A psychiatric intake lasts 50 minutes face-to-face, plus 15 minutes of same-day preparation and documentation. A medication-management follow-up includes 22 minutes of psychotherapy. Before another visit, the patient completes both a PHQ-9 and a GAD-7.
What can you appropriately bill for each?
The answer is not just a matter of looking up a code. You have to identify which service you performed, choose the correct way to report it, and determine whether any additional services can be reported on the same claim.
Done properly, that prevents both unsupported billing and missed reimbursement for work you genuinely performed.
We'll work through those decisions in the order a psychiatric prescriber would make them.
A common assumption is that a psychiatric intake automatically means 90792. That assumption can leave money on the table.
90792 is a psychiatric diagnostic evaluation with medical services. It can encompass diagnostic formulation, medication assessment, prescribing, and treatment planning.
It is a single diagnostic-evaluation code, not a series of levels selected by time or medical decision making (MDM). You cannot add prolonged E/M services or psychotherapy-with-E/M add-ons to 90792.
99204 and 99205 are new-patient office/outpatient evaluation and management (E/M) codes. When E/M appropriately describes the encounter, you may select its level by MDM or qualifying total time on the date of service.
That includes appropriate same-day preparation and documentation, not just minutes spent with the patient.
Suppose your intake involves:
That's 65 minutes of total E/M time.
If E/M is the appropriate service, the visit supports 99205 by time, even if the clinical decisions would support only 99204 by MDM.
For illustration, the October 2026 Medicare national physician non-facility fee-schedule reference amounts are approximately:
| Code | Reference reimbursement |
|---|---|
| 99204 | $177 |
| 90792 | $202 |
| 99205 | $237 |
These are national physician-fee-schedule reference amounts, not PMHNP-specific allowed payments or your contracted rates. Geography, practitioner adjustments, and commercial agreements change the actual numbers.
Notice what happens if you compare only 90792 to 99204: 90792 appears financially preferable.
But for a sufficiently long psychiatric intake appropriately reported as E/M, 99205 may be the better-supported code based on total time, even without high-complexity MDM.
And an even longer time-selected E/M encounter may qualify for additional prolonged-service reimbursement. Unlike 99205, 90792 does not have that prolonged E/M billing pathway.
This is why automatically selecting 90792 can mean overlooking legitimately reportable work.
None of this means you can substitute E/M for 90792 simply because it pays more. The actual service and applicable payer rules must support the code.
90792 remains appropriate for a medically necessary psychiatric diagnostic evaluation with medical services. That can include an evaluation leading to ongoing treatment, diagnostic clarification, or a second opinion. Some payers also specifically require psychiatric diagnostic-evaluation codes for certain intakes.
Likewise, an intake does not become 90792 merely because you spend most of it gathering history, defer medication, or fail to reach 60 minutes face-to-face. Diagnostic evaluation is also part of E/M.
And 90792 is not a workaround for the three-year E/M new-patient rule. A repeat diagnostic evaluation must be medically necessary and may be limited by payer policies.
The practical decision: Is the encounter appropriately reported as a psychiatric diagnostic evaluation or office/outpatient E/M? If E/M is appropriate, check the full qualifying time before defaulting to a lower level.
These are alternative primary services, not codes to bill together for the same encounter.
For the more intricate choices, see 90792 vs E/M: How to Choose for New Patient Intakes.
Printable quick reference (PDF + editable Word): CPT Coding Logic Quick Reference. Included for Forum and Full members, $5 for free accounts.