Back to CPT Codes
By
Dr. Marina A. Badillo-Diaz
7
Min read
•
May 29, 2025
CPT code 90885 represents a specific billing code for psychiatric evaluation of records or reports without direct patient contact. This code allows mental health professionals to receive compensation for their expertise when reviewing patient records, medical documentation, and other relevant reports to inform clinical decision-making and treatment planning.
This guide explores the nuances of CPT code 90885, providing practical information for mental health practitioners seeking to optimize compliance and reimbursement.
What Is CPT Code 90885?
CPT code 90885 specifically refers to "Psychiatric evaluation of records, reports, and/or other information record sources concerning a patient's psychiatric status." This procedure code represents the professional time and expertise required to review and evaluate various documents related to a patient's mental health history, treatment, or status.
Unlike codes for direct patient evaluation or therapy, 90885 covers work performed without the patient present. The mental health professional reviews materials such as:
Previous psychiatric evaluations
Medical records from other providers
School records or educational assessments
Legal documents relevant to mental health
Reports from other healthcare or social service agencies
Psychological or neuropsychological test results
Treatment records from other facilities
Who Can Bill CPT Code 90885?
CPT code 90885 can be billed by qualified mental health professionals who have the appropriate credentials and training to evaluate psychiatric records and reports. The ability to use this code varies based on provider type, state regulations, and payer policies.
Eligible Mental Health Professionals
Psychiatrists (MD/DO)
Psychologists (PhD/PsyD)
Clinical Social Workers (when permitted by state law and payer policy)
Licensed Professional Counselors (varies by state and payer)
Marriage and Family Therapists (varies by state and payer)
Appropriate Clinical Settings
Private practices
Hospital outpatient departments
Community mental health centers
Integrated healthcare settings
Forensic evaluation services
Consultation-liaison services
Telehealth practices (subject to specific payer policies)
It's important to note that eligibility to bill this code doesn't automatically ensure reimbursement. Providers must verify that their specific credentials, practice setting, and contractual relationships with insurance companies support billing for this service.
CPT Code 90885 vs. Similar Codes
Understanding how 90885 differs from related CPT codes helps ensure appropriate billing practices and prevents coding errors that could lead to claim denials or compliance issues.
90885 vs. 90887 (Interpretation of Results)
90885: Focuses on reviewing existing records and reports without any contact with the patient or the patient’s family
90887: Involves explaining evaluation results or treatment recommendations to family members or other responsible persons. The focus is on helping those involved in the patient’s care understand the implications of the findings and how they can support the patient
90885 vs. 90889 (Preparation of Report)
90885: Covers the evaluation and analysis of records
90889: Represents the time spent preparing comprehensive reports based on psychiatric evaluation. This involves organizing and documenting findings, impressions, and recommendations in a formal report format. This is distinct from simply reviewing records as it requires synthesizing information into a structured, shareable document.
90885 vs. E/M Consultation Codes (99241-99255)
90885: Limited to record review without patient presence
E/M Consultation: Involves direct face-to-face patient assessment, history taking, and physical examination
90885 vs. 96130-96133 (Psychological Testing)
90885: Review of existing test results and reports
96130-96133: Administration and interpretation of new psychological tests
When determining which code to use, consider the specific service provided, whether the patient was present, the purpose of the service, and the time spent on the activity. In some cases, multiple codes may be appropriate if distinct services were provided.
Cost of CPT Code 90885
The reimbursement rates for CPT code 90885 vary significantly based on several factors, including geographic location, payer type, and provider status. Understanding these variations helps with financial planning and setting appropriate fee schedules.
Typical Reimbursement Ranges:
Medicaid: Typically $30-50, with significant state-to-state variation
Commercial Insurance: Generally $50-120, depending on the specific payer and contract
Private Pay: Practices typically charge $75-200 based on market factors and overhead
Factors Affecting Reimbursement:
Geographic location and regional cost adjustments: Reimbursement rates typically vary by region, with higher rates in areas with higher costs of living.
Provider participation status (in-network vs. out-of-network): In-network providers generally receive lower but more reliable reimbursement rates based on negotiated fee schedules. Out-of-network providers may bill at higher rates but face greater challenges with collection and patient responsibility portions.
