90792 — Psychiatric Diagnostic Evaluation with Medical Services
A diagnostic evaluation that includes medical services such as physical examination, medication assessment, and prescription management. This code is reserved for physicians (psychiatrists) and other qualified prescribers who are performing an integrated psychiatric and medical evaluation.
Time Requirements
Typically 60-90 minutes. Must include both psychiatric evaluation and medical/medication assessment components.
Modifiers
| Code | Description |
|---|---|
| 95 | Synchronous telemedicine service rendered via real-time audio/video. |
When to Use
- Initial psychiatric evaluation by a prescriber that includes medication assessment
- Comprehensive re-evaluation including medication review by a psychiatrist
- When both diagnostic and medical components are performed in a single encounter
When Not to Use
- When the provider cannot prescribe medication — use 90791 instead
- Follow-up medication management visits — use E/M codes (99213, 99214)
- When only a diagnostic interview is performed without medical services
Common Denial Reasons
- Billed by a non-prescribing provider (therapist, counselor, social worker)
- Documentation does not include a medical/medication component
- Billed on the same day as 90791 without distinct documentation
- Insufficient documentation of diagnostic complexity to justify the code
Payer Notes
Limited to prescribers (MDs, DOs, NPs, PAs with prescriptive authority). Most payers allow one per client episode. Medicare requires that the medical services component be clearly documented.
Frequently Asked Questions
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