CPT Codes

Understanding CPT code 90834- PCC Quick Guide

Understanding CPT code 90834

In the medical billing field, Current Procedural Terminology (CPT) codes refer to the universal code that is used by healthcare providers to report and bill their rendered services. These codes are crucial in ensuring that medical services are accompanied by the right documentation and billing practices making the healthcare system effective. There are numerous sets of CPT codes for reporting various mental health services, CPT code 90834 holds great significance, which is billed for individual psychotherapy sessions.

In this article, we will discuss detailed information regarding what the 90834 CPT code means, who can assign it, and the services covered by it.  Differences between 90834 and similar codes, documentation requirements, and CPT code 90834 reimbursement tips will also be discussed. Knowledge of this code is crucial to mental health practitioners who want to improve the overall quality of patient care, reduce legal costs, and want timely reimbursements.

CPT Code 90834 Description

The 90834 CPT code is a mental health code that is used to bill the therapy sessions, which last for about 45 minutes. CPT code 90834 time range is essential to document to avoid overcrowding and under-coding. Therapy sessions billed by code 90834 generally involve structured treatment approaches.

There should be clear clinical indications for such types of sessions, and these indications should be documented to justify the use of 90834 in medical bills. This code refers to some specific types of mental health disorders, including anxiety, depression, PTSD, and other psychological problems. Insight-oriented, supportive, cognitive, and behavior-modifying therapeutic interventions are made in this session to improve the mental health of the patient.

The Role of Psychotherapy in Healthcare

Psychotherapy is one of the basic types of treatment that should be used when the patient experiences any emotional, behavioral, or psychological disorders. Its purpose is to provide mental health support to people with psychological problems while using various forms of therapy that have to be scientifically proven and evidence-based.

For example, a psychotherapist who has a professional practicing license might embrace the cognitive-behavioral approach to urge the patient to overcome negative thinking methods. Mindfulness approaches to boost anxiety patients are also used. These are some of the procedures that enable the patients to get back control of their lives.

The 90834 CPT code is important to guarantee that the providers are fairly paid for offering these important services. There are many rules and regulations being made from time to time, depending upon the frequency of psychotherapy sessions provided to the patients.

Who can Bill CPT Code 90834?

Only licensed mental health professionals are permitted to send the bill for the services offered defined by code 90834. This includes clinical psychologists and psychotherapists, LCSWs and LPCs, psychiatrists, and MFTs as well. To bill for the 90834 code, these professionals must be duly licensed and credentialed in the state they practice. They should also be recognized by the insurance companies as well.

For example, a clinical therapist who, after completing their degree, practices in a clinic under the supervision of a licensed therapist may not be in a position to self-bill 90834. Licensing is important because it ensures the patients and the payers that they are dealing with professionally verified healthcare professionals and they are in safe hands. As such following the licensing requirement will help mental health professionals to avoid their claims being denied besides ensuring they are in line with the state and federal health care laws.

Billing Considerations for CPT 90834

There are some key elements that should be kept in mind when billing for this code. These include the following in order to avoid any denial or low reimbursement for the 90834 CPT code.

Billing Considerations for CPT 90834

1. Insurance Verification And Pre-Authorization

Before delivering services, it’s very important for healthcare providers to check whether the patient’s insurance includes mental health services under the 90834 code or not. These sessions are delivered under specific insurance plans, which may not be available in mental health insurance plans.

Therefore, insurance companies insist on prior approval of psychotherapy sessions, especially if they plan to apply CPT codes for additional sessions. Lack of following protocols for prior-authorization can be a hindrance in claim submission and reimbursement approval.

2. Payer-Specific Policies And Reimbursement Rates

While filing for reimbursement, it might also be found that various insurance companies have different policies concerning the rates of psychotherapy services.  Reimbursement rates may differ based on factors like the geographical location of the service provider, their qualification, and type of insurance policy.

Medicare and Medicaid may have different payment systems from those of the private health insurance plans. One has to be up to date with such different payer policies and fee schedules to bill for the 90834 CPT code and receive reimbursement for services. This information is available through the provider online portal of the insurance company or through the insurer’s billing section.

3. Use of Modifiers

When services are delivered through different mediums, such as individual psychotherapy delivered through telemedicine, then suitable modifiers should be used. There are two-digit add-on codes used along with parent CPT codes like 90834 to give the payer extra details about the service. Important modifiers in this case are:

  • 95 Modifier: It suggests that the psychotherapy session was done through synchronous telemedicine. Therefore, CPT code 90834 with modifier 95 is used in the medical bills.
  • GT Modifier: Also applied to telemedicine services to mean that while the provider and the patient are not in the same room or building, they are actually connected through a secure telecommunications connection.

These modifiers make sure that the payer understands that the service was performed via telecommunication technology means and thus reimburses it at the correct price. Use of incorrect or missing modifiers cause possible claims denials and potential revenue loss for the services.

