What Is CPT Code 90791? – Demystified!

CPT code 90791 is a specific billing code utilized within the medical field, particularly in the realm of behavioral health. This code signifies a psychiatric diagnostic evaluation, which is an in-depth assessment of a patient’s mental health.

The evaluation is conducted by a licensed behavioral health professional and encompasses a thorough review of the patient’s medical and psychiatric history. Additionally, the evaluation includes a mental status examination, which is a structured assessment of the patient’s cognitive, emotional, and behavioral functions.

Based on the findings from this evaluation, the professional will provide recommendations for the most appropriate treatment interventions.

Who can use CPT code 90791?

CPT Code 90791 doctor

But who exactly is qualified to use this CPT code? The answer is a range of licensed behavioral health professionals. These professionals have undergone specialized training and have met the necessary licensure requirements to provide psychiatric evaluations.

Here’s a breakdown of the professionals who can use CPT code 90791:

  1. Psychiatrists: Medical doctors who specialize in the diagnosis, treatment, and prevention of mental illnesses and disorders. They can prescribe medications and offer psychotherapy.
  2. Clinical Psychologists: Professionals trained in the science of behavior and mind. They provide psychological testing, diagnosis, and treatment, often through various forms of psychotherapy.
  3. Licensed Clinical Social Workers (LCSWs): These are social workers who have a clinical focus. They are trained to provide psychotherapy and help individuals deal with a variety of mental health and daily living challenges.
  4. Licensed Professional Counselors (LPCs): These counselors are trained to diagnose and treat mental and emotional disorders. They provide counseling and therapy to individuals, groups, and families.
  5. Licensed Marriage and Family Therapists (LMFTs): These therapists specialize in interpersonal relationships and treat individuals, couples, and families. They address issues related to marriage, family, and relationship dynamics.

When is CPT code 90791 used?

CPT code 90791 is a designated billing code in the medical field, specifically for behavioral health services. This code is primarily employed for the psychiatric diagnostic evaluation of a patient. Such evaluations are crucial, especially when a patient presents with new or previously undiagnosed behavioral health concerns or illnesses.

The code serves as a marker for these initial evaluations, ensuring that the patient’s mental health is thoroughly assessed from the outset. However, the use of CPT code 90791 is not limited to just initial evaluations.

In instances where a patient returns for a follow-up appointment and there’s a notable change in their mental or emotional state, this code can be used again. This ensures that any significant shifts in the patient’s condition are adequately addressed, even if they have been previously evaluated.

What does a CPT code 90791 evaluation typically include?

CPT Code 90791 patient

The evaluation associated with CPT code 90791 is comprehensive and designed to provide a holistic understanding of the patient’s mental health. Here’s a detailed breakdown of what such an evaluation encompasses:

  1. Comprehensive History: This is a thorough review of the patient’s medical and psychiatric background. It delves into past illnesses, treatments, hospitalizations, and any other relevant medical or psychiatric events. This history provides context and can offer insights into the patient’s current condition.
  2. Mental Status Examination: A structured assessment that evaluates the patient’s cognitive, emotional, and behavioral functions. It examines various aspects like thought processes, mood, perceptions, and more. This examination is pivotal in understanding the patient’s current mental state and any potential disorders.
  3. Review of Medications and Treatment History: This involves a detailed look at any medications the patient is currently taking or has taken in the past. It also reviews previous treatments, therapies, or interventions the patient has undergone. This review can highlight what treatments have been effective or ineffective, guiding future therapeutic decisions.
  4. Physical Examination: While the primary focus of the 90791 code is on psychiatric evaluation, a physical examination might be conducted if deemed necessary. Sometimes, physical health issues can manifest as or exacerbate mental health symptoms, so it’s essential to rule out any underlying medical conditions.
  5. Recommendations for Treatment: Based on all the gathered information, the professional will outline a treatment plan tailored to the patient’s needs. This could include therapy, medications, lifestyle changes, or a combination of various interventions.

How long does a CPT code 90791 evaluation typically take?

The CPT code 90791 evaluation, also known as a psychiatric diagnostic evaluation, is a comprehensive assessment designed to understand a patient’s mental health condition thoroughly. Typically, this evaluation is scheduled for 60 minutes, giving the healthcare professional ample time to delve into the patient’s medical and psychiatric history, conduct a mental status examination, and gather other pertinent information.

However, it’s essential to note that the duration of the evaluation isn’t set in stone. Depending on the intricacies of the patient’s case, the evaluation might take longer.

For instance, if a patient has a complex history or presents with multiple symptoms, the professional might need more time to ensure a thorough assessment.

What is the reimbursement rate for CPT code 90791?

Reimbursement rates for medical services, including the CPT code 90791 evaluation, can vary widely based on several factors. One of the primary determinants is the patient’s insurance plan.

On average, the reimbursement rate for this evaluation falls within the range of $200 to $300. However, it’s crucial for healthcare providers to check with individual insurance companies or consult the latest fee schedules to get accurate and up-to-date reimbursement rates.

What modifier is needed for CPT code 90791?

CPT Code 90791 calculation

Modifiers are essential in the medical billing process as they provide additional information about the service rendered. For CPT code 90791:

  • The modifier HO is used to signify that the evaluation was conducted by a non-psychiatrist. This could be any other licensed behavioral health professional, such as a clinical psychologist or a licensed clinical social worker.
  • On the other hand, the modifier HP indicates that a non-psychiatrist performed the evaluation, but it took place in a hospital setting. This distinction is crucial as the setting can influence reimbursement rates.

Additional Resources

For those seeking further information or clarification on CPT codes, billing, and related topics, several reputable resources can be consulted:

  1. The American Medical Association (AMA): As the organization that publishes the CPT code manual, the AMA’s website is a valuable resource for all things related to medical coding and billing.
  2. The Centers for Medicare & Medicaid Services (CMS): CMS’s website offers a wealth of information, especially for providers who cater to Medicare and Medicaid patients. They provide updates on reimbursement rates, policies, and other essential topics.
  3. The National Alliance on Mental Illness (NAMI): While not specifically focused on billing, NAMI’s website is an excellent resource for understanding mental health conditions, treatments, and advocacy efforts.


What is the difference between CPT code 90791 and CPT code 90792?

The main difference between CPT code 90791 and CPT code 90792 is that CPT code 90792 includes medical services, such as ordering and interpreting diagnostic tests. CPT code 90791 does not include medical services.

How do I find a behavioral health professional who accepts my insurance?

The best way to find a behavioral health professional who accepts your insurance is to contact your insurance company. They can provide you with a list of providers in your area who are in-network.

You can also search online for behavioral health professionals in your area.

What are the benefits of seeking a psychiatric evaluation?

A psychiatric evaluation can help you to get a diagnosis for your mental health condition. This can be helpful in getting the right treatment.

A psychiatric evaluation can also help you to understand your condition and how to manage it.

Closing Thoughts

CPT code 90791 is a valuable tool for assessing patients with new or changing behavioral health concerns. It can help providers to develop an accurate diagnosis and make appropriate treatment recommendations.

If you are seeking mental health services, be sure to ask your provider if they use CPT code 90791 for their initial evaluations.