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Home Posts What is CPT Code 90791? When and How to use it?

What is CPT Code 90791? When and How to use it?

CPT Code 90791

Introduced in the year 2013 the CPT 90791 is one of a plethora of diagnostic codes used in medical billing. The CPT code 90791 is specific to psychiatric and psychosocial diagnostic examinations and was articulated to replace the previously implemented code 90801. 

The CPT code 90791 can be used in various applications by either licensed professional counselors, clinical psychologists, licensed marriage and family therapists or licensed social workers which is a testament to its adaptable nature. 

The main advantage of using this code over other codes such as the 90837 or 90834, implying to individual psychotherapy sessions for 45 and 60 minutes respectively, is the fact that implementing CPT code 90791 in many cases does not require any pre authorisation, although some plans might require you to do so anyway. 

CPT Code 90791 and Medicare

Apart from medical necessity, medicare allows only one payment per year related to the CPT code 90791. In case of a patient being organically diagnosed with a particular mental health issue, the diagnosis has to be billed. 

When to use CPT Code 90791?

The CPT code is known for its applications in a plethora of examinations and adaptability, making it a popular contender. 

On the other hand there are some prerequisites in place which constrain its use. One needs to be aware of these prerequisites for smooth reimbursement processing. 

Firstly, the frequency of use might vary on a yearly basis depending on the payers discretion. Some may allow bi annual use whereas some only allow for single use per year per client. 

This is the main reason why the CPT code 90791 is generally implemented for annual progress examination and preliminary evaluations.

The procedure to be adopted when implementing the CPT code 90791 must include what constitutes any particular session. According to medicare every session conducted under the code 90791 must comply to or fulfill the following requirements:

  • A comprehensive explanation of medical and psychiatric history.
  • Mental states evaluation
  • Assessment of the patient’s capability to handle treatment
  • Preliminary treatment plan
  • Daily reporting
  • Coverage at the outset 
  • The E/M service was not reported separately, as it was performed by the same provider on the same day.

Usually private practitioners also follow the same prerequisites as medicare. Every provider has distinct requirements hence it is important to confer with specific insurance providers to know their particular criterion before using the CPT code 90791. 

Documentation Needed for CPT Code 90791

Before implementing CPT code 90791 there also have to be some other requirements that need to be met regarding specific documentation that has to be presented which comprise of:

  • Exact Time keeping
  • Modalities and frequency
  • Clinical notes that should include:
  • Diagnosis
  • Symptoms
  • Functional status 
  • Mental status evaluation
  • Treatment plan, prognosis, and progress
  • Name, signature and credentials of the person providing the service

Among the  several prerequisites for the sustained functioning of any therapy practice billing, seemingly a boring prospect, is a necessary aspect. It is important to be aware of the particular CPT codes for the services you provide for smooth and accurate reimbursements. CPT code 90791 is one such code which must be implemented when required.

 

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