CPT 90791 + ICD-10 F43.12: Post-traumatic stress disorder, chronic
Psychiatric diagnostic evaluation billed with Post-traumatic stress disorder, chronic — documentation requirements, denial reasons, modifiers, and reimbursement context.
CPT Code
90791
Psychiatric diagnostic evaluation
ICD-10 Code
F43.12
Post-traumatic stress disorder, chronic
Compatibility Notes
Used for evaluation of a patient with established chronic PTSD (symptoms persisting 3+ months). Appropriate when a new provider is conducting a formal intake evaluation for an existing PTSD patient or when a new evaluation is clinically indicated. F43.12 is the preferred specifier when chronicity is confirmed at intake.
Documentation Required
- ✓Comprehensive evaluation with trauma onset date confirming chronicity
- ✓PCL-5 or equivalent administered
- ✓Prior PTSD treatment history reviewed
- ✓Current functional impairment documented
- ✓Treatment plan including evidence-based modality
Common Denial Reasons
- ✗Duplicate evaluation without basis for a new diagnostic evaluation
- ✗90791 billed multiple times in the same year by the same provider
- ✗Evaluation note lacks the breadth of a comprehensive intake
Applicable Modifiers
Reimbursement Notes
OON UCR $175–$350. Chronic PTSD evaluations are covered under mental health parity. Bill 90791 at intake for every new PTSD patient.
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