Reimbursement policy update: Frequency Editing - professional

Beginning with dates of service on or after December 1, 2020, we will apply a frequency limit to CPT® codes 90791 (Psychiatric diagnostic evaluation) and 90792 (Psychiatric diagnostic evaluation with medical services) with the following limitations:

 

• One (1) per 365 days, per member, per provider NPI for members over 21
• Two (2) per 365 days, per member, per provider NPI for members under age 21

 

For more information about this policy, visit the Reimbursement Policies page at anthem.com.  

 

CPT® is a registered trademark of the American Medical Association.

 

633-0920-PN-NE