CPT 90791 + ICD-10 F90.0: Attention-deficit hyperactivity disorder, predominantly inattentive type
Psychiatric diagnostic evaluation billed with Attention-deficit hyperactivity disorder, predominantly inattentive type — documentation requirements, denial reasons, modifiers, and reimbursement context.
CPT Code
90791
Psychiatric diagnostic evaluation
ICD-10 Code
F90.0
Attention-deficit hyperactivity disorder, predominantly inattentive type
Compatibility Notes
Used for the initial psychiatric evaluation when ADHD-I is the presenting concern. CPT 90791 covers the clinical interview and psychiatric evaluation — it does not include neuropsychological testing (use 96130–96131 for comprehensive ADHD testing). Most payers cover 90791 for ADHD evaluation without prior authorization.
Documentation Required
- ✓Comprehensive psychiatric evaluation including developmental and academic history
- ✓ADHD-I DSM-5 criteria assessed across two settings
- ✓Age of onset confirmed (before age 12)
- ✓ADHD rating scales (Conners, CAARS, ASRS) administered if applicable
- ✓Functional impairment documented
- ✓Differential diagnosis considered (anxiety, depression, learning disability)
Common Denial Reasons
- ✗Neuropsychological testing billed as 90791 — cognitive testing requires 96130–96131
- ✗90791 billed more than once per year by same provider
- ✗Age of onset not documented
- ✗Dual-setting criterion not addressed in the evaluation
Applicable Modifiers
Reimbursement Notes
OON UCR $175–$350. ADHD evaluations are covered under mental health parity. Comprehensive neuropsychological testing (96130–96131) reimburses significantly higher and should be billed separately when cognitive testing is performed.
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