In the field of psychotherapy, accurate medical coding is essential for proper billing and reimbursement. The psychotherapy intake CPT code is a standardized code used by mental health professionals to bill insurance companies for an initial assessment. Understanding this code is crucial for therapists, psychologists, and counselors to ensure compliance, receive proper payment, and maintain smooth administrative operations.
What is a Psychotherapy Intake CPT Code?
The Current Procedural Terminology (CPT) code for a psychotherapy intake session is 90791. This code is used for the first session with a client, during which a mental health professional conducts a comprehensive diagnostic assessment. It is a critical step in the therapy process, allowing the clinician to gather essential background information, discuss presenting concerns, and formulate a treatment plan.
What Does CPT Code 90791 Cover?
CPT code 90791 is specifically designated for a psychiatric diagnostic evaluation, which typically includes:
- A thorough clinical interview with the client
- Review of medical and psychological history
- Assessment of current mental health symptoms
- Risk assessment (suicidal ideation, self-harm, or harm to others)
- Diagnosis based on DSM-5 criteria
- Development of a personalized treatment plan
- Coordination of care with other healthcare providers (if needed)
Important Considerations for CPT 90791
- No Psychotherapy Component: CPT 90791 is strictly for assessment and does not include ongoing therapy.
- No Time Restriction: Unlike regular therapy session codes, this code does not specify a time duration (e.g., 45 or 60 minutes), though sessions typically last 60 to 90 minutes.
- Can Be Used More Than Once: In certain cases, such as a significant gap in treatment or a new presenting issue, 90791 may be used again.
- Not Limited to Psychologists: This code is applicable to licensed professionals, including clinical social workers, licensed professional counselors (LPCs), and psychiatrists.
How Does CPT 90791 Differ from 90792?
There is another intake CPT code, 90792, which is specifically for psychiatrists or other medical professionals who can prescribe medication. The key difference is:
- 90791: Used for non-prescribing mental health professionals (e.g., psychologists, counselors, social workers).
- 90792: Includes a medical assessment and may involve prescribing or adjusting psychiatric medications.
Billing and Reimbursement for 90791
Insurance providers, including Medicare, Medicaid, and private insurers, typically cover CPT 90791. However, reimbursement rates may vary based on the provider and region. Some key billing points include:
- Verify Insurance Coverage: Confirm with the client’s insurance whether CPT 90791 is covered and if any pre-authorization is required.
- Use the Correct Diagnosis Code: A DSM-5 diagnosis is often needed for insurance claims.
- Documentation is Crucial: Maintain detailed records of the assessment to justify billing and avoid claim denials.
- Telehealth Use: Many insurers now allow 90791 to be billed for telehealth sessions using appropriate modifiers (e.g., 95 or GT for virtual appointments).
Alternatives and Additional CPT Codes
After the initial intake session, therapists typically use different CPT codes for ongoing therapy sessions:
- 90832 – 30-minute individual therapy session
- 90834 – 45-minute individual therapy session
- 90837 – 60-minute individual therapy session
- 90846 – Family therapy without the patient present
- 90847 – Family therapy with the patient present
Conclusion
The psychotherapy intake CPT code (90791) is a critical billing tool for mental health professionals, ensuring proper compensation for initial assessments. Understanding its usage, documentation requirements, and reimbursement guidelines can streamline the administrative process, allowing therapists to focus on providing quality care. By staying informed about medical coding and insurance policies, mental health providers can enhance their practice’s efficiency and financial stability.