CPT Code 90834: Psychotherapy, 45 minutes

What is code 90834?

The American Medical Association (AMA) defines and maintains CPT codes for psychotherapy services, which are regularly updated to reflect current clinical practice and innovation in mental health care.

CPT 90834 is the billing code for a 45-minute individual psychotherapy session with a patient. Mental health professionals use it to document and charge for sessions focused on improving emotional, behavioral, or mental health issues. The service is different from group therapy, as it is conducted individually and typically includes ongoing assessment, therapeutic interventions, and treatment planning. CPT 90834 is one of the most commonly used codes for standard outpatient therapy sessions.

In addition to basic psychotherapy codes, there are add-on codes that help capture services requiring more detailed documentation. One such add-on code is the interactive complexity code, which is used when therapy sessions involve increased communication challenges, such as multiple participants or other complicating factors that affect the treatment process. These codes are critical when providing medical evaluation and ensuring the medical necessity of the treatment.

Insurance payers rely on these codes to assess the medical necessity and appropriateness of treatments provided, ensuring that psychotherapy services meet established reimbursement criteria. Proper coding is crucial for mental health professionals to receive compensation for their work and to ensure that their services are appropriately documented for medical evaluation.

CPT code 90834 documentation requirements

When billing for CPT code 90834 for individual psychotherapy sessions, proper documentation is critical to ensure accurate billing and reimbursement. The following key elements should be included in the documentation:

Patient’s presenting problem and symptoms

Document the patient's current diagnostic evaluation, including presenting concerns, mental health status, and relevant symptoms. It’s essential to note any diagnostic evaluation findings that inform the treatment plan. This documentation provides a clear picture of the patient’s needs and guides the course of treatment.

Treatment goals and progress

Clearly outline the patient's treatment goals and track their progress during individual psychotherapy sessions. This section should show the relationship between the patient's current symptoms and the therapeutic interventions used. Record how the patient’s condition has improved or changed and note any obstacles or challenges encountered.

Therapy techniques used

Document the specific psychotherapy techniques used during the session, including any special approaches such as cognitive-behavioral therapy, dialectical behavior therapy, or psychiatric services. This section also includes services provided through telehealth services if applicable, as these modalities may require different documentation for the same service but via an alternative delivery method.

CPT code 90834 billing guidelines

When submitting a claim for CPT code 90834 sessions, it is essential to follow specific billing guidelines to ensure accurate coding and reimbursement. The following points outline key factors healthcare professionals should consider when billing for psychotherapy services:

• The billing must reflect the services performed accurately, including any interpretation services provided during the session.
• If the therapy session extends beyond the typical 45 minutes, such as in cases where longer sessions are necessary due to patient complexity, you may need to apply additional codes or use other codes to capture the extended service duration.
• Third-party payers, such as insurance companies, may have specific requirements for how claims for individual therapy sessions are submitted. Always check with them first.
• Ensure that the codes used reflect the medical necessity of the session and the full scope of the treatment provided.

Other relevant CPT codes

When billing for psychotherapy services, it’s important to consider other relevant CPT codes to ensure accurate documentation and proper reimbursement. Here are key CPT codes commonly used alongside CPT code 90834:

• CPT 90837: Psychotherapy, 60 minutes with patient
• CPT 90832: Psychotherapy, 30 minutes with patient
• CPT 90846: Family psychotherapy (without the patient present)
• CPT 90847: Family psychotherapy (conjoint psychotherapy) (with patient present)
• CPT 90853: Group psychotherapy (other than of a multiple family group)