Payer-specific policies and limitations: Each insurance company maintains unique policies regarding record review services. Some may require specific documentation elements, impose frequency limitations, or restrict which provider types can bill for this service.
Complexity of the review and documentation: Though the code itself doesn't differentiate levels of complexity, thorough documentation of extensive or complex record reviews can support appeals if reimbursement is denied or reduced.
Time spent on the evaluation: While CPT 90885 is not explicitly time-based, documenting the actual time spent helps justify the service, adds credibility and transparency, and may support reimbursement in the event of an audit or appeal.
Contractual fee schedules and negotiated rates: Large group practices or those with significant leverage may negotiate better rates for this service than standard fee schedules offer.
Modifiers that may be required in certain situations: In some cases, modifiers may be necessary to indicate special circumstances, such as when the record review is performed on the same day as a direct patient service. Payer-specific rules vary, and many do not permit same-day billing for 90885 and psychotherapy codes without a clear separation. If allowed, documentation must clearly distinguish each service, its purpose, and the time spent.
When establishing fees for this service, providers should consider both the direct time spent reviewing records and the indirect time required for documentation and communication of findings.
Insurance Coverage for CPT Code 90885
Coverage policies for CPT code 90885 vary widely across different insurance types and individual plans. Understanding these variations is crucial for effective billing and revenue cycle management.
Medicare Coverage
Medicare does not generally cover or reimburse CPT code 90885 as a standalone, billable service, regardless of provider qualifications, documentation, or medical necessity. It is considered part of the work for other billable psychiatric services.
Medicaid Coverage
Medicaid coverage varies by state, but generally includes record review services when:
The service aligns with state-specific behavioral health policies
Prior authorization requirements (if any) are met
The provider is enrolled in the state's Medicaid program
The service is provided within coverage limitations
Commercial Insurance Considerations
Commercial payers have diverse policies, but common elements include:
Requirements for medical necessity documentation
Potential prior authorization needs for certain patient populations
Specific documentation standards for the evaluation
Limitations on frequency (e.g., once per episode of care)
Restrictions based on diagnosis codes
Best Practices for Insurance Billing:
Verify benefits and coverage before providing services: Contact the insurance company or use their online portal to confirm the patient's coverage for CPT code 90885. Document the verification details, including date, representative name, and confirmation number if available.
Document clear medical necessity for the record review: Explicitly state in your documentation why reviewing these specific records is necessary for providing effective treatment. Connect the review to specific clinical questions or treatment planning needs.
Maintain detailed documentation of time spent and materials reviewed: Create a comprehensive log of all materials reviewed, including the source, date, and type of document. Document the total time spent and break down time by document category if applicable.
Use appropriate diagnostic codes that support the need for evaluation: Select ICD-10 codes that accurately reflect the patient's condition and clearly justify why record review is necessary for their specific presentation or treatment needs.
Ensure compliance with specific payer requirements for documentation: Research and adhere to any payer-specific guidelines regarding what must be included in documentation. Some payers may require specific elements or formats.
Submit claims with all required information to avoid processing delays: Include all required identifiers, authorization numbers, and supporting documentation with the initial claim to prevent unnecessary denials and processing delays.
Common Issues and Solutions with CPT Code 90885
Providers frequently encounter challenges when billing CPT code 90885. Understanding these issues and implementing effective solutions can improve reimbursement rates and reduce administrative burden.
Issue: Claim Denials Due to Medical Necessity
Solution: Ensure documentation clearly establishes why the record review was necessary for patient care. Include specific details about how the information obtained will impact treatment planning or clinical decision-making.
Issue: Confusion About Time Requirements
Solution: While not required by the code, documenting the actual time spent reviewing records is a best practice. This can help justify the service if questioned by payers or during audits. .
Issue: Overlapping With Other Services
Solution: Clearly separate record review from direct patient services. If billing for both types of services on the same day, use appropriate modifiers if required by the payer and ensure documentation distinguishes between the activities.
Issue: Inadequate Documentation
Solution: Develop a standardized documentation template that includes:
List of specific records reviewed with dates
Time spent on review
Clinical impressions formed from the review
How the information impacts patient care
Any recommendations resulting from the evaluation
Issue: Frequency Limitations
Solution: Monitor the frequency of billing this code for individual patients. When multiple reviews are necessary within a short timeframe, document changes in circumstances that necessitate additional evaluation.
