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The 90834 CPT code is a commonly billed code among therapists and other mental health clinicians.
This article explains when to use CPT code 90834, as well as when to use it for 45 minute telehealth sessions.
Like all Current Procedural Terminology (CPT) codes, the 90834 CPT code is a standardized code used across the United States to describe healthcare services, including mental health services, to insurers for reimbursement purposes.
What is the 90834 CPT code description?
CPT code 90834 refers to "Psychotherapy, 45 minutes with patient."
The actual range defined by the American Medical Association (AMA) for the 90834 CPT code is 38 to 52 minutes. This means that for billing purposes, a session that is less than 38 minutes would not typically qualify for the use of 90834.
Sessions longer than 52 minutes might necessitate the use of a different CPT code, such as 90837, which is intended for psychotherapy sessions of approximately 60 minutes.
CPT code 90834 is widely used in mental health practices for billing purposes. It is one of the key procedural codes within the mental health sector and is broadly recognized by insurance companies for reimbursement purposes.
When using the 90834 code within your electronic health record (EHR) for therapists, such as SimplePractice, it's essential to ensure that the session duration aligns with the requirements of the code. This means that the therapy session should be focused on psychotherapy and last around 45 minutes.
It is crucial to document the session appropriately, noting the start and end times, to support the use of this code in case of an audit by an insurance company.
Tips for using the 90834 CPT code
Here are some actionable steps and considerations when using the 90834 CPT code for billing and insurance claims:
Documentation
Ensure that each session billed with the 90834 CPT code is properly documented in the patient's record. The documentation should include the focus of the therapy, techniques or interventions used, and progress notes that justify the therapeutic necessity of the session.
Insurance verification
Before using CPT code 90834, verify the client's insurance benefits to ensure that psychotherapy sessions of 45 minutes are covered. Some insurance plans may have specific limitations or preferences for different psychotherapy session lengths.
Pre-authorization
Check if the client's insurance plan requires pre-authorization for psychotherapy sessions. If so, obtaining approval before billing with the 90834 CPT code can help avoid claim denials.
Billing
When entering billing information into an EHR like SimplePractice, accurately input the 90834 CPT code along with any relevant diagnosis codes from the DSM-5 that justify the need for psychotherapy. This can help streamline the claims process and reduce the likelihood of denials.
Denial management
If a claim using the 90834 CPT code is denied, review the explanation of benefits (EOB) to understand the reason for denial.
Common issues can include lack of pre-authorization, incorrect patient information, or insufficient documentation. Address these issues and resubmit the claim if necessary.
Client communication
Inform your clients about their insurance benefits and any potential out-of-pocket costs associated with their therapy sessions. Clear communication can help manage expectations and reduce billing surprises.
Using the 90834 CPT code accurately and effectively requires attention to detail and a good understanding of insurance billing practices.
By following these guidelines, mental health clinicians can navigate the billing and reimbursement process more smoothly, ensuring that they are compensated for their services and that clients receive the coverage benefits they are entitled to.
Can the 90834 CPT code be billed as telehealth?
Yes, CPT code 90834 can indeed be billed for telehealth services, provided that certain criteria are met.
Here’s what you need to know to bill CPT code 90834 as telehealth:
Modifier usage
When billing 90834 for telehealth services, it’s essential to use the appropriate modifiers to indicate that the session was conducted via telehealth.
The most commonly used modifier is 95 for synchronous telehealth services. Modifier GT is largely outdated and has been replaced by modifier 95 for most commercial payers, though you should verify requirements with specific payers.
Place of Service (POS) code
You also need to use the correct Place of Service (POS) code, which varies by payer.
While POS code 02 (telehealth) was commonly used during the COVID-19 public health emergency, many payers now accept standard POS codes (such as POS 11 for office) combined with the appropriate telehealth modifier (95). Medicare and some commercial payers have specific requirements, so verify the correct POS code with each insurance payer you bill.
Insurance payer guidelines
Be aware of the specific guidelines and requirements of the insurance payers you’re billing.
While many insurers have expanded coverage for telehealth services, especially in response to the COVID-19 pandemic, policies can vary significantly between insurers.
It's critical to verify coverage for telehealth services, including the use of the 90834 CPT code with telehealth modifiers, directly with each insurance payer.
Documentation
Just like in-person sessions, thorough documentation of telehealth sessions is crucial. Ensure that your clinical notes reflect that the session was conducted via telehealth, including the technology used (while maintaining compliance with HIPAA regulations) and any pertinent observations about the telehealth setting.
Stay informed
Regulations and policies around telehealth, including billing for mental health services, are subject to change.
Stay informed about the latest guidelines from Centers for Medicare & Medicaid Services (CMS), insurance payers, and professional boards relevant to your practice.
Other common mental health CPT codes
Understanding psychotherapy CPT codes is crucial for accurate billing and efficient insurance claim processing.
Here are some other common CPT codes for psychotherapy and diagnostic evaluations:
90832: Psychotherapy, 30 minutes with patient. This code is often used for shorter, more focused therapy sessions.
90837: Psychotherapy, 60 minutes with patient. This code is for longer sessions, which may be needed depending on the client's situation and treatment plan.
90846: Family psychotherapy (without the patient present), 50 minutes
90847: Family psychotherapy (with the patient present), 50 minutes
90791: Psychiatric diagnostic evaluation without medical services. This code is used for the initial assessment of a new client, not requiring a medical exam.
90792: Psychiatric diagnostic evaluation with medical services. This is similar to 90791, but is used when the evaluation includes a medical service, such as a medication evaluation.
90853: Represents a group therapy session, regardless of the modality. It's important to note that group sizes and session lengths can vary.
90785: Used in addition to codes for diagnostic procedures or psychotherapy, indicating factors that complicate the delivery of care, such as the need for the involvement of third parties in therapy or the use of nonverbal communication methods.
90839 and 90840: Used for psychotherapy for a crisis (90839 for the first 60 minutes and 90840 for each additional 30 minutes). These codes are used in situations where a patient is in a high-level crisis requiring immediate and intensive therapy.
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