CPT Code 90792

CPT code 90792 is used for initial psychiatric diagnostic evaluations that include medical services. It’s most often billed by psychiatrists, psychiatric nurse practitioners, or physicians performing comprehensive mental health assessments that involve prescribing or evaluating medication.

This guide covers:

• What CPT 90792 includes
• When to use it
• Who can bill it
• Documentation requirements
• Reimbursement rates and common errors

What is CPT Code 90792?

CPT 90792 refers to a psychiatric diagnostic evaluation with medical services, typically performed at intake or during an initial consultation.

It includes:

• A full psychiatric history
• Mental status exam
• Medical assessment (e.g., labs ordered, vitals taken, med review)
• Initial diagnosis
• Treatment planning (often including medication)

Key difference: 90792 includes medical services — unlike 90791, which is non-medical and used by psychologists, LCSWs, and other non-prescribers.

When to Use CPT Code 90792

Use 90792 when:

• The provider is a prescriber (e.g., psychiatrist, psychiatric NP, physician)
• The session includes medical assessment or medication management
• It is the patient’s initial psychiatric evaluation

Don’t use 90792 for:

• Follow-up visits (use E/M codes with psychotherapy add-ons)
• Non-prescribers (use 90791 instead)
• Therapy sessions without a medical component

Who Can Bill CPT 90792?

Eligible clinicians include:

• Psychiatrists (MD/DO)
• Psychiatric nurse practitioners (PMHNPs)
• Clinical nurse specialists with prescribing authority
• Physicians (e.g., pediatricians treating mental health in collaborative care)

Non-medical mental health professionals (e.g., psychologists, LCSWs) should use 90791, not 90792.

Documentation Requirements

Your documentation for 90792 should include:

• Date and total time of the session
• Patient history (psychiatric, medical, social, family)
• Mental status exam
• Medical decision-making (e.g., labs ordered, med discussion)
• Diagnosis and treatment plan
• Rationale for medication or further evaluation

Link medical services directly to the patient's presenting condition and treatment strategy.

Reimbursement Rates for 90792

Medicare reimbursement for CPT 90792 typically ranges from $150 to $190. Commercial insurers may reimburse at even higher rates, especially for board-certified psychiatrists.

Tip: Strong documentation of the medical decision-making justifies the higher reimbursement.

Common Billing Errors to Avoid

• Using 90792 without providing medical services
• Non-prescribers billing 90792 (use 90791 instead)
• Incomplete documentation of medical assessment
• Not distinguishing between initial vs. follow-up visits

Final Thoughts

CPT code 90792 is essential for initial psychiatric evaluations that include a medical component. It's reserved for prescribers, and accurate documentation of both psychiatric and medical findings ensures compliance and full reimbursement.