CPT 90791 + ICD-10 F43.10: Post-traumatic stress disorder, unspecified
Psychiatric diagnostic evaluation billed with Post-traumatic stress disorder, unspecified — documentation requirements, denial reasons, modifiers, and reimbursement context.
CPT Code
90791
Psychiatric diagnostic evaluation
ICD-10 Code
F43.10
Post-traumatic stress disorder, unspecified
Compatibility Notes
Used for the initial evaluation of a patient with suspected or known PTSD. The diagnostic evaluation should document the traumatic event(s), DSM-5 PTSD criteria across all four clusters, and current functional impairment. Most payers allow 90791 once per year without prior authorization.
Documentation Required
- ✓Comprehensive evaluation including trauma history
- ✓DSM-5 PTSD criteria across all four clusters assessed
- ✓PCL-5 administered at intake
- ✓Safety assessment
- ✓Treatment recommendations (evidence-based modality identified)
Common Denial Reasons
- ✗90791 billed more than once per year by same provider
- ✗Evaluation note reads like a therapy session rather than a diagnostic intake
- ✗Trauma history not documented in the evaluation
Applicable Modifiers
Reimbursement Notes
OON UCR $175–$350. PTSD evaluations are fully covered under mental health parity. Some payers require documentation of the evidence-based treatment plan initiated at the intake.
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