Wiki 90791 Age Restriction

[emilyuw]

For 90791 I need some help to verify if there is an age restriction to bill for this code. Would appreciate the help for guidelines on how to bill for this code.

 

[ckeeney]

I have never seen an age restriction. There are other guidelines such as frequency allowed (payer specific) although generally most are either once every 6 months or once a year without a change that would warrant a new evaluation. Many payers do not allow any other mental health service such as therapy on the same day.

 

[TThivierge]

For 90791 I need some help to verify if there is an age restriction to bill for this code. Would appreciate the help for guidelines on how to bill for this code.

Emily
No age restriction on CPT 90791,but some MH diagnosis have age restrictions such as F93.8, F40.8 ,F98,F80.8 . The CPT 90791 only used by MD NP PA or LCSW or LPC but can use once a year IF for same mental health problem. If pt comes in for new MH problem then can use it again but most payers will not cover it for more than 2 a year. Also cannot bill this CPT 90791-90792 two times same day by differ therapist or docs.I hope helped you but also check with payer may want pre authorized done.
Lady T