What insurance policy changes affect CPT 90791?

There are 22 tracked policy changes affecting CPT 90791, including updates from Wisconsin Medicaid (ForwardHealth), Aetna, Nebraska Medicaid. 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: Wisconsin Medicaid (ForwardHealth), Aetna, Nebraska Medicaid, Maryland Medicaid, Connecticut Medicaid (HUSKY Health), CareSource, SC Medicaid - SCDHHS, MassHealth, Harvard Pilgrim Health Care, 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 22 tracked payer policy changes from Wisconsin Medicaid (ForwardHealth), Aetna, and 12 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.

High impact

Attention Deficit/Hyperactivity Disorder (CPB 0426, reviewed 2026-07-07)

Aetna·Effective Jul 7, 2026

Aetna's updated ADHD policy (CPB 0426, effective 2026-07-07) clarifies covered assessment and treatment services while explicitly excluding numerous experimental and unproven diagnostic and therapeutic interventions. The policy reaffirms coverage for psychiatric evaluation, medical workup, and pharmacotherapy/behavioral modification, but denies coverage for neuropsychological testing in uncomplicated cases, all forms of neurofeedback, computerized attention testing, and numerous complementary therapies. Billing teams must ensure claims align with the covered services list and deny or appeal claims for excluded procedures.

90791 Insurance Policy Changes

New Place of Service Code for Narcotic Treatment Services Providers

Attention Deficit/Hyperactivity Disorder (CPB 0426, reviewed 2026-07-07)

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

Claims Submission Information for Expanded School-Based ServicesMay 15, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 1, 2, and 4.

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

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