CPT Code 90834: Complete Guide with Reimbursement Rates [2020]

CPT Code 90834 is the most common procedure code used in mental health and behavioral health billing.

Learn how to bill Cpt Code 90834 accurately every time with our insurance billing guide.

You’ll discover the differences between procedure codes 90834 and 90837, the reimbursement rate for 90834, which add-on codes to use, and how to code your claims using procedure code 90834.

If you’d rather hand these sorts of tasks off to a team of billers who can help, consider reaching out to our mental health billing service.

CPT Code 90834 Description

Individual psychotherapy for 45 minutes in an outpatient setting.

(Source) (Source)

The Centers for Medicare Services (CMS) defines 90834 as insight oriented, behavior modifying, supportive, and/or interactive psychotherapy.

cpt code 90837 description

Services not to be included in coding insurance claims with 90834 are:

  • Teaching grooming skills
  • Recreational therapy (dance, art, or play)

Other CPT codes besides 90834 are to be used for working with clients with an intellectual disability or sever dementia.  (Source)

Speaking about psychiatric services,  CMS writes:

Psychotherapy without medical evaluation and management services are reported as 90832, 90834 and 90837. (Source)

When you are billing for therapy services with medical evaluation and management services, you will need to use a E/m code plus a psychotherapy add-on code such as +90833, +90836, +90838.

See our Guide to Psychiatry CPT Codes to learn how to bill this common scenario or reach out to our billing service for help.

90834 Time Frame

CPT Code 90834 Length: 45 Minutes

Typically individual therapy sessions coded with 90834 must between 38 and 52 minutes in length.

CPT Code 90834 Reimbursement Rate

cpt code 90834 reimbursementTypically therapy sessions 45 minutes in length are paid for less than your intake evaluation session (90791) and your 60 minute therapy sessions (90837).

Expect 70%-80% of the payment compared to a 60 minute individual therapy session.

Medicare 2020 90834 Reimbursement Rate:  $94.55

(Source)

Billing 90834 vs 90837

This is straightforward enough.  Pick the duration of time the session occurred within and use the corresponding code.

Add-On Codes for 90834 Billing

Here are the three most common add-on CPT codes to use when billing 90834:

  • +90785 – Interactive complexity. Example: play therapy using dolls or other toys.

This is an interactive complexity add-on code that is not necessarily a payable expense. This code only indicates that the treatment is complex in nature.

  • +99050 – Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
  • +99051 – Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.

More on our guide to mental health CPT codes here.

How to Bill CPT Code 90834

Here is a great visual example of how to use 90834 on a CMS-1500 for for submitting your insurance claims:

cpt code 90834

Billing 90834 for Telehealth

Like our visual guide above, here is a visual diagram on how to bill 45 minute therapy sessions with telehealth:

cpt code 90834 for telehealth

You will also need to select the best Telehealth Modifier to bill with based on your client’s insurance plan.  We wrote an exhaustive guide on how to do telehealth billing you can review, or reach out and perhaps we can help.

License Level Requirements for Billing CPT Code 90834

One of these 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)

 

 

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