Can 90792 and 90833 Be Billed Together?

Medical billing for services provided on the same day can be intricate, particularly when it involves distinct psychiatric procedures. Understanding the specific guidelines and requirements for each Current Procedural Terminology (CPT) code is important for accurate claims submission and to ensure compliance with payer regulations. Improper billing practices can lead to claim denials, audits, and potential financial penalties for healthcare providers. This complexity underscores the need for clear guidance on how different services can be legitimately combined.

The CPT Codes Defined

CPT code 90792 designates a Psychiatric Diagnostic Evaluation with medical services. This comprehensive assessment involves gathering a complete medical and psychiatric history, performing a mental status examination, establishing an initial diagnosis, and developing an initial treatment plan. It is used for new patients or when a significant change warrants a full re-evaluation. Providers qualified to bill this code include psychiatrists and psychiatric nurse practitioners.

CPT code 90833 represents psychotherapy services lasting 30 minutes, specifically when performed in conjunction with an Evaluation and Management (E/M) service. This add-on code must accompany a primary E/M service provided by the same clinician on the same day. The psychotherapy component involves therapeutic interventions lasting 16 to 37 minutes. This combination allows for a single encounter to address both the medical management and therapeutic needs of a patient, making it suitable for prescribing providers like psychiatrists.

Billing Services on the Same Date

Billing multiple services on the same date requires careful consideration, especially when one service might be considered inclusive of another. Generally, 90833 is not reported on the same day as 90792. This is because the diagnostic evaluation often encompasses the initial assessment and formulation of a treatment plan, which may precede or inform subsequent therapeutic interventions.

However, there are specific circumstances where combined billing might be considered. The key principle for billing distinct services on the same day is that each service must be “significant, separately identifiable,” and medically necessary. When an E/M service is performed on the same day as another procedure, Modifier 25 is appended to the E/M code to indicate it was a distinct, separately identifiable service. While 90833 is an add-on to an E/M code, not 90792, some payers might permit a distinct psychotherapy service if it clearly goes beyond the scope of the diagnostic evaluation.

For combined billing to be appropriate, the psychotherapy (90833) must represent a therapeutic intervention that is separate from the diagnostic work performed during the 90792 evaluation. This means the E/M component of 90833 must be distinct from the comprehensive psychiatric diagnostic evaluation. For instance, if a full diagnostic assessment is completed, and then a separate, medically necessary therapeutic intervention is initiated and documented on the same day, this could potentially justify combined billing, though many payers still explicitly prohibit it. It is important to verify specific payer policies, as guidelines vary significantly.

Documentation Requirements

Thorough and distinct documentation is essential to support billing 90792 and 90833, particularly if billed on the same day. For the psychiatric diagnostic evaluation (90792), documentation must clearly detail the complete medical and psychiatric history, mental status examination findings, the established diagnosis, and the initial treatment plan. All elements required for a comprehensive diagnostic assessment must be present and clearly articulated in the patient’s record.

For the psychotherapy service (90833), the documentation must clearly delineate the specific therapeutic interventions provided, the time spent exclusively on psychotherapy (16-37 minutes), and how this service was distinct and medically necessary beyond the diagnostic evaluation. It is important to demonstrate that the E/M portion of 90833 is significantly and separately identifiable from the diagnostic work. This involves separate sections in the clinical note, differentiating diagnostic assessment from therapeutic session content. The medical record must explicitly indicate the length of time spent in the psychotherapy encounter.

If combined billing is attempted, the use of Modifier 25 on the appropriate E/M code (which 90833 is linked to) signals that a significant, separately identifiable E/M service was performed on the same day as another procedure. However, many payers consider 90792 comprehensive enough that a separate psychotherapy service on the same day is not allowed, regardless of Modifier 25. Providers should adhere to specific payer guidelines and ensure all documentation clearly justifies the medical necessity and distinctness of each service to avoid denials and audits.