CPT 90791 + ICD-10 F40.10: Social anxiety disorder (social phobia), unspecified
Psychiatric diagnostic evaluation billed with Social anxiety disorder (social phobia), unspecified — documentation requirements, denial reasons, modifiers, and reimbursement context.
CPT Code
90791
Psychiatric diagnostic evaluation
ICD-10 Code
F40.10
Social anxiety disorder (social phobia), unspecified
Compatibility Notes
Initial evaluation for social anxiety disorder. The evaluation should document feared social situations, avoidance behaviors, and functional impairment. LSAS is commonly administered at intake. Most payers process this combination without scrutiny.
Documentation Required
- ✓Comprehensive evaluation with social anxiety history
- ✓Feared situations and avoidance documented
- ✓LSAS or equivalent administered
- ✓Functional impairment assessment
- ✓CBT or exposure-based treatment plan recommended
Common Denial Reasons
- ✗90791 billed more than once per year by same provider
- ✗Evaluation note does not document DSM-5 social anxiety criteria specifically
- ✗Notes read like a therapy session rather than a diagnostic intake
Applicable Modifiers
Reimbursement Notes
OON UCR $175–$350. Social anxiety disorder evaluations are straightforward and well-covered under mental health parity.
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