What is CPT Code 90791 ? When & How To Use It

Before delving into the specific guidelines for using code 90791, let’s examine how this code is most frequently used and how it differs from the similarly-themed code 90792.

“Integrated biopsychosocial assessment, encompassing history, mental status, and recommendations” is denoted by the code 90791. It first appeared in 2013, when code 90801 was replaced by a number of revised mental health CPT codes.

Code 90792 and code 90701 were developed concurrently, and many practitioners frequently become perplexed by these two codes. The only significant distinction between the two numbers is that code 90792 covers medical services like filling a prescription. This makes code 90792 only available to psychiatrists and other qualified medical personnel.

Understanding CPT Codes Can Help You Expand Your Practice

For a therapy practice to be wholesome and long-lasting, numerous factors are required. Even though billing isn’t generally thought of as an exciting subject, it’s one of the most crucial parts of establishing a solid foundation for your practice. Additionally, knowing your CPT codes is crucial for receiving accurate payment for the services you render.

What Conditions Must Be Met to Use Code 90791?

Code 90791 is widely used since it is flexible and covers a wide range of evaluations. Its use is however constrained by a few regulations, and if you are unaware of these guidelines, being compensated may prove difficult.

First off, most payers only reimburse the code once a year per client, even though some enable providers to charge this code every six months. This is why initial evaluations and yearly progress reviews frequently use code 90791.

What information should I write down for CPT code 90791?

A diagnostic assessment is the normal supporting document for an intake session that you will be using CPT code 90791. Each state in the US will have its own requirements, but they are generally similar. These are the diagnostic standards of Minnesota, where CPT30 was put up. 

Can I use my license to bill CPT code 90791?

Contrary to CPT code 90792, CPT code 90791 does not require billing by a qualified medical professional. CPT code 90791 is typically used by clinical psychologists, licensed professional clinical counselors, licensed marriage and family therapists, and licensed clinical social workers.

Is pre-authorization required for CPT code 90791?

It varies. Some plans do, while others don’t (the majority don’t). It’s best to call the client’s payer and confirm that an intake session is covered without pre-authorization, even if you may already be aware of this.

CPT Code 90791 Duration

Before applying an add-on CPT code to specify session length, the Centers for Medicare Services (CMS.gov) stipulates that CPT code 90791 must be at least 16 minutes long and at most 90 minutes long. 

Why Outsource? 

You may feel confident that professionally educated professionals are using all the proper codes when you outsource medical billing requirements to a third-party company like Medisys Data Solutions.  At  Medisys Data Solutions, we advise our therapists to complete an intake session for at least 60 minutes. We assist providers by attaching the proper add-on code to their claim if they require assistance charging their intake sessions that last more than 90 minutes.

Wrapping Up 

You may have to wear several different hats if you’re a single practitioner or have a small but expanding practice with no administrative support. The majority of mental health professionals have little to no formal training in medical billing and coding  procedures, which puts them at risk of experiencing severe delays in their inflow of funds. You should not make the mistake of resorting to your in-house team and rather pick professionals such as Medisys Data Solutions. We’re merely one tap away!