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CPT 90791 + ICD-10 F33.9: Major depressive disorder, recurrent, unspecified

Psychiatric diagnostic evaluation billed with Major depressive disorder, recurrent, unspecified — documentation requirements, denial reasons, modifiers, and reimbursement context.

CPT Code
90791
Psychiatric diagnostic evaluation
ICD-10 Code
F33.9
Major depressive disorder, recurrent, unspecified
Common Modifiers

Compatibility Notes

Used at intake when the patient has a recurrent MDD course but severity has not yet been specified. The prior episode history must be documented in the evaluation. Refine to a severity specifier at the first therapy session.

Documentation Required

  • Comprehensive evaluation with prior MDD episode history
  • Current episode symptoms and PHQ-9 at intake
  • Risk assessment
  • Treatment plan initiated

Common Denial Reasons

  • Prior episode not documented to justify recurrent specifier
  • 90791 billed more than once per year by same provider
  • Evaluation note lacks diagnostic evaluation scope

Applicable Modifiers

Reimbursement Notes

OON UCR $175–$350. Refine the severity specifier at the first therapy session to reduce audit risk.

Related Billing Guides

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