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CPT 90791 + ICD-10 F90.1: Attention-deficit hyperactivity disorder, predominantly hyperactive type

Psychiatric diagnostic evaluation billed with Attention-deficit hyperactivity disorder, predominantly hyperactive type — documentation requirements, denial reasons, modifiers, and reimbursement context.

CPT Code
90791
Psychiatric diagnostic evaluation
ICD-10 Code
F90.1
Attention-deficit hyperactivity disorder, predominantly hyperactive type
Common Modifiers

Compatibility Notes

Used for the initial clinical evaluation when predominantly hyperactive/impulsive ADHD is the presenting concern. As with F90.0, 90791 covers the psychiatric interview only — neuropsychological testing requires 96130–96131. More common in pediatric presentations. Dual-setting criteria must be documented.

Documentation Required

  • Comprehensive evaluation with developmental history
  • ADHD-HI criteria documented across two settings
  • Age of onset before 12 confirmed
  • Parent or teacher report obtained for pediatric cases
  • Differential (oppositional behavior, anxiety, mood disorder) considered

Common Denial Reasons

  • Testing billed as 90791 rather than 96130–96131
  • 90791 billed more than once per year by same provider
  • Single-setting reporting only (home or school, not both)

Applicable Modifiers

Reimbursement Notes

OON UCR $175–$350. Pediatric ADHD-HI evaluations are well-covered. Multi-informant assessments (parent report + teacher report) strengthen medical necessity documentation.

Related Billing Guides

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