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90791
Quick jump to procedure code: Printer Friendly Version
90832

CPT® 90792: PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES

Short Description: Psych diag eval w/med srvcs

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$146.54
$142.24

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $125.04


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5841
Psychotherapy

2016 OPPS Status Indicator: Q3

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
No ICD-9 claims data for this code.

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

90792 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 90792

CCI and MUE Edits*         Hide this section.

CCI Edits for 90792
Denied Codes (1)
Effective
Modifier
Accepted (2)
0359T Behavioral id assessment
10/01/2014 No
0360T Observ behav assessment
10/01/2014 No
0361T Observ behav assess addl
10/01/2014 No
0362T Expose behav assessment
10/01/2014 No
0363T Expose behav assess addl
10/01/2014 No
0364T Adaptive behavior treatment
10/01/2014 No
0365T Adaptive behavior tx addl
10/01/2014 No
0366T Group behavior treatment
10/01/2014 No
0367T Group behav treatment addl
10/01/2014 No
0368T Behavior treatment modified
10/01/2014 No
0369T Behav treatment modify addl
10/01/2014 No
0370T Fam behav treatment guidance
10/01/2014 No
0371T Mult fam behav treat guide
10/01/2014 No
0372T Social skills training group
10/01/2014 No
0373T Exposure behavior treatment
10/01/2014 No
0374T Expose behav treatment addl
10/01/2014 No
0405T Ovrsght xtrcorp liv asst pat
01/01/2016 No
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
90791 Psych diagnostic evaluation
01/01/2013 No
90832 Psytx pt&/family 30 minutes
10/01/2014 No
90833 Psytx pt&/fam w/e&m 30 min
10/01/2014 No
90834 Psytx pt&/family 45 minutes
10/01/2014 No
90836 Psytx pt&/fam w/e&m 45 min
10/01/2014 No
90837 Psytx pt&/family 60 minutes
10/01/2014 No
90838 Psytx pt&/fam w/e&m 60 min
10/01/2014 No
90839 Psytx crisis initial 60 min
01/01/2013 No
90840 Psytx crisis ea addl 30 min
01/01/2013 No
90845 Psychoanalysis
10/01/2014 No
90846 Family psytx w/o patient
01/01/2013 No
90847 Family psytx w/patient
01/01/2013 No
90849 Multiple family group psytx
10/01/2014 No
90853 Group psychotherapy
01/01/2013 No
90863 Pharmacologic mgmt w/psytx
10/01/2014 No
90865 Narcosynthesis
10/01/2014 No
90867 Tcranial magn stim tx plan
10/01/2014 No
90868 Tcranial magn stim tx deli
10/01/2014 No
90869 Tcran magn stim redetemine
10/01/2014 No
90870 Electroconvulsive therapy
10/01/2014 No
90875 Psychophysiological therapy
10/01/2014 No
90876 Psychophysiological therapy
10/01/2014 No
90880 Hypnotherapy
10/01/2014 No
90882 Environmental manipulation
10/01/2014 No
90885 Psy evaluation of records
10/01/2014 No
90887 Consultation with family
10/01/2014 No
90889 Preparation of report
10/01/2014 No
96116 Neurobehavioral status exam
01/01/2013 No
96127 Brief emotional/behav assmt
01/01/2015 No
96150 Assess hlth/behave init
01/01/2013 No
96151 Assess hlth/behave subseq
01/01/2013 No
96152 Intervene hlth/behave indiv
01/01/2013 No
96153 Intervene hlth/behave group
01/01/2013 No
96154 Interv hlth/behav fam w/pt
01/01/2013 No
96155 Interv hlth/behav fam no pt
01/01/2014 No
97802 Medical nutrition indiv in
01/01/2013 No
97803 Med nutrition indiv subseq
01/01/2013 No
97804 Medical nutrition group
01/01/2013 No
99184 Hypothermia ill neonate
01/01/2015 No
99201 Office/outpatient visit new
01/01/2013 No
99202 Office/outpatient visit new
01/01/2013 No
99203 Office/outpatient visit new
01/01/2013 No
99204 Office/outpatient visit new
01/01/2013 No
99205 Office/outpatient visit new
01/01/2013 No
99211 Office/outpatient visit est
01/01/2013 No
99212 Office/outpatient visit est
01/01/2013 No
99213 Office/outpatient visit est
01/01/2013 No
99214 Office/outpatient visit est
01/01/2013 No
99215 Office/outpatient visit est
01/01/2013 No
99217 Observation care discharge
01/01/2013 No
99218 Initial observation care
01/01/2013 No
99219 Initial observation care
01/01/2013 No
99220 Initial observation care