Mistakes to Avoid When Using CPT Code 90885
Avoiding common coding and billing errors is essential for maintaining compliance and optimizing reimbursement for record review services.
Mistake: Billing Without Proper Documentation
The evaluation of records must be thoroughly documented in the patient's medical record. Without detailed documentation that includes what was reviewed, clinical impressions, and the relevance to patient care, claims may be denied during audits or reviews.
Mistake: Using the Code for Brief Reviews
CPT code 90885 represents a comprehensive evaluation, not a quick review of incoming documents. Using this code for minimal reviews (e.g., briefly scanning a lab report) can constitute upcoding and may trigger compliance issues.
Mistake: Billing Without a Referral When Required
Some payers require a referral or order from another provider before they will cover record review services. Failing to obtain and document this referral when required will result in denied claims.
Mistake: Failing to Check Payer-Specific Requirements
Each payer may have unique requirements regarding:
Specific provider types that are eligible to bill the code
Documentation standards
Frequency limitations
Diagnosis code requirements
Prior authorization needs
Failing to identify and adhere to these specific requirements leads to payment delays or denials.
Mistake: Double-Billing for Services
Avoid billing separately for record review when that review is already included as part of another service, such as an initial psychiatric evaluation or ongoing care management.
Maximizing Proper Use and Reimbursement
Strategic approaches to using CPT code 90885 can help mental health providers improve both patient care and practice revenue while maintaining compliance.
Develop a Systematic Approach to Record Reviews
Establishing structured processes for record reviews enhances both clinical value and documentation quality:
Create a standard intake process that identifies cases likely to benefit from formal record review
Develop templates for requesting relevant records from various sources
Implement a tracking system for pending record requests
Establish documentation templates that meet payer requirements
Set up internal quality reviews to ensure compliance
Optimize Documentation Practices
Effective documentation not only supports reimbursement but also improves clinical communication:
Clearly state the clinical rationale for reviewing records
Detail specific documents reviewed (with dates and sources)
Document the time spent on the review
Articulate clinical impressions and how they inform treatment
Note any discrepancies or significant findings
Explain how the information will be used in patient care
Implement Strategic Billing Processes
Refine billing practices to maximize proper reimbursement:
Verify insurance coverage for this service before providing it
Submit claims promptly with appropriate supporting documentation
Track denial patterns and address recurring issues
Appeal inappropriate denials with comprehensive documentation
Consider bundling with other services when clinically appropriate and permitted by payers
Regularly update fee schedules based on reimbursement data
Educate Clinical and Administrative Staff
Staff training significantly improves coding accuracy and compliance:
Provide education on the appropriate use of CPT code 90885
Train clinicians on documentation requirements
Ensure billing staff understand payer-specific requirements
Implement regular audits to identify training needs
Create quick-reference guides for common scenarios
Frequently Asked Questions
Can I bill CPT code 90885 for reviewing my own previous notes?
No, CPT code 90885 is specifically for reviewing records or reports from other sources or providers. Reviewing your own previous documentation is considered part of standard care management and is not separately billable under this code.
Is there a minimum time requirement for billing CPT code 90885?
The code does not specify a minimum time requirement. However, most payers expect the review to be substantial enough to warrant professional analysis and separate billing. Minimal or incidental review (such as a cursory glance) does not justify using 90885. Most payers and best practices expect the review to be substantial enough to warrant professional analysis and separate billing. t.
Can I bill this code on the same day as a therapy or evaluation service?
In most cases, yes, you can bill for record review (90885) on the same day as direct patient services if they are distinct activities. However, some payers may require a modifier to indicate that these were separate services. Always check payer-specific guidelines and document each service separately.
Bottom Line
CPT code 90885 represents an important mechanism for mental health professionals to receive appropriate compensation for the time and expertise invested in evaluating patient records and reports.
When used correctly, this code acknowledges the significant clinical value of thorough record reviews in developing comprehensive treatment approaches.
Disclaimer
This guide provides general information about CPT code 90885 and related billing practices. It does not constitute legal, financial, or coding advice. Healthcare regulations, payer policies, and coding guidelines change frequently. Providers should consult with qualified coding specialists, their specific payers, and current CPT guidelines for the most up-to-date information before implementing billing practices. The authors and publishers of this guide are not responsible for any actions taken based on this information.