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.
