The CPT code 90834 has been around for a while, but changes in rules for practices have made it much more difficult to document and bill for psychotherapy sessions. More attention to the intricacies of timing, detailed notes, matching ICD-10 codes, and the right telehealth modifiers has changed reimbursement success. Add to the mix payer-specific rules, and the practice has no chance of getting paid in a timely manner. Mental health practices can avoid denials and improve revenue integrity to stay compliant, even while practicing medicine, by following the new billing policies, verifying payer rules, and educating staff on a consistent basis.
The expansion of psychotherapy services in response to increased demand has driven changes in mental and behavioral health billing. CPT 90834 is one of the most essential psychotherapy codes and is used frequently in outpatient mental health. This code has not changed over the years, but billing-related rules and payer policies have changed and impact how mental health practices document, code, and submit claims. Non-compliance to these new rules and policies leads to denials, audits, and slow payments. Mental health practices may find new billing requirements for CPT 90834 create additional challenges concerning accuracy, compliance, and revenue cycle management within the practice.
What Is CPT Code 90834?
CPT code 90834 is billed for services rendered to a single patient/ client for a psychotherapy session that is 45 minutes long. 90834 requires the session to be between 38 and 52 minutes in order to bill for it. This is a service provided by psychologists, psychiatrists, licensed clinical social workers, and other outpatient mental health counselors and professionals. This code is for psychotherapy services and for the outpatient mental health service professionals, that includes some of the other types of cognitive behavioral therapy, psychodynamic therapy, and other empirically supported psychotherapies. For 90834 to be billed by the provider, the session must be in that exact time range.
Recent Updates to CPT 90834
Expanded Documentation Expectations
Recent changes in psychotherapy billing requires documentation to be more comprehensive and detailed. For CPT 90834, payers expect physicians to document time intervals in more detail than approximations. This helps keep the session within the appropriate time constraints and helps corroborate the coded services billed.
In addition to time documentation, the narrative must capture the specific techniques used, the patient’s response to the techniques and how she/he reacted, and describe any steps forward in relation to the goals of the treatment. Auditors routinely flag notes that are too generic or repetitious. Providing individualized documentation that articulates the specific service rendered is critical for a thorough audit. This will reduce the risk of a denial.
Telehealth Billing Rules and Modifiers
Because behavioral health providers primarily offer care using telehealth platforms, CPT 90834 is a telehealth service that is generally reimbursed. Telehealth is now a permanent fixture in behavioral health service delivery. However, the billing guidelines that surround telehealth psychotherapy have gotten more stringent. Practices will need to adjust their telehealth psychotherapy service billing to their claims policies. Bill the telehealth service using the appropriate telehealth modifiers (like modifier -95) that indicate the service was delivered via real-time audio-video capability.
In addition, practitioners have to be precise in their reporting of the place of service (POS) codes. When telehealth services are not offered in the patient’s home, POS 02 will suffice. However, when services are offered to the patient in their home, the provider should use POS 10. Some payers permit audio-only psychotherapy, provided that the telehealth service is compliant in the guiding policies. These payers require modifier -93, and there may also be additional note, file, or ledger requirements. Telehealth services are frequently denied payment due to an incorrect modifier or POS code.
ICD-10 Code Precision and Compliance
As behavioral health providers, when billing for services delivered via telehealth platforms using CPT billing codes, the details of the diagnosis need to be precise and aligned with the diagnosis being billed. More recent updates to the ICD-10 System provide more details for various mental health disorder diagnoses, including anxiety disorders, depressive disorders, and trauma-related diagnoses. Payers’ systems, policies, and guidelines are being updated to take a more precise look at the diagnosis codes tied to the patient’s presentation rather than relying on larger, more general diagnosis categories.
Claims may be denied for reasons such as insufficient medical necessity when diagnosis codes are inconsistent with documented psychotherapy services. Practices must note that ICD-10 codes must justify the medical necessity for psychotherapy, describing the patient’s evolving condition. Compliance requires the diagnosis, treatment plan, and services rendered to be linked.
Payer-Specific Rules and Coverage Policies
While the definitions of CPT codes are the same, the records needed for reimbursement of CPT 90834 are quite different depending on the payer. Each coverage plan for Medicare, Medicaid, and commercial insurance have different requirements for coverage, documentation, and reimbursement. While some payers require prior authorization for psychotherapy, some have restrictions on how often and how long clients can be seen.
Payers