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CPT provides distinct codes for psychiatric diagnostic evaluations, differentiating between behavioral health professionals and medical practitioners. These codes define the scope of assessments, settings of service, and documentation requirements. A clear understanding of their application supports accurate reporting, compliance, and appropriate delivery of psychiatric care.
Psychiatric Diagnostic Evaluation Codes
There are two codes for psychiatric diagnostic evaluation:
- 90791 Psychiatric diagnostic evaluation
- 90792 Psychiatric diagnostic evaluation with medical services
90791 Psychiatric Diagnostic Evaluation
90791 is used by psychologists, social workers, and other licensed behavioral health professionals.
According to CPT®, “Psychiatric diagnostic evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies.”
90792 Psychiatric Diagnostic Evaluation with Medical Services
90792 is used by psychiatrists, psychiatric nurse practitioners, and physician assistants because it includes medical services.
CPT® defines it as, “Psychiatric diagnostic evaluation with medical services is an integrated biopsychosocial and medical assessment, including history, mental status, other physical examination elements as indicated, and recommendations. The evaluation may include communication with family or other sources, prescription of medications, and review and ordering of laboratory or other diagnostic studies.”
Additional Guidelines for Psychiatric Diagnostic Evaluation
Repetition of Diagnostic Evaluations
CPT® further states that in some cases, someone other than the patient may be seen who provides the needed information, and that these codes may be billed more than once when two separate diagnostic evaluations are required. These evaluations may be reported more than once for a patient if medically needed. This does not imply that all diagnostic evaluations should be conducted over two sessions, or that the practice should routinely bill two diagnostic evaluations at the start of treatment. A psychiatric diagnostic evaluation may be reported a second time on a patient if there has been a break in service or if a patient has recently been discharged from the hospital, and a new evaluation is required. CPT states that this evaluation may be conducted in two separate sessions on different days and reported twice if information is collected from another person. Although CPT does not set a frequency limit, some payers may impose restrictions on usage.
Service Locations
These services can be performed in any location, including an office, an emergency department, an outpatient department, or an inpatient unit.
Use of Evaluation and Management (E/M) Codes
Psychiatric medical practitioners can use either the code for a psychiatric diagnostic evaluation with Evaluation and Management (E/M) services (90792) or the E/M service code for an evaluation. E/M services are coded using codes for initial inpatient services, observation services, emergency department visits, consults, or new or established patient office/outpatient codes (in addition to nursing home or home visit codes for services provided in those locations). These E/M services are within the scope of service of medical practitioners.
Disadvantages of E/M Codes
The disadvantage to using E/M codes for an initial evaluation is two-fold:
- selecting the correct category of code (new or established patient, inpatient hospital care, ED visit, consult)
- selecting the accurate level of service.
90792 does not include specific requirements for review of systems or the exam. This evaluation may be repeated if the medical condition requires it, for example, an admission to the hospital. However, be aware of denials based on frequency limitations. If using an E/M code, review the requirements for each level of service and the 1997 single specialty psychiatric exam.
Restrictions on Same-Day Services
According to the CPT® book, neither psychotherapy services nor psychotherapy for crisis may be reported on the same day as the psychiatric diagnostic evaluation. Usually, time constraints would mean that psychotherapy couldn’t be provided on the day of the diagnostic evaluation. An E/M service may not be billed on the day of this service, either. If psychotherapy is performed on the day of an evaluation reported as a new or established patient, use an E/M service based on medical decision making for 99202-99215, and add the psychotherapy add-on code. Document a separate section of the note labeled “Psychotherapy”.
MindCare Specialized Billing Support for Psychiatric Diagnostic Services
At MindCare, we bring unmatched expertise to psychiatric diagnostic evaluations and mental health billing. The guidelines we provide are informed by years of working directly with mental health practices, ensuring accuracy in CPT coding, ICD-10 compliance, payer-specific policies, and adherence to documentation standards. From correctly applying codes like 90791, 90792, and 90785 to managing medical necessity requirements and telehealth regulations, every recommendation reflects real-world experience, not theory.
Our knowledge is built on practical solutions that reduce claim denials and improve reimbursement for psychiatrists, psychologists, and behavioral health clinics. We go beyond billing by streamlining processes, ensuring compliance, and safeguarding revenue integrity. MindCare is a trusted partner dedicated to optimizing the financial health of mental health practices while allowing providers to focus entirely on patient care.