The Truth About Reporting CPT 90792 More Than Once

This is one of the most common misconceptions in psychiatric billing. While CPT guidelines limit the reporting of 90792 to once per day, they do not restrict its use to once per year or prohibit its use within three years, provided medical necessity is documented.

This guideline clarifies the frequency limits for CPT 90792 and explains when and how multiple claims may be appropriate. With proper documentation and justification, clinicians can report this code more than once, even for the same patient, within a year.

Myth Vs. Reality About 90792

Myth: You Can Report 90792 Multiple Times Per Day

Reality: CPT guidelines only limit the frequency of reporting 90792 to once per day. Depending on the circumstances and medical necessity, you can report 90792 multiple times for evaluation of the patient within three years of the initial claim for 90792.

Understanding 90792 Usage Within the Three years

Depending on the circumstances and medical necessity, you can report 90792 multiple times for evaluation of the patient within three years of the initial claim for 90792. The three-year timeframe plays a key role in distinguishing new and established patient E/M codes. However, code 90792 may be used with both new and established patients, so the three-year rule does not come into play the same way it does for E/M codes like office visits.

According to Medicare, you can only claim one unit of 90792 in a year. But, if the necessity arises, you are allowed to claim more than one unit of 90792 in a year. So, don't automatically reach out to report an E/M service when your clinician evaluates the patient within three years of the initial psychodiagnostic evaluation. If the nature of service provided is best described by a psychodiagnostic evaluation code, you may report 90792 instead of an E/M code.

Example Scenario for Reporting 90792

Your psychiatrist reviews a previously seen patient for recurring signs and symptoms of depression. The patient was initially evaluated in July 2012 and was prescribed antidepressant medications and concomitant psychotherapy. The patient had continued with her medications for some time until she began to feel fine and then discontinued the medications. Her symptoms of depression began to recur about three months prior and had been getting severe since then.

Your clinician performed a complete psychodiagnostic evaluation to check the adverse effects of discontinuation of her medication and to check for a change in mental status. Since he performed a psychodiagnostic evaluation to check the patient for a change in mental status, you will report this visit with 90792.

Even though it is less than two years since the first evaluation, you are justified in reporting another unit of 90792. Provide documentation indicating the medical necessity of the evaluation.

Simplify Complex Behavioral Health Reimbursement with BillingFreedom

Behavioral health billing can be complex, especially when correctly reporting psychodiagnostic evaluations like CPT 90792. At BillingFreedom, we specialize in behavioral health billing services that align your claims with current guidelines. While 90792 can only be reported once per day, multiple claims are allowed within three years if medically necessary. We know the difference between mental health billing services and other evaluation codes, so you avoid defaulting to E/M services unnecessarily and get the reimbursements you deserve.

Partnering with BillingFreedom means having a team that manages your mental health billing services accurately and efficiently. We help you maintain proper documentation, adhere to Medicare rules, and apply the three-year rule for new and established patients. 

Let us take the billing burden off your shoulders so you can focus on what matters most, providing quality care.

For more details about our exceptional behavioral health billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472.