The first visit with a mental health patient is billed as a Psychiatric Diagnostic Evaluation. Choosing between CPT 90791 and 90792 ↗ depends entirely on the credentials of the provider.
90791: Without Medical Services
CPT 90791 is billed by providers who cannot prescribe medication, such as Licensed Clinical Social Workers (LCSW), Clinical Psychologists (PhD/PsyD), and Licensed Professional Counselors (LPC). It involves assessing the patient's psychosocial history and formulating a diagnosis.
90792: With Medical Services
CPT 90792 is billed by providers who have prescribing authority, such as Psychiatrists (MD/DO) and Psychiatric Nurse Practitioners (PMHNP). It includes everything in 90791, PLUS a medical assessment, physical exam elements, and prescription drug management.
Medical Necessity & Frequency limits
Most payers only allow one psychiatric diagnostic evaluation per patient, per provider, per year. If the patient needs to be re-evaluated later, standard E/M or psychotherapy codes are used.
NCCI Edits
Do not bill 90791 or 90792 on the same day as a standard psychotherapy code (e.g., 90832) or an E/M visit (e.g., 99204). The evaluation inherently encompasses all time and effort on that first day.