What insurance policy changes affect CPT 90791?

There are 20 tracked policy changes affecting CPT 90791, including updates from Nebraska Medicaid, Maryland Medicaid, Connecticut Medicaid (HUSKY Health). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 90791?

Payers that have issued tracked updates for CPT 90791 include: Nebraska Medicaid, Maryland Medicaid, Connecticut Medicaid (HUSKY Health), CareSource, SC Medicaid - SCDHHS, MassHealth, Harvard Pilgrim Health Care, Aetna, Sentara Health Plans, Alaska Medicaid, Blue Cross of Idaho, Health Net, L.A. Care Health Plan.

How do I get notified when CPT 90791 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 90791. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 90791?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

90791 — A thorough mental health assessment where a doctor talks with you to understand your symptoms, history, and current emotional well-being.: Insurance Policy Changes

90791 Insurance Policy Changes

CPT 90791, in plain terms, covers A thorough mental health assessment where a doctor talks with you to understand your symptoms, history, and current emotional well-being. CPT 90791 is referenced in 20 tracked payer policy changes from Nebraska Medicaid, Maryland Medicaid, and 11 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 90791 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

Blue Cross of Idaho·Effective Aug 1, 2025

Blue Cross of Idaho updated FQHC billing requirements for Medicare Advantage patients, removing MMCP/IMP billing requirements and clarifying language for Chronic Care Management (CCM), Virtual Communication Services (VCS), Psychiatric Collaborative Care Model (CoCM), and telehealth services. FQHCs must continue using specific revenue codes and HCPCS codes for qualifying services under the CMS Prospective Payment System.

90791 Insurance Policy Changes

Billing changes and clarifications for Crisis Intervention Mental Health and Social Detoxification services

PT 66-26: Federally Qualified Health Center and Rural Health Center Coding Guidelines

Claim Denial Issue for 3003 Prior Authorization Required

[Georgia] CareSource Policy and Prior Authorization changes

Rehabilitative Behavioral Health and Substance Use Services Rate Increases

2025.57 - October 2025 - Updates to Autism Spectrum Disorder Services

2025.56 - Implementation of Children’s Mental Health Urgent Crisis Centers Services for Children 18 Years Old & Younger

All Provider Bulletin 408: Annual Behavioral Health Wellness Examinations

Billing updates for mental health centers

Managed Care Entity Bulletin 135: Mental Health Center Policy Updates

OfficeLink Updates - April 2025 notices and reminders (PDF)

Summer 2025 Authorization Updates

January Town Hall FAQ

2025.80 - Update to the Implementation of Children's Mental Health Urgent Crisis Centers Services for Children 18 Years Old & Younger

MAPAP111 - Billing Requirements for Federally Qualified Health Centers (FQHCs) - Updated language CCM, VCS, CoCM, and telehealth

MAPAP113 - Billing Requirements for Rural Health Centers (RHCs) - Revised exclusions added

2025.30 - Provider Bulletin - Updates to Autism Spectrum Disorder Services

Tribal FQHC FAQs Updated

25-607 Use Correct CPT Codes and Modifiers When Billing for Mobile Crisis Services

Behavioral Health Treatment (BHT) – Applied Behavioral Analysis (ABA) Authorization Request Form