What insurance policy changes affect CPT 90792?

There are 13 tracked policy changes affecting CPT 90792, including updates from Aetna, Nebraska Medicaid, CareSource. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 90792?

Payers that have issued tracked updates for CPT 90792 include: Aetna, Nebraska Medicaid, CareSource, SC Medicaid - SCDHHS, Connecticut Medicaid (HUSKY Health), Harvard Pilgrim Health Care, MassHealth, Sentara Health Plans, Blue Cross of Idaho, Health Net.

How do I get notified when CPT 90792 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 90792. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 90792?

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.

90792 — A mental health professional evaluates your emotional and behavioral concerns and may prescribe psychiatric medications during the visit.: Insurance Policy Changes

90792 Insurance Policy Changes

CPT 90792, in plain terms, covers A mental health professional evaluates your emotional and behavioral concerns and may prescribe psychiatric medications during the visit. CPT 90792 is referenced in 13 tracked payer policy changes from Aetna, Nebraska Medicaid, and 8 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 90792 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.

90792 Insurance Policy Changes

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

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

[Georgia] CareSource Policy and Prior Authorization changes

Rehabilitative Behavioral Health and Substance Use Services Rate Increases

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

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

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

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