In running your practice successfully, you have to bill correctly to be paid. It’s probably not why you entered the profession, but it’s the nature of the business. As such, understanding the intricacies of billing and coding is essential for running and growing your practice. One of the most commonly used CPT codes that’s crucial to know is 90834, which represents a 45-minute individual psychotherapy session.

Navigating the complexities of this code can be challenging, but having a clear grasp of its description, time requirements, and documentation guidelines is key for accurate billing and reimbursement. Let’s do a deeper dive into CPT code 90834, when to use it, and how best to apply it to maximize your reimbursement and run your billing most efficiently. 

What is the 90834 CPT Code?

‍Let’s start with the acronyms: CPT code 90834 is part of the Current Procedural Terminology (CPT) system, which was first introduced by the American Medical Association (AMA) in 1966. This coding system was designed with the goal of standardizing billing, documentation, and communication among healthcare providers, third-party payers, and patients.

The AMA’s CPT Editorial Panel has guided significant development and updates of the CPT system since its inception. This panel is composed of experts from various medical specialties, including mental health, that is responsible for reviewing, revising, and updating the codes. To ensure the codes remain accurate, relevant, and comprehensive, the panel also solicits input from healthcare professionals, medical societies, and other stakeholders.

Over the years, the psychotherapy codes have been simplified and standardized as well. The early 2010s saw the system refined to include three primary timed codes for psychotherapy sessions: 90832 (30 minutes), 90834 (45 minutes), and 90837 (60 minutes). These codes are used across all settings and are intended to cover the majority of individual psychotherapy sessions.

CPT code 90834 specifically represents a standard 45-minute individual psychotherapy session, falling within the 38-52 minute time range. This code is widely used in mental health practices and is essential for accurate billing and reimbursement for these services. It ensures that mental health professionals receive appropriate compensation for their time and expertise.

With the rise of telehealth, the AMA has introduced modifiers to existing codes rather than creating new ones. For example, the 95 modifier is added to the original code (e.g., 90834-95) to signify a teletherapy session. This adaptation ensures that the CPT system remains relevant and useful as healthcare delivery continues to evolve. 

When to use 90834

‍The 90834 CPT code is specifically designed for individual psychotherapy sessions lasting between 38 and 52 minutes, falling within the commonly referred to "45-minute" therapy session. To accurately bill using this code, the following criteria must be met:

• Face-to-face interaction: The session must be conducted in-person with the patient present for the majority of the allotted time. However, teletherapy sessions of the same length will be 90834-95.
• Mental health focus: The primary purpose of the session should be to treat a mental health condition or concern, addressing the patient's emotional, behavioral, or psychological well-being.
• Evidence-based interventions: Therapists should employ scientifically-validated methods such as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), or Interpersonal Psychotherapy (IPT) during the session. These approaches have been extensively researched and proven effective in treating various mental health conditions.

When not to use 90834

‍When aiming to ensure proper reimbursement for your valuable expertise, it’s also crucial to know when not to use this code. The 90834 code is not appropriate for sessions primarily involving non-psychotherapy services, such as:

• Teaching grooming skills or daily living activities
• Engaging in recreational therapy (e.g., dance, equine, or music therapy)
• Providing case management or care coordination services
• Conversing with the client via text or email

When in doubt in trying to determine whether to use the 90834 code, consider the session's duration, ensuring it falls within the 38-52 minute range. This time frame captures the face-to-face therapeutic interaction and does not include any of your administrative tasks like scheduling or documentation. Further down in this article is a deeper exploration of some pitfalls of using the 90834 CPT code if you’d like more information.

Requirements and Billing Criteria for 90834

‍To bill the 90834 CPT code, you must meet specific requirements and adhere to established billing criteria, including:

• License requirements: You must hold a valid mental health provider license, such as LCSW, LPC, LMFT, PsyD, PhD, or MD.
• Outpatient setting: The psychotherapy session must be conducted in an outpatient setting, as this code is not applicable for inpatient or residential treatment.
• Accurate documentation: You are required to maintain comprehensive and precise documentation of each 90834 session. This includes recording the start and stop times, date, and place of service to ensure the session falls within the 38-52 minute time range.
• Clinical content: Session notes should encompass patient-centered observations, detailing the specific clinical interventions utilized, progress made towards treatment goals, and any relevant risk assessments conducted.

