TL;DR, does it pay more than a regular session? Yes, but you also will have to complete a thorough diagnostic assessment.
CPT code 90791 is one of the most common CPT codes used by mental health professionals. Its typical use is during the first session with a new client in order to complete a diagnostic assessment. Many insurers will reimburse this code only once per year, but some as frequently as every six-months. Regardless, it’s a good idea to do a new diagnostic assessment each year to stay up-to-date with how your clients’ lives have changed. Each time you do a new diagnostic assessment, it’s time to bill CPT code 90791.
CPT Code 90791 is defined as:
An integrated biopsychosocial assessment, including history, mental status, and recommendations.
Basically, you want to get an initial 360-degree view of your patient. The bio part relates primarily to medical concerns, but it can also include factors such as family history. The psycho part relates to the person’s psychology and mental status. The social factors include the person’s support network and quality of interpersonal relationships. There’s always overlap and everything relates to the person’s overall well-being which is why the diagnostic assessment should include as many of relevant variables as possible.
If you’re doing a long intake, you can you use CPT code 99354. That’s for sessions over an hour and a half but less than two hours. If you go over two hours, use CPT code 99355. That code is for intake sessions two to three hours long.
The typical document that accompanies an intake session that you will bill using CPT code 90791 is called a diagnostic assessment. In the United States, each state will have its own criteria, but are generally similar. In the state of Minnesota (where CPT30 was assembled), these are the diagnostic criteria. The diagnostic criteria relate to the biopsychosocial considerations.
Unlike CPT code 90792, CPT code 90791 doesn’t have to be billed by a licensed medical doctor. Typically, Licensed Clinical Social Workers, Licensed Professional Clinical Counselors, Licensed Marriage and Family Therapists, and Clinical Psychologists will bill CPT code 90791.
It depends. Some plans do and some plans don’t (most plans don’t). You might know this already, but it’s always best to call the client’s payer and make certain that an intake session is covered without pre-authorization.