (90792) that Medicare has established as default.
In CMS there is a lot of documentation on the subject: some say only 1 Psych Eval and others say 2 Psych Eval per fiscal year.

For example, the Medicaid Handbook for Florida says: Medicaid covers 2 Psych Eval w/medical service per client per fiscal year.

It would be good to have exact documentation from Medicare specifying the maximum amount of that service per fiscal year for the client.
 
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guantanamero1974 said:
How many Psych Eval w/medical services (90792) does Medicare allow per fiscal year for the same patient?
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II. Service-specific Guidelines:
  1. 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. The same provider may repeat it for the same patient if an extended break in treatment occurs, if the patient requires admission to an inpatient status for a psychiatric illness, or for a significant change in mental status requiring further assessment. This contractor considers an extended break as approximately 6 months from the last time the patient was seen or treated for their psychiatric condition. A psychiatric diagnostic evaluation may also be utilized again if the patient has a previously established neurological disorder or dementia and there has been an acute and/or marked mental status change, or a second opinion or diagnostic clarification is necessary to rule out additional psychiatric or neurological processes, which may be treatable.
    An E/M service may be substituted for the initial interview procedure provided required elements of the E/M service billed are fulfilled. E/M services require, in addition to the interview and examination, the provision of a written opinion and/or advice. E/M CPT codes do not include a psychotherapy service.
 
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