CPT 90791: Psychiatric Diagnostic Evaluation
Psychiatric diagnostic evaluation without medical services. An initial comprehensive assessment of a patient's mental health status, including history, mental status examination, and diagnostic formulation.
Why CPT 90791 Claims Get Denied
Claims billed under CPT 90791 are frequently denied or downcoded for the following reasons. Understanding these patterns helps your practice reduce denial rates and recover revenue faster.
Billed by a provider type not authorized for psychiatric evaluation
Frequency limit exceeded (typically once per episode of care)
Missing or incorrect mental health diagnosis
Prior authorization required but not obtained
Billing Tips for CPT 90791
This code is for the initial evaluation only — do not bill for follow-up visits. Use 90792 if medical services (e.g., medication management) are included. Verify the provider's credentials meet payer requirements. Some payers require prior authorization for mental health services.
Documentation Requirements
To support a clean claim for CPT 90791, your clinical documentation should include:
Comprehensive psychiatric history
Mental status examination
Diagnostic assessment and formulation
Treatment plan with goals
Risk assessment (suicidality, homicidality)
Functional assessment
Common Modifiers for CPT 90791
Reduce CPT 90791 Denials by 60%
RediClaim's pre-submission scrubber catches documentation gaps and coding errors before you submit, while the appeal generator handles denials that slip through.