CPT Code 90792: Psychiatric Diagnostic Evaluation with Medical Services
Reviewed against AMA CPT and CMS guidance. See sources.
What is CPT 90792?
CPT 90792 is the psychiatric diagnostic evaluation with medical services. It covers the same biopsychosocial assessment as 90791 plus medical elements such as medication review, physical or neurological examination, and prescribing decisions. It is untimed and is billed by physicians and other prescribers, such as psychiatric nurse practitioners and physician assistants, within their scope.
A diagnostic evaluation that includes medical services such as physical examination, medication assessment, and prescription management. This code is used by physicians (psychiatrists) and other qualified prescribers performing an integrated psychiatric and medical evaluation.
Time Requirements
Not a timed code. CPT sets no minimum duration. The evaluation must include both the psychiatric diagnostic assessment and medical services.
Modifiers
| Code | Description |
|---|---|
| 95 | Synchronous audio-video telehealth. Many payers also require a telehealth place of service code (02 or 10). |
| 93 | Synchronous audio-only service, where the payer allows audio-only care. |
Billing a session by video or phone? See telehealth modifiers 95, 93, GT and POS 02 vs 10.
When to Use
- Initial psychiatric evaluation by a prescriber that includes medication assessment
- Comprehensive re-evaluation including medication review by a psychiatrist or psychiatric nurse practitioner
- When both diagnostic and medical components are performed in one encounter
When Not to Use
- When the clinician does not provide medical services: use 90791
- Follow-up medication management visits: use E/M codes such as 99213 or 99214
- On the same day as an E/M service or psychotherapy by the same clinician
- When only a diagnostic interview is performed without medical services
What to Document for CPT 90792
- Full psychiatric history and mental status examination
- Medical elements: medication history and review, relevant physical or neurological findings, labs ordered or reviewed
- Risk assessment
- Diagnosis with ICD-10-CM codes
- Medication plan and other treatment recommendations
Common Denial Reasons
- Billed by a clinician who cannot provide medical services (therapist, counselor, social worker)
- Documentation has no medical or medication component
- Billed on the same day as an E/M or psychotherapy service by the same clinician
- Documentation does not support a full diagnostic evaluation
Payer Notes
Limited to clinicians who can perform medical services within their license, typically psychiatrists and other physicians, and in many states nurse practitioners and physician assistants. Many payers allow one per client per episode. Payer rules vary.
ICD-10 diagnosis codes
Every claim pairs the CPT code with the diagnosis the clinician documented. See the mental health ICD-10 code reference or a condition guide:
Related Codes
Frequently Asked Questions
Can an NP or PA bill 90792?
Usually yes, when state scope of practice and payer enrollment allow them to provide medical services. The medical component must be documented. Check state law and each payer.
What is the difference between 90791 and 90792?
Both are untimed diagnostic evaluations. 90792 adds medical services such as medication evaluation or physical examination, so only clinicians who can provide medical services use it. Therapists, counselors, social workers, and psychologists bill 90791.
Can I bill 90792 and an E/M visit on the same day?
No. CPT does not allow 90791 or 90792 on the same date as an E/M service by the same clinician. Choose the code that best describes the visit.
Can I add psychotherapy to a 90792 visit?
Not on the same day by the same clinician. Psychotherapy add-on codes (90833, 90836, 90838) pair with E/M codes, not with 90792.
Sources: American Medical Association (AMA), CPT Professional codebook: code descriptors, psychotherapy time rules, and add-on code guidance. Centers for Medicare & Medicaid Services (CMS): Medicare Physician Fee Schedule and National Correct Coding Initiative (NCCI) policy.
- AMA: CPT overview
- CMS: National Correct Coding Initiative (NCCI) edits
- CMS Medicare Coverage Database: Billing and Coding, Psychiatry and Psychology Services (A57480)
- CMS: Physician Fee Schedule relative value files
- CMS MLN901705: Telehealth and Remote Monitoring (PDF)
Payer rules vary. Confirm coverage, time, modifier, and documentation rules with each payer before billing. This page is general education, not billing or legal advice.
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