Adhering to best practices in psychotherapy documentation is crucial for successful 90834 billing. Aim to have your progress notes strike a balance between objective information (e.g. client behaviors and statements) and subjective insights (e.g. clinical interpretations and hypotheses). Employing standardized templates like SOAP or DAP can help ensure consistency and thoroughness in your documentation.

Moreover, session notes should be completed promptly, ideally within 24-48 hours of the appointment, to ensure accuracy and timely billing. Collaborating with your clients during the documentation process by clarifying key points before the session ends can further enhance the quality and precision of progress notes.

Common Pitfalls to Avoid for 90834 CPT Code

‍When billing with the 90834 CPT code, there are several common pitfalls that mental health professionals should be aware of to ensure accurate reimbursement and compliance with billing guidelines:

• Incorrect session duration: One of the most frequent mistakes is billing for sessions that do not meet the 38-52 minute time requirement for the 90834 code, as there are other codes to use for shorter or longer sessions. It is crucial to accurately track and document the face-to-face time spent on psychotherapy to justify the use of this code.
• Billing for non-therapeutic services: The 90834 code is specifically designed for psychotherapy sessions and should not be used for non-therapeutic activities such as teaching grooming skills, recreational therapy, or case management. Billing these services under 90834 can lead to claim denials and potential audits.
• Incomplete or inaccurate documentation: Failing to maintain thorough, accurate, and timely documentation can jeopardize reimbursement for 90834 sessions. Progress notes should include patient-centered observations, clinical interventions, treatment progress, and risk assessments. Omitting key information or providing vague descriptions can raise red flags during claim reviews.
• Incorrect modifiers or place of service codes: Using the wrong modifier or place of service code can result in denied claims. For example, when billing 90834 for telehealth sessions, it is essential to add the appropriate modifier (e.g., 95) to indicate the use of telecommunication technology. Similarly, accurately reporting the place of service (e.g. office, outpatient clinic) is necessary for proper reimbursement.
• Neglecting to verify patient insurance coverage: Skipping the critical step of verifying a patient's insurance coverage and eligibility can lead to unexpected claim denials. Before providing services, you should confirm the patient's policy status, covered services, financial responsibilities, prior authorization requirements, and any visit limits or restrictions. This proactive approach helps prevent billing issues on your end and ensures your clients are informed about their coverage.

How to Maximize your 90834 Reimbursement

‍There’s no denying that you deserve to be compensated appropriately for helping your clients. To do so, maximizing reimbursement for CPT code 90834 requires a proactive and informed approach. Here are some key strategies to optimize your billing practices and ensure fair compensation for your services:

• Stay current with reimbursement trends: Regularly review industry updates and policy changes that may impact 90834 reimbursement rates. Attend webinars, read professional publications, and engage with colleagues to stay informed about the latest developments in mental health billing.
• Verify patient coverage: Prior to each session, confirm the patient's insurance eligibility and coverage for 90834 services. This crucial step helps prevent unexpected claim denials and ensures you are aware of any limitations or requirements specific to their plan.
• Use appropriate modifiers: When billing for 90834, use the correct modifiers to accurately reflect the service provided. For example, append modifier 95 for telehealth sessions or modifier 59 for distinct procedural services, such as the client having two different services provided on the same day. Proper modifier usage enhances claim specificity and supports appropriate reimbursement.
• Document thoroughly: Maintain detailed, accurate, and timely documentation that clearly demonstrates the medical necessity and duration of each 90834 session. Progress notes should include patient-centered observations, clinical interventions, treatment progress, and any relevant risk assessments. To make this a lighter lift, consider using an AI Assistant to help automate your progress notes. Comprehensive documentation is essential for justifying the use of the 90834 code and withstanding potential audits.
• Put technology to work: Implement a reliable billing software or consider partnering with a reputable billing service to streamline your claims process. These tools can help ensure accurate coding, reduce errors, and provide valuable insights into your billing performance. Automating certain aspects of your billing workflow allows you to focus more on patient care while optimizing reimbursement.
• Negotiate rates strategically: Engage in proactive rate negotiations with insurance payers to secure fair reimbursement for your 90834 services. Prepare a compelling case highlighting your expertise, patient outcomes, and the value you bring to the healthcare system. Be willing to advocate for yourself and your services, as annual rate adjustments are often necessary to keep pace with inflation and maintain a sustainable practice. 

