What pays more, 99205 or 90792?
Asked by: Dr. Horace Mueller Sr. | Last update: November 10, 2025Score: 4.2/5 (16 votes)
How much does 99205 pay?
CPT Code 99205 Reimbursement Rate (Medicare, 2025): $215.75
In the past years, this E/m code has been paid $224.36 by Medicare in 2021.
How much does 90792 pay?
Medicare reimburses psychiatrists at a higher rate for this code. As of 2023, the Medicare reimbursement rate for 90792 is $196.55. It is important to check with individual payers and insurance companies for specific reimbursement rates.
What is a 99205 medical decision making?
CPT code 99205 is a high-level evaluation and management code used for new patients with comprehensive history, examination, and high medical decision-making. It is used for patients with acute or chronic conditions that pose an immediate threat to life or physical function.
What is the modifier 25 for 90792?
If the psychiatric diagnostic evaluation (90792) is performed on the same day as a significant, separately identifiable E/M service, you may need to append modifier -25 to the E/M code (99205). This indicates that the E/M service was a distinct and separately identifiable service from the psychiatric evaluation.
Salaries of Presidents from Different Countries Annually.
Which pays more 90792 or 99205?
Some companies pay better on 90792 than 99205. Interactive complexity rarely pays that much (my best payer it's an extra $14; my worst it's an extra $4). Sometimes I have a bunch of past evals to review, so 99205 + 99417x2 is the best bet. Sometimes it's 99204 + 90933 (+90785 if applicable).
What is the reimbursement rate for group therapy?
The current Medicare reimbursement rate for group therapy is $27.18 per group session. Other reimbursement rates for group therapy are dependent on your licensure, the state in which group therapy is conducted, and the payor source.
When to use 90792?
CPT Code 90792 description: Psychiatric Diagnosis Interview Examination (PDE) performed by a licensed mental health provider. According to CMS.gov, CPT Code 90792 requires: Elicitation of complete medical and psychiatric history (including past, family, social) Mental status examination.
Can 99205 be used for telehealth?
Office visit evaluation and management services (CPT codes 99202-99205, 99211-99215) furnished using audio-video telecommunications technology are reported using the same CPT codes as you would have had the visit been conducted in-person.
Does Medicare cover CPT code 90792?
When billing for Medicare, CMS will allow only one claim of 90791 or 90792 in a year. However, in some cases, depending on the medical necessity, Medicare might allow reimbursement for more than one unit of 90791 or 90792.
What is the reimbursement rate for 90792?
90792 – Psychiatric Diagnostic Evaluation with Medical Services – ($196.55)
What type of diagnoses are seen in level 99205?
High complexity medical decision making: Codes 99205 and 99215 include one or more chronic illnesses with a severe exacerbation, progression, or side effects of treatment, or one acute or chronic illness or injury that poses a threat to life or bodily function.
What is the difference between 99205 and 99204?
Code 99204 requires a minimum of 45 minutes of face-to-face time with the patient and Code 99205 requires a minimum of 60 minutes face-to-face time with the patient. For both services, at least 50% of the face-to-face time must be spent providing counseling and/or coordination of care.
Can 99205 and 90792 be billed together?
If the psychiatrist is billing an 99204 or 99205 then they could not bill a 90792 as there is a CCI edit for these two codes that does not allow for any modifier.
Can a nurse practitioner bill for 90792?
Code 90792 is used for an intake assessment for care that includes medical services, such as ordering diagnostic work or prescribing medication. For this reason, 90792 can only be billed by a qualified medical clinician like a psychiatrist or nurse practitioner.
What is CPT code 99205?
CPT Code 99205
This code describes a level 5 new patient visit that requires a comprehensive level of medical decision-making. The typical time for this visit is 60 minutes. Documentation requirements for new patient CPT code 99205 are as follows: History: Comprehensive history.
What is the difference between 99205 and 99215?
Another important difference between the codes is that the new patient codes (99201–99205) require that all three key components (history, exam and medical decision making) be satisfied, while the established patient codes (99211–99215) require that only two of the three key components be satisfied.
Can you bill 99205 and 99417 together?
Both CPT ® code 99417 and HCPCS code G2212 may only be reported in conjunction with 99205 or 99215 if the codes were selected based on the time alone and not medical decision making. A service of less than 15 minutes should not be reported.
How much is a typical copay for therapy?
Even when insurance does cover mental health care, you will usually be required to pay a copay, which is a portion of the therapist fee out of pocket. These copayments can vary in price, often from around $10 per visit to up to $50 or more per visit.
Is group therapy more expensive?
Group therapy is typically less expensive than individual therapy.