01/01/2013 No
99221 Initial hospital care
01/01/2013 No
99222 Initial hospital care
01/01/2013 No
99223 Initial hospital care
01/01/2013 No
99224 Subsequent observation care
01/01/2013 No
99225 Subsequent observation care
01/01/2013 No
99226 Subsequent observation care
01/01/2013 No
99231 Subsequent hospital care
01/01/2013 No
99232 Subsequent hospital care
01/01/2013 No
99233 Subsequent hospital care
01/01/2013 No
99234 Observ/hosp same date
01/01/2013 No
99235 Observ/hosp same date
01/01/2013 No
99236 Observ/hosp same date
01/01/2013 No
99238 Hospital discharge day
01/01/2013 No
99239 Hospital discharge day
01/01/2013 No
99241 Office consultation
01/01/2013 No
99242 Office consultation
01/01/2013 No
99243 Office consultation
01/01/2013 No
99244 Office consultation
01/01/2013 No
99245 Office consultation
01/01/2013 No
99251 Inpatient consultation
01/01/2013 No
99252 Inpatient consultation
01/01/2013 No
99253 Inpatient consultation
01/01/2013 No
99254 Inpatient consultation
01/01/2013 No
99255 Inpatient consultation
01/01/2013 No
99281 Emergency dept visit
01/01/2013 No
99282 Emergency dept visit
01/01/2013 No
99283 Emergency dept visit
01/01/2013 No
99284 Emergency dept visit
01/01/2013 No
99285 Emergency dept visit
01/01/2013 No
99288 Direct advanced life support
01/01/2013 No
99291 Critical care first hour
01/01/2013 No
99292 Critical care addl 30 min
01/01/2013 No
99304 Nursing facility care init
01/01/2013 No
99305 Nursing facility care init
01/01/2013 No
99306 Nursing facility care init
01/01/2013 No
99307 Nursing fac care subseq
01/01/2013 No
99308 Nursing fac care subseq
01/01/2013 No
99309 Nursing fac care subseq
01/01/2013 No
99310 Nursing fac care subseq
01/01/2013 No
99315 Nursing fac discharge day
01/01/2013 No
99316 Nursing fac discharge day
01/01/2013 No
99318 Annual nursing fac assessmnt
01/01/2013 No
99324 Domicil/r-home visit new pat
01/01/2013 No
99325 Domicil/r-home visit new pat
01/01/2013 No
99326 Domicil/r-home visit new pat
01/01/2013 No
99327 Domicil/r-home visit new pat
01/01/2013 No
99328 Domicil/r-home visit new pat
01/01/2013 No
99334 Domicil/r-home visit est pat
01/01/2013 No
99335 Domicil/r-home visit est pat
01/01/2013 No
99336 Domicil/r-home visit est pat
01/01/2013 No
99337 Domicil/r-home visit est pat
01/01/2013 No
99339 Domicil/r-home care supervis
01/01/2014 No
99340 Domicil/r-home care supervis
01/01/2014 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99341 Home visit new patient
01/01/2013 No
99342 Home visit new patient
01/01/2013 No
99343 Home visit new patient
01/01/2013 No
99344 Home visit new patient
01/01/2013 No
99345 Home visit new patient
01/01/2013 No
99347 Home visit est patient
01/01/2013 No
99348 Home visit est patient
01/01/2013 No
99349 Home visit est patient
01/01/2013 No
99350 Home visit est patient
01/01/2013 No
99354 Prolong e&m/psyctx serv o/p
01/01/2013 No
99355 Prolong e&m/psyctx serv o/p
01/01/2013 No
99356 Prolonged service inpatient
01/01/2013 No
99357 Prolonged service inpatient
01/01/2013 No
99358 Prolong service w/o contact
01/01/2014 No
99359 Prolong serv w/o contact add
01/01/2014 No
99360 Physician standby services
01/01/2014 No
99363 Anticoagulant mgmt initial
01/01/2014 No
99364 Anticoagulant mgmt subseq
01/01/2014 No
99366 Team conf w/pat by hc prof
01/01/2013 No
99367 Team conf w/o pat by phys
01/01/2013 No
99368 Team conf w/o pat by hc pro
01/01/2013 No
99374 Home health care supervision
01/01/2014 No
99375 Home health care supervision
01/01/2014 No
99377 Hospice care supervision
01/01/2014 No
99378 Hospice care supervision
01/01/2014 No
99379 Nursing fac care supervision
01/01/2014 No
99380 Nursing fac care supervision
01/01/2014 No
99381 Init pm e/m new pat infant
01/01/2014 No
99382 Init pm e/m new pat 1-4 yrs
01/01/2014 No
99383 Prev visit new age 5-11
01/01/2014 No
99384 Prev visit new age 12-17
01/01/2014 No
99385 Prev visit new age 18-39
01/01/2014 No
99386 Prev visit new age 40-64
01/01/2014 No
99387 Init pm e/m new pat 65+ yrs
01/01/2014 No
99391 Per pm reeval est pat infant
01/01/2014 No
99392 Prev visit est age 1-4