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Frequently Asked Questions (FAQ)

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What is the typical reimbursement rate for CPT code 90834?
Reimbursement rates for the 90834 code can vary based on factors such as the payer, geographic location, and the therapist's credentials. It's essential to stay updated on current reimbursement trends and negotiate rates with insurance providers to ensure fair compensation for your services.

Is it possible to use the 90834 code for telehealth sessions?
Yes, the 90834 code can be used for telehealth sessions as long as the session meets all other requirements and criteria, such as falling within the 38-52 minute time range. When billing for telehealth sessions using 90834, therapists should:

• Use the appropriate telehealth modifier: Append modifier 95 to indicate that the service was provided via real-time interactive audio and video telecommunications systems.
• Ensure patient consent: Obtain patient consent for telehealth services at the time of service. 
• Meet location requirements: Make sure to include the appropriate Place of Service (POS) in billing documentation to avoid claim delays and denials. For all in office and telehealth sessions conducted the POS should be indicated as 11. 

How does the 90834 code differ from the 90837 CPT code?
The primary difference between CPT codes 90834 and 90837 lies in the length of the psychotherapy session:

• 90834: This code is used for sessions lasting between 38 and 52 minutes, falling within the commonly referred to "45-minute" therapy session range.
• 90837: This code is reserved for longer sessions, lasting 53 minutes or more, often referred to as "60-minute" sessions.

Accurately selecting the appropriate code based on the face-to-face time spent on psychotherapy is crucial for proper billing and reimbursement.

90834 Bill Code Limitations

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While CPT code 90834 is widely accepted by most payers for billing 45-minute psychotherapy sessions, there are some limitations to be aware of:

• Session frequency restrictions: Some payers may limit the number of 90834 sessions that can be billed within a specific timeframe, such as per week, month, or year. Be sure to verify these limits to avoid claim denials.
• Diagnosis coverage: Certain diagnoses or treatment approaches may not be covered under the 90834 code. Payers might have specific guidelines on which mental health conditions are eligible for reimbursement using this code. Again, definitely worth looking into. 
• Prior authorization requirements: Some payers may require prior authorization or have other specific requirements for reimbursement of 90834 sessions. Failure to obtain necessary approvals can result in denied claims.
• Documentation standards: Payers often have specific documentation requirements for 90834 sessions. Progress notes must clearly justify the medical necessity of the service and include essential elements such as start and stop times, risk assessments, and treatment plans. Keep these in mind so you can format your progress notes accordingly.
• Telehealth restrictions: While telehealth has become more widely accepted, some payers may still have limitations on reimbursement for 90834 sessions conducted via telehealth. It's important to verify payer-specific rules regarding telehealth services.
• Multiple services billing: Billing for multiple services on the same day, such as 90834 and a diagnostic evaluation, may require the use of modifiers to avoid claim denials. Understanding payer guidelines for billing multiple services is essential.

Be sure to familiarize yourself with the policies and requirements of the payers you work with to ensure compliance and minimize the risk of claim denials when billing CPT code 90834. Staying updated on payer-specific guidelines, verifying patient eligibility, and maintaining accurate documentation are key to successfully navigating the limitations surrounding this code.

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