90834 CPT Code: Know Your Codes
Basics of 90834
CPT Code 90834: Psychotherapy, 45 minutes with a patient in an outpatient setting. 90832, 90834, and 90837 describe individual psychotherapy services for the patient and may include an informant. The patient is required to be present for all or most of the service. The codes include an ongoing assessment and adjustment of treatment interventions. The times for these codes are:
|CPT Code||Code Description||Time Range|
|90832||Psychotherapy 30 minutes||16 to 37 minutes|
|90834||Psychotherapy 45 minutes||38 to 52 minutes|
|90837||Psychotherapy 60 minutes||53 minutes or more|
Some health insurance companies may consider 90834 as the standard psychotherapy session. In such cases when reporting 90837, it would be beneficial to document in the clinical record why the longer service was warranted rather than the shorter service.
CPT CODE 90834 REIMBURSEMENT RATE
Medicare (2020): $94.55
Check your contract with the payer to ensure that 9083 is available for reimbursement, and verify that your client is covered for that service. Most of the time, their plan doesn’t’ have any limit or require preauthorization for 90834. Your documentation should reflect both the accurate amount of time spent with the client and the services performed during the full duration of the session. As long as your claim and documentation are accurate, you should be paid justly for your services.
BILLING 90834 VS 90837
Both 90834 and 90837 are designed to bill for the same service: psychotherapy. The primary distinguishing factor between the two codes is time; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes. As defined by the CPT, 90834 should be used when you spend an estimated 38–52 minutes on therapy with the client, and 90837 is for all therapy sessions that are at least 53 minutes long. This means a traditional 50-minute therapy hour should be billed as 90834; however, this also means that you should be rightfully reimbursed for longer sessions with 90837.
ADD-ON CODES FOR 90834 BILLING
Add-on codes identify an additional part of the treatment above and beyond the principal service. Both the principal service code and add-on code should be listed on the billing form.
ADD-ON CODE 90785
Interactive complexity (List separately in addition to the code for primary procedure). Add-on code 90785 can be reported with appropriate psychotherapy code based on length of the session i.e. for diagnostic evaluation (90791), psychotherapy (90832, 90834, 90837) and group psychotherapy (90853)
ADD-ON CODE 90863
Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services. Add-on code 90863 is used for pharmacologic management, including prescription and review of medication, when performed on the same day as one of the stand-alone psychotherapy codes (90832, 90834, 90837).
ADD-ON CODES 99050 AND 99051
- Add-on Code 99050: Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
- Add-on Code 99051: Services provided in the office during the regularly scheduled evening, weekend, or holiday office hours.
MENTAL HEALTH PROVIDERS
All mental health professionals including psychologists, psychiatrists, nurses and social workers delivering psychotherapy services use the same applicable CPT® codes when billing clients and filing health insurance claims with third-party payers, including Medicare, Medicaid and private health insurance carriers. One of the following mental health provider licenses is required for rendering 45-minute individual outpatient therapy sessions:
- Licensed Clinical Social Workers (LCSW)
- Licensed Professional Counselors (LPC)
- Licensed Marriage Family Therapist (LMFT)
- Clinical Psychologists (PsyD or PhD)
- Psychiatrists (MD)
CPT © Copyright 2021 American Medical Association
For accurate Mental/Behavioral Health medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate Mental/Behavioral Health medical billing and coding. To know more about our services call us at 888-552-1290 or write to us at [email protected]