01/01/2014 No
99393 Prev visit est age 5-11
01/01/2014 No
99394 Prev visit est age 12-17
01/01/2014 No
99395 Prev visit est age 18-39
01/01/2014 No
99396 Prev visit est age 40-64
01/01/2014 No
99397 Per pm reeval est pat 65+ yr
01/01/2014 No
99401 Preventive counseling indiv
01/01/2013 No
99402 Preventive counseling indiv
01/01/2013 No
99403 Preventive counseling indiv
01/01/2013 No
99404 Preventive counseling indiv
01/01/2013 No
99406 Behav chng smoking 3-10 min
01/01/2013 No
99407 Behav chng smoking > 10 min
01/01/2013 No
99408 Audit/dast 15-30 min
01/01/2013 No
99409 Audit/dast over 30 min
01/01/2013 No
99411 Preventive counseling group
01/01/2013 No
99412 Preventive counseling group
01/01/2013 No
99415 Prolong clincl staff svc
01/01/2016 No
99416 Prolong clincl staff svc add
01/01/2016 No
99420 Health risk assessment test
01/01/2013 No
99441 Phone e/m phys/qhp 5-10 min
01/01/2013 No
99442 Phone e/m phys/qhp 11-20 min
01/01/2013 No
99443 Phone e/m phys/qhp 21-30 min
01/01/2013 No
99444 Online e/m by phys/qhp
01/01/2013 No
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99450 Basic life disability exam
01/01/2014 No
99455 Work related disability exam
01/01/2014 No
99456 Disability examination
01/01/2014 No
99460 Init nb em per day hosp
01/01/2014 No
99461 Init nb em per day non-fac
01/01/2014 No
99462 Sbsq nb em per day hosp
01/01/2014 No
99463 Same day nb discharge
01/01/2014 No
99464 Attendance at delivery
01/01/2014 No
99465 Nb resuscitation
01/01/2014 No
99466 Ped crit care transport
01/01/2014 No
99467 Ped crit care transport addl
01/01/2014 No
99468 Neonate crit care initial
01/01/2014 No
99469 Neonate crit care subsq
01/01/2014 No
99471 Ped critical care initial
01/01/2014 No
99472 Ped critical care subsq
01/01/2014 No
99475 Ped crit care age 2-5 init
01/01/2014 No
99476 Ped crit care age 2-5 subsq
01/01/2014 No
99477 Init day hosp neonate care
01/01/2014 No
99478 Ic lbw inf < 1500 gm subsq
01/01/2014 No
99479 Ic lbw inf 1500-2500 g subsq
01/01/2014 No
99480 Ic inf pbw 2501-5000 g subsq
01/01/2014 No
99485 Suprv interfacilty transport
01/01/2014 No
99486 Suprv interfac trnsport addl
01/01/2014 No
99487 Cmplx chron care w/o pt vsit
01/01/2014 No
99489 Cmplx chron care addl 30 min
01/01/2014 No
99490 Chron care mgmt srvc 20 min
01/01/2015 No
99495 Trans care mgmt 14 day disch
01/01/2014 No
99496 Trans care mgmt 7 day disch
01/01/2014 No
99497 Advncd care plan 30 min
01/01/2016 No
99605 Mtms by pharm np 15 min
01/01/2013 Yes
99606 Mtms by pharm est 15 min
01/01/2013 Yes
G0270 Mnt subs tx for change dx
01/01/2013 No
G0271 Group mnt 2 or more 30 mins
01/01/2013 No
G0380 Lev 1 hosp type b ed visit
01/01/2013 Yes
G0381 Lev 2 hosp type b ed visit
01/01/2013 Yes
G0382 Lev 3 hosp type b ed visit
01/01/2013 Yes
G0383 Lev 4 hosp type b ed visit
01/01/2013 Yes
G0384 Lev 5 hosp type b ed visit
01/01/2013 Yes
G0396 Alcohol/subs interv 15-30mn
01/01/2013 Yes
G0397 Alcohol/subs interv >30 min
01/01/2013 Yes
G0406 Inpt/tele follow up 15
01/01/2013 No
G0407 Inpt/tele follow up 25
01/01/2013 No
G0408 Inpt/tele follow up 35
01/01/2013 No
G0409 Corf related serv 15 mins ea
01/01/2013 Yes
G0410 Grp psych partial hosp 45-50
01/01/2013 Yes
G0411 Inter active grp psych parti
01/01/2013 Yes
G0425 Inpt/ed teleconsult30
01/01/2013 No
G0426 Inpt/ed teleconsult50
01/01/2013 No
G0427 Inpt/ed teleconsult70
01/01/2013 No
G0442 Annual alcohol screen 15 min
01/01/2013 Yes
G0443 Brief alcohol misuse counsel
01/01/2013 Yes
G0444 Depression screen annual
01/01/2013 Yes
G0445 High inten beh couns std 30m
01/01/2013 Yes
G0446 Intens behave ther cardio dx
01/01/2013 Yes
G0447 Behavior counsel obesity 15m
01/01/2013 Yes
G0459 Telehealth inpt pharm mgmt
10/01/2013 No
G0463 Hospital outpt clinic visit
07/01/2014 No
G0473 Group behave couns 2-10
07/01/2015 Yes
96111 Developmental test extend
01/01/2013 Yes
G0402 Initial preventive exam
01/01/2013 Yes
G0438 Ppps, initial visit
01/01/2013 Yes
G0439 Ppps, subseq visit
01/01/2013 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 90792.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 90792


