CPT code and Description

90791 Psychiatric Diagnostic Examination without medical services

90792 Psychiatric Diagnostic Examination with medical services

+90785 – Use the add-on code with 90791 or 90792 for interactive psychiatric diagnostic interview examination using play equipment, physical devices, language interpreter, or other mechanisms of communication

Billing Guidelines

Limits – One psychiatric diagnostic interview exam allowed per client, per provider, per calendar year

A psychiatric diagnostic interview exam (CPT code 90791 or 90792) and a psychological testing (CPT codes 96130, 96131, 96136, 96137, 96138 and 96139) cannot be billed on the same day, without prior authorization.

Billing for professional services in an emergency room setting for a client who is transferred to another facility for an inpatient psychiatric admission

Psychiatric Diagnostic Evaluation without medical services (90791)The evaluation may include communicating with family or other sources, as well as reviewing and ordering non-medical diagnostic studies.

Psychiatric Diagnostic Evaluation with medical services (90792) As above (90791), the evaluation may include communicating with family or other sources, as well as reviewing and ordering diagnostic studies. It must include medical services. “Medical services” refers to “medical thinking” as well as medical activities (eg, physical examination, prescription of medication, and review and ordering of medical diagnostic tests). Medical thinking must be documented (eg, consideration of a differential diagnosis, medication change, change in dose of medication, drug-drug interactions).

For both 90791 and 90792:

• In certain circumstances one or more other informants (family members, guardians, or significant others) may be seen in lieu of the patient.
• Both codes may be reported more than once for the patient when separate diagnostic evaluations are conducted with the patient and other informants on different days.
• Use the same codes, for later reassessment, as indicated.
• Do not report on the same day as psychotherapy or an E/M service.
• If present, the interactive complexity component of the diagnostic evaluation is captured by reporting the interactive complexity add-on code 90785 in conjunction with 90791 or 90792.

Outpatient psychiatric services and limitations

See the Mental Health Services Coverage Table for covered mental health services. The agency pays for only one psychiatric diagnostic interview exam (CPT® codes 90791 or 90792) per client, per provider, per calendar year.

Professional services for involuntarily admitted clients

Each involuntarily committed person must be examined and evaluated by a licensed physician or P-ARNP within 24 hours of admission or payment will be denied. This evaluation may be used for both treatment purposes and court testimony. Bill admissions through the emergency room using either CPT® code 90791 or 90792.

Psychiatric Diagnostic Evaluation Procedure Codes: 565-90792

Two new codes distinguish between:

90791: an initial evaluation without medical services includes the following:
• Biopsychosocial assessment including history, mental status and recommendations and may include:
• communication with family, others, and
• review and ordering of diagnostic studies

90792: an initial evaluation with medical activities provided only by a medical provider includes those services in 90791 and:
• Medical assessment Physical exam beyond mental status (when appropriate)
• May include:
• communication with family, others,
• prescription medications, and
• review and ordering of laboratory or other diagnostic studies
• Reporting Psychiatric Diagnostic Procedures
• Each Psychiatric Diagnostic Codes may be reported only once per day (unless seeing the client and significant other separately).
• 90791 Psych Diag Eval may be provided by a non-medical provider on the same day 565-90792 Psych Diag Eval with Medical Component is provided by a medical provider (psychiatrist/ANP/PA).
• Cannot be reported with an E/M code on same day by same individual provider.
• Cannot be reported with psychotherapy service code on same day by any provider.
• May be reported more than once for a client when separate diagnostic evaluations are conducted with the client and other collaterals (such as family members, guardians, and significant others).

1. Diagnostic evaluation for child with child.
2. Diagnostic evaluation for child with caretaker.

Telemedicine Services

First Choice covers telemedicine services for providers who are currently enrolled with the South Carolina Healthy Connections Medicaid program and bill for telemedicine and telepsychiatry when the service is within the scope of their practice. The communication system must be HIPAA compliant. Covered Telemedicine services includes:
• Office or other outpatient visits (99201 – 99215)
• Inpatient consultation (99251-99255)
• Psychotherapy, (90832, 90834, and 90837)
• Psychiatric diagnostic interview examination (90791 and 90792)
• Neurobehavioral status examination (96116)
• Electrocardiogram interpretation and report only (93010)
• Echocardiography (93307, 93308, 93320, 93321 and 93325)
For behavioral health: Psychiatric diagnostic assessment with/without medical evaluation, 90791/90792, for adults (ages 19 and over) are subject to the $3.30 co-pay when rendered by a medical doctor or nurse practitioner. No other co-pays or deductibles apply for persons receiving behavioral health services