2025 CPT code 90785
(Active) Effective Date: N/A Revision Date: N/A Psychiatry - Psychiatry Add-on Codes Medicine Services and Procedures > Psychiatry Services and Procedures Feed
Add-on code for interactive complexity in psychiatric services; reflects increased work intensity due to communication difficulties.
Modifiers may be applicable depending on the circumstances of the service provided (e.g., modifier -59 for multiple procedures).Consult the AMA CPT manual for appropriate modifier usage.
Medical necessity for 90785 is established when the communication factors significantly increase the complexity of providing the primary psychiatric service.This should be clearly documented in the medical record.
The physician or other qualified healthcare professional is responsible for managing communication difficulties, addressing caregiver concerns, ensuring mandated reporting when necessary, and using appropriate communication strategies (e.g., play therapy) to facilitate effective treatment. This adds significant complexity to the delivery of the main psychiatric service.
In simple words: This code is added to a bill for mental health services when extra work is needed because of communication problems.This might happen if family members disagree, a caregiver's feelings make treatment hard, a serious event needs reporting to authorities, or the patient needs help understanding the therapist.
CPT code 90785, Interactive Complexity, is an add-on code reported in conjunction with codes for diagnostic psychiatric evaluation (90791, 90792), psychotherapy (90832, 90833, 90834, 90836, 90837, 90838), and group psychotherapy (90853).It accounts for increased service complexity due to communication factors hindering the delivery of the primary psychiatric procedure.These factors include managing maladaptive communication among participants, caregiver emotional interference with treatment, mandated reporting of sentinel events, and the use of communication aids (play equipment, interpreters) to overcome language barriers.The time spent addressing interactive complexity is considered part of the overall psychotherapy time and does not increase the time unit of the primary psychotherapy code.
Example 1: A child with autism spectrum disorder is brought to therapy by both parents who frequently interrupt the session with conflicting opinions on treatment approach. The therapist utilizes 90785 to account for the increased effort required to manage the communication dynamics and deliver therapy., An adolescent patient discloses past trauma, mandating a report to child protective services. The therapist spends time discussing this with the patient and their parents, utilizing 90785 due to the complexity added by the legal and emotional ramifications., A non-verbal young adult patient communicates primarily through drawings and gestures. The therapist uses play therapy techniques and visual aids, utilizing 90785 to account for the additional effort in adapting communication methods to deliver therapeutic intervention.
Detailed notes should include:1) The primary psychotherapy code utilized. 2) Specific communication factors that made the session more complex. 3) Time spent addressing these factors (although this time doesn't change the time unit of the primary psychotherapy code). 4) Documentation supporting any mandated reporting or legal considerations. 5) Description of the communication methods used (play therapy, interpreter, etc.).
** This add-on code does not increase the unit of time for the primary psychotherapy code.It is meant to reflect only the increased intensity of the service due to communication challenges.Audits have shown significant misuse of this code, so it's crucial to follow all applicable guidelines and document appropriately. Pay close attention to the payer-specific guidelines for reimbursement.
- Revenue Code: Y1 (OTHER - MEDICARE FEE SCHEDULE)
- RVU: RVUs vary depending on the payer and geographic location.This is an add-on code, so the RVU value will be added to the RVU value of the primary procedure.
- Global Days: Not applicable. This is an add-on code for increased service intensity, not for a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is an add-on code and does not have a technical component.
- Fee Schedule: Fee schedules vary by payer and location.Historical fee data can be found via publicly available resources or through the payer's specific fee schedule. Contact the payer for the most up-to-date reimbursement information.
- Specialties:Psychiatry, Psychology, Social Work, Child and Adolescent Psychiatry
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Telehealth (depending on payer and state regulations)