Billing and Coding: Psychiatric Codes

This billing and coding guidance clarifies that diagnostic interview codes (e.g., CPT 90791/90792) may be used for initial evaluations and by a new provider on first encounter, CPT 96105 is intended for a formal aphasia evaluation (generally once per treatment), and HCPCS G0017/G0018 apply to non-facility POS excluding Office. Providers must follow the related LCD (L35101) for reasonable and necessary documentation, avoid billing non-covered services as covered (use appropriate modifiers), and limit reporting to no more than three 90791/90792 services per beneficiary per year by the same provider; treating physicians should not bill testing codes solely for reading results and psychotherapy codes should not replace appropriate E/M codes.

"Diagnostic interview codes (e."

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