4. Session Limits

There are always limitations placed by insurance companies on the number of sessions for psychotherapy within a year or within a policy period. An insurance plan may allow a patient to be given 20 therapy sessions in a year, after which the patient will pay extra charges on their own.

For this reason, customers should know about the number of sessions offered. They should also be informed when they are close to the set limit. It also means that patients are educated about their financial status so that the claims are not declined due to a violation of session limits.

5. Documentation And Compliance

Documentation is properly important during billing for 90834. The use of the 90834 code is justified if detailed and comprehensive notes of the session are taken and recorded. These notes are presented to the insurance company as evidence of the therapy offered. Providers must document key details like:

  • The starting and ending time of the meeting.
  • The type of therapy that is given (Cognitive behavioral therapy, psychoanalysis).
  • All therapeutic interventions of psychotherapy should be noted, and the outcome of the session should also be mentioned in the documents.

The lack of documentation may result in an audit, leading to claim denial and fines for noncompliance with Medicare and Medicaid regulations. Session notes should be formed as per rules and regulations set by the government and payers.

6. Appealing Denied Claims

When an Insurance Claim is rejected, healthcare providers have the right to appeal. The denied claims can be due to clerical mistakes, lack of necessary supporting information, improper coding, or lack of appropriate modifiers. The objection is mentioned by the payers on claim rejection. There is always a second opportunity to submit the lacking documents and information to again get the billing process on track. Claims are again submitted by the healthcare professionals. Payers review them and issue CPT code 90834 reimbursement payments if everything is correct. Knowledge about the appeals procedure is the key to getting back the lost revenues and maintaining the financial equilibrium.

CPT 90834 vs. CPT 90837: What's the difference?

The 90834 CPT code addresses 45-minute psychotherapy sessions, and the 90837 code is used for 60-minute sessions. While many providers use these two codes interchangeably, they are much different, and invalid coding directly leads to claim denial. Billing and coding require an understanding of the differences between them.

90837 defines sessions of 53 minutes and above with more intensive cases or where patients present with complex issues. However, CPT code 90834 time  range lies between 38-52 minutes. If a therapist uses 48 minutes in a session with a patient, the correct code is 90834. However, if the discussion goes beyond 55 minutes, then 90837 should have been billed. The separation of these codes ensures that providers do not bill less in an attempt to increase their customer base or bill higher to put themselves in challenges of an audit and malpractice.

The Reimbursement Rate of CPT Code 90834

Regarding the reimbursement rate for 45-minute therapy sessions billed by 90834, rates are approximately 25 percent less than 60-minute therapy sessions billed by 90837. It is because of the complexity of sessions and more time duration for the 90837 CPT code. The psychotherapy sessions for code 90834 deal with less intricate situations, leading to lower reimbursement rates. Below is a comparison of the Medicare reimbursement rates for 90834 over recent years:

  • 2024: $101.51
  • 2023: $99.97
  • 2022: $112.29
  • 2021: $103.28
  • 2020: $94.55

The reimbursement rate had risen to 9.2% between 2020 to 2021. This is evidence of a positive attitude towards the importance of mental health in society. These numbers change from year to year, but this data is enough to get an idea of what providers can make within a 45-minute psychotherapy session.

Conclusion

For mental health practitioners, the importance of knowledge of the code 90834 CPT cannot be underestimated. To avoid discrepancies in billing and timely reimbursement for individual psychotherapy sessions, the CPT code 90834 description is recommended. Starting from the clinical indications and duration of the session to the documentation and outcomes report, all things should be clear in the mind. Ninety thousand eight hundred thirty-four bills 45-minute long psychotherapy sessions for treating mental health patients.

Only licensed professionals can bill the payer for this code. There are some billing considerations that should be followed for the effective and smooth undergoing of the process. These considerations include insurance verification, prior authorization, knowledge about payer-specific details, use of modifiers, and tips to tackle denied claims. Healthcare professionals can avoid revenue leaks by following all protocols related to medical billing and coding of the 90834 CPT code.

FAQ - People Also Asks

It is used to bill 45-minute long individual psychotherapy sessions with the patients. This code is used when the provider provides therapeutic treatment of a mental illness that involves face-to-face contact with the patient. The therapy can be used for any sort of emotional, behavioral, or psychological problem. Also read our blog to know about the 90833 CPT.

The CPT 90834 code is one that can be used by any licensed mental health professional who is allowed to perform and then bill for psychotherapy services. This includes:

  • Psychiatrists
  • Psychologists
  • Licensed Clinical Social Workers (LCSWs)
  • LPCs

CPT code 90834 in telehealth means that a psychotherapy session of 40 minutes was provided to the patient via telecommunication. The doctor and patient were not in the same room, but they were in one-to-one meetings through audio or video call communication. However, there is a need to mention modifiers here, along with 90834 in the medical bills, to determine the virtual nature of therapy sessions.

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