Psychiatric diagnostic eval (90791) + with med services (90792)
90791 (without medical services) and 90792 (with medical services) cannot be reported together for the same evaluation.
Why this pair bundles
Mutually exclusive codes — 90792 includes 90791's work plus medical services (Rx, physical exam).
Modifier-bypass policy
Modifier indicator: 0 — no modifier bypass is permitted for this pair under any circumstance.
No bypass. Choose based on whether prescriber providing medical services (90792) or non-prescriber doing therapy eval (90791).
Documentation requirements
- Provider type and scope (prescriber vs therapist) determines code
Common clinical scenarios
- Initial psychiatric eval by MD/NP — 90792
- Initial therapy eval by LCSW/LPC — 90791
Frequently asked questions
Why does CMS bundle 90791 and 90792?
Mutually exclusive codes — 90792 includes 90791's work plus medical services (Rx, physical exam).
What documentation supports separate billing?
Provider type and scope (prescriber vs therapist) determines code.
When does this conflict typically arise?
Initial psychiatric eval by MD/NP — 90792; Initial therapy eval by LCSW/LPC — 90791.
Sources
Catch NCCI 90791/90792 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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