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CPT® 90785 add-one code, is reported in addition to the code for a primary psychiatric service. It is used when the patient being treated has certain factors that increase the complexity of the treatment rendered. These factors are limited to the following: the need to manage disruptive communication that complicates the delivery of treatment; complications involving the implementation of a treatment plan due to caregiver behavioral or emotional interference; evidence of a sentinel event with subsequent disclosure to a third party and discussion and/or reporting to the patient(s); or the use of play equipment or a translator to enable communication when a barrier exists.
CPT® 90785 – Coding Tips and Reporting Guidelines
CPT® 90785 is an add-on code and reported in conjunction with the following services: psychiatric evaluation (90791–90792), individual psychotherapy (90832–90834, 90836–90838), and group psychotherapy (90853).
Do not report CPT® 90785 with:
- Psychotherapy for crisis (90839–90840)
- Psychological and neuropsychological testing (96130–96134, 96136–96139, 96146)
- Adaptive behavior assessment or treatment services (97151–97158, 0362T, 0373T)
- E/M services provided without psychotherapy
This ensures correct coding, compliance, and avoids improper billing.
CPT® 90785 – Documentation Tips for Interactive Complexity
Documentation should indicate:
- The type of interactive methods used, such as an interpreter, play, or a physical device.
- That the patient did not have the ability to communicate through normal verbal means.
Other catatonic states may also be covered if documentation is submitted with the claim. Coverage includes interactive examinations of patients with primary psychiatric diagnoses, excluding dementias and sleep disorders, when one of the following conditions is present:
- Developmental speech or language disorders
- Conductive hearing loss
- Deaf mutism
- Aphasia
- Voice disturbance or aphonia
- Other speech disturbances, such as dysarthria or dysphasia
All of these conditions must be clearly and concisely recorded in the medical record.
The time spent by the clinician providing interactive complexity services should be reflected in the timed service code for the psychotherapy service, or the psychotherapy add-on code provided in combination with an E/M service. It must only include time spent delivering interactive complexity interventions.
Reimbursement Tips For Interactive Complexity | CPT 90785
Telemedicine services can be reported by the provider performing the service by adding modifier 95 to the procedure code and specifying the appropriate place of service. When services are delivered at the origination site, they are reported using HCPCS Level II code Q3014. The Correct Coding Initiative explains that
“Interactive services, whether diagnostic or therapeutic, are distinct services for patients who have lost, or have not yet developed, the expressive language skills to communicate their symptoms or responses to treatment.”
Add-on CPT code 90785 is used to report the interactive complexity of psychiatric services. If a clinical social worker provides the service, assignment of benefits is required. Medicare reimburses clinical social workers at 75% of the physician fee schedule for this service.
Psychiatric Diagnostic Evaluation – 90791 & 90792
Codes:
- 90791 – Psychiatric diagnostic evaluation
- 90792 – Psychiatric diagnostic evaluation with medical services
Explanation:
A psychiatric diagnostic evaluation involves a comprehensive assessment of the patient’s psychosocial history and current mental status, along with review and ordering of any necessary diagnostic tests. Based on this evaluation, appropriate treatment recommendations are made.
90792 differs from 90791 in that it also includes additional medical services, such as a physical examination and the prescription of medications, in addition to the psychiatric assessment. Both codes encompass interviews and communication with family members or other relevant sources as part of the evaluation process.
Coding Tips for Psychiatric Diagnostic Evaluation (90791–90792)
A physician or another qualified healthcare professional can perform these evaluations. Both 90791 and 90792 include a review of the patient’s history, mental status assessment, and, when applicable, other elements of the physical examination. Code 90792 also allows for the prescribing of medications and ordering or review of laboratory or diagnostic tests.
Coverage may vary by payer, so it is essential to confirm specific requirements. In some cases, family members, guardians, or other informants may be consulted if the patient is unable to participate fully in the process.
When communication challenges complicate the evaluation, such as the need for interactive tools, involvement of third parties, or other factors, CPT code 90785 (interactive complexity) may be reported in addition to the primary code.
These services should not be billed alongside psychotherapy for crisis (90839–90840), adaptive behavior assessment or treatment services (97151–97158, 0362T, 0373T), or standard evaluation and management (E/M) codes (99202–99337, 99341–99350, 99366–99368, 99401–99443).
Psychiatric diagnostic evaluations may be reported multiple times if conducted during separate encounters with the patient or other informants. For evaluation of hospital records, psychometric or projective testing, or other collected data, see 90885. For interpretation or explanation of psychiatric or other medical tests, see 90887.
Documentation Tips for Interactive Complexity – 90791/90792
Medical record documentation should indicate when interactive complexity services are required. It should specify the interactive methods used, such as the use of an interpreter, play tools, or other physical devices, and note that the patient was unable to communicate through typical verbal means. Coverage may also apply to other catatonic states if proper documentation is submitted.
Interactive complexity services include assessments of patients with primary psychiatric diagnoses (excluding dementias and sleep disorders) who have one or more of the following conditions: developmental speech or language disorders, total conductive hearing loss, mixed conductive and sensorineural hearing loss, deaf mutism, aphasia, voice disturbances, aphonia, or other speech disorders such as dysarthria or dysphasia. These conditions must be clearly and concisely documented in the patient’s medical record.
Reimbursement Tips for Interactive Complexity – 90791/90792
Telemedicine services for these codes may be reported by adding modifier 95 and using the appropriate place of service. Services provided at the patient’s origination site are reported with HCPCS Level II code Q3014. According to the Correct Coding Initiative, CPT codes for psychiatric services encompass both diagnostic procedures (90791, 90792) and therapeutic procedures, including individual and group psychotherapy.
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