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 2 Not Listed
Adjudication Indicator: 1 Line Edit 1 Line Edit Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   90792 Top 5 Ordering Providers National*
YUPO CHANG -HOUSTON,TX 4,667
ANNELINE KINGSLEY -JACKSONVILLE BEACH,FL 1,481
GADSON JOHNSON -SANTA MONICA,CA 1,245
LAWRENCE JAFFE -SAN DIEGO,CA 1,225
RAMON PINO -GAINESVILLE,FL 1,174

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 90792*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 603,994
Total Services Denied 2014: 61,319 (10.2%)
National Charges Submitted 2014: $161,698,292.00
National Charges Allowed 2014: $ 75,088,667.00
National Average (No Modifier) Fee Submitted 2014: $264.90
National Average (No Modifier) Fee Allowed 2014: $138.35


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Psychiatry 447,292 74.1% $275.80 44,478 9.9%
Nurse practitioner 96,410 16.0% $237.70 10,402 10.8%
Certified clinical nurse specialist 18,052 3.0% $231.03 1,270 7.0%
Psychiatry, neurology
(osteopaths only)
(discontinued 5/92 use code 86)
10,729 1.8% $249.88 648 6.0%
Physician assistant
(eff 5/92)
8,241 1.4% $243.66 759 9.2%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 233,221 38.6% $263.17 28,432 12.2%
Inpatient hospital 96,656 16.0% $289.83 7,285 7.5%
Nursing facility 64,345 10.7% $229.81 5,284 8.2%
Skilled nursing facility 59,285 9.8% $241.36 4,629 7.8%
Outpatient hospital 46,303 7.7% $292.59 3,814 8.2%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 565,059 93.6% $264.90 56,370 10.0%
GT 12,193 2.0% $203.93 1,421 11.7%
GC 10,730 1.8% $370.48 692 6.4%
59 - Distinct Procedural Service 3,475 0.6% $626.25 462 13.3%
AQ 2,850 0.5% $261.40 329 11.5%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.



   CMS Transmittals: Hide this section.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
05/25/2016 11:46:36 54.80.139.48

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