CPT 90834 – Psychotherapy, 45 Minutes with Patient
CPT code 90834 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90834
?
CPT 90834 denotes a 45-minute psychotherapy session delivered by a licensed mental health provider. This code is primarily utilized for ongoing therapeutic interventions aimed at addressing various behavioral, cognitive, and emotional difficulties faced by individuals. The specified duration of this session permits ample opportunity for comprehensive exploration of issues, emotional processing, and the formulation of treatment strategies, thereby making it one of the most prevalent codes billed within mental health practices.
Applicable to individual therapy sessions (which may include brief family involvement), CPT 90834 is recognized across both in-person and telehealth environments. The service must demonstrate medical necessity, directly correlating with a diagnosed mental health condition, and must be substantiated by a well-documented treatment plan.
Psychotherapy sessions billed under 90834 aim to enhance emotional regulation, bolster problem-solving capabilities, and develop effective coping strategies. This form of therapy is often integrated into broader treatment frameworks that may encompass medication management, behavioral interventions, or family therapy to address the multifaceted nature of mental health conditions.
Documentation Tips
Thorough and precise documentation is crucial for compliant billing of CPT 90834. Each session note should encompass the following essential elements:
- Start and end times of the session, confirming the 38–52 minute duration
- Type of therapy delivered (e.g., Cognitive Behavioral Therapy, Dialectical Behavior Therapy, or trauma-informed approaches)
- Clinical focus, detailing objectives such as symptom alleviation, behavioral adjustments, or emotional processing
- Patient response to therapeutic interventions, highlighting engagement and insight
- Progress toward identified goals or a rationale for continued therapeutic engagement
- Telehealth statement if applicable, along with documentation of patient consent for remote services
Tip: Utilize standardized documentation formats like SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan) to enhance audit preparedness and payer compliance.
At a Glance
- Session Duration: 38–52 minutes
- Typical Setting: Outpatient clinic or telehealth
- Provider Types: Psychologists, licensed therapists, clinical social workers, and licensed counselors
- Requires: Documented diagnosis and a personalized treatment plan
- Billable Units: Per session
- Telehealth Eligible: Yes, with modifier
95 - Typical Reimbursement: $85–$130, varying by insurance provider
Billing Examples
Example 1: A patient diagnosed with generalized anxiety disorder engages in a 45-minute cognitive-behavioral therapy session focusing on exposure therapy and relaxation techniques. The clinician meticulously documents the session duration, specific interventions employed, and tangible progress toward managing anxiety symptoms, thereby qualifying for CPT 90834.
Example 2: During a 50-minute trauma-focused therapy session, a patient with post-traumatic stress disorder (PTSD) explores triggering events and strategies for emotional regulation. The clinician records notable symptom fluctuations and updates the treatment plan accordingly, allowing for appropriate billing under CPT 90834.
Example 3: In a 45-minute session, a therapist provides individual therapy while briefly including the patient’s spouse for 10 minutes of support. As the primary objective remains focused on the individual’s therapeutic goals, this session is correctly billed under CPT 90834.
Compliance Guidelines
To uphold compliance with payer and Medicare regulations for CPT 90834, practitioners should adhere to the following guidelines:
- Confirm patient eligibility and ascertain authorization requirements prior to initiating therapy.
- Utilize modifier 95 for telehealth sessions, ensuring that documentation includes patient consent for remote care.
- Bill CPT 90834 separately from evaluation and management (E/M) codes, unless psychotherapy is distinctly separate and adequately documented.
- Maintain detailed session notes that substantiate medical necessity, as claims lacking specific therapeutic goals are frequently denied by payers.
- Adhere to frequency limitations mandated by insurance carriers; many policies restrict the number of psychotherapy sessions covered annually.
- Implement a compliant EHR or practice management system to systematically track session duration, documentation, and coding.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F32.0 – Major depressive disorder, single episode, mild
- F41.1 – Generalized anxiety disorder
- F43.10 – Post-traumatic stress disorder
- F33.1 – Major depressive disorder, recurrent, moderate
- F41.9 – Anxiety disorder, unspecified
- F34.1 – Dysthymic disorder
- F43.21 – Adjustment disorder with depressed mood
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
Need more help? Reach out to us.
Q1. What is the purpose of CPT 90834?
CPT 90834 is utilized for billing 45-minute psychotherapy sessions aimed at addressing mental, emotional, or behavioral disorders.
Q2. Is it permissible to bill 90834 for telehealth services?
Yes, this code is reimbursable for telehealth sessions when modifier 95 is included, along with proper documentation of patient consent.
Q3. Are psychiatrists allowed to bill 90834?
Certainly — psychiatrists can bill for this code when psychotherapy is distinct from medication management, ensuring that both services are documented separately.
Q4. Can I bill CPT 90834 alongside an E/M code?
Billing for 90834 with an E/M code is permitted only if the psychotherapy is a separate and distinct service, typically utilizing add-on codes like 90833.
Q5. Does billing for CPT 90834 require prior authorization?
Many insurance providers necessitate prior authorization beyond initial visits. It is advisable to review the specific payer policy before proceeding with billing.
Q6. What are common reasons for claim denials?
Claims may be denied due to missing session start/end times, lack of medical necessity documentation, or failure to appropriately link an ICD-10 diagnosis to the therapy provided.
Q7. Can family members participate in the therapy session?
Yes, family members may join the session, provided the primary focus remains on the individual’s therapeutic objectives.
