Do you know that mental health conditions have become a significant healthcare issue in the United States? In just 2022 alone, there were about 59.3 million people in the country with mental illness. This is a point of concern for both the patients and healthcare providers.
More patients mean more insurance claims. And a higher volume of claims also means more denials. Among the most frequently used CPT codes in mental/behavioural health is the CPT code 90834. But how can you ensure that you are billing this code correctly? Because if you are not, you may lose hundreds of thousands of dollars in revenue.
That is what we are going to discuss in this blog. We will discuss what CPT code 90834 is, and where and how you can use it effectively. So, let’s start.
CPT Code 90834 Description
CPT code 90834 is officially defined as:
“Psychotherapy, 45 minutes with patient.”
The Centers for Medicare & Medicaid Services (CMS) further explains this code as insight-oriented, behavior-modifying, supportive, and interactive psychotherapy. There are two important points to note for successful CPT code 90834 billing:
- The code is used for face-to-face patient-physician sessions
- There is a time limit of 45 minutes.
However, it is also vital to mention here that although the code specifies “45 minutes,” the accepted time range for a session billed under 90834 is typically between 38 and 52 minutes. This flexibility allows providers to bill accurately while accommodating natural variations in session length.
Another vital point that many billers overlook is that CPT code 90834 is a psychotherapy code without medical evaluation and management (E/M) services. If E/M services are also provided in the same session, use other more appropriate codes, such as 90833.
Additionally, face-to-face interaction does not have to be physical. CPT code 90834 is permanently covered under telehealth services. So, online therapy sessions can also be billed via this code.
Key characteristics of CPT 90834 include:
- Individual psychotherapy sessions only (not group or family therapy)
- Face-to-face interaction with the patient
- Therapeutic intervention focused on behavioral modification, insight development, or supportive care
Scenarios Where CPT Code 90834 is Applicable
To better understand the usage of CPT code 90834, let’s look at a couple of real-world scenarios in which it can be used.
Depression
A 45-year-old patient presents with major depressive disorder following job loss. The therapist conducts a 42-minute session focused on cognitive-behavioral interventions, mood stabilization techniques, and coping strategies. The session duration of 42 minutes falls within the 38-52 minute range. So, the biller can use code 90834 to bill the psychotherapy session.
PTSD Therapy
Suppose a soldier has recently returned from a warzone. He is experiencing clear signs of post-traumatic stress disorder (PTSD), like flashbacks, nightmares, and recurring traumatic memories that he cannot get rid of. He visits a psychotherapist who starts the treatment with a 50-minute therapy session. The therapist employs trauma-focused cognitive processing therapy techniques, making this an appropriate use of CPT 90834.
Applicable Modifiers for CPT Code 90834
The CPT code 90834 is a simple therapy session and, in most cases, it does not require modifiers. However, if the services are provided virtually, the following telehealth modifiers can be used:
Modifier 95 – Synchronous Telemedicine
This modifier indicates that the psychotherapy session was conducted via real-time interactive audio and video telecommunications systems. The session must include both audio and video components to qualify for this modifier.
Modifier GT – Interactive Audio and Video Telecommunications Systems
Similar to modifier 95, GT indicates services provided through interactive audio and video telecommunications. While many insurance carriers have transitioned to preferring modifier 95, some still accept GT for telehealth billing.
However, an important point to note here is that Medicare does not recognize the use of modifiers 95 and GT. Instead, it asks billers to use the appropriate place of service (POS) codes. You can use these modifiers for other payers if required by them.
CPT Code 90834 – Billing & Reimbursement Guidelines
The following are some important points to consider while filing claims for CPT code 90834.
Report ICD-10-CM Codes that Support Medical Necessity
Supporting the medical necessity of the provided services is the most important part of medical billing. Like every other code, 90834 must also be supported with valid ICD-10 codes. The following are some ICD-10 codes that justify its medical necessity:
- F01.511: Vascular dementia, unspecified severity, with agitation
- F03.C4: Unspecified dementia, severe, with anxiety
- F10.20: Alcohol dependence, uncomplicated
- F10.21: Alcohol dependence, in remission
- F20.0: Paranoid schizophrenia
You can check the complete list of valid ICD-10 codes for CPT code 90834 on the CMS Psychiatry and Psychology Services guide.
Meet the Documentation Requirements
Apart from valid ICD-10 codes, the following documentation is required for CPT code 90834 claims:
- Time element as noted above
- Modalities and frequency
- Clinical notes for each encounter that summarize the following:
- Symptoms
- Diagnosis
- Functional status
- Focused mental status examination
- Treatment plan, prognosis, and progress
Confirm the Medicare Reimbursement Rate
The Medicare reimbursement amount for CPT code 90834 varies for each Medicare Administrative Contractor (MAC) locality. However, the national average reimbursement amount for facility settings is $90.89 and $104.16 for non-facility settings.
You can check the exact amount for your MAC address via the PFS Lookup Tool.
Wrapping Up
CPT code 90834 is a common psychotherapy code and represents a 45-minute face-to-face session. For successful billing, append the essential documents, medical records, and modifiers. Also, support the medical necessity with at least one valid ICD-10 code.
In this guide, we have tried our best to explain 90834 as simply as we could. However, many providers may still face hurdles and denials. So, it is better to let the experts handle your billing operations. If you want to reduce your claims denials and boost revenue, our experts are always available to provide the best mental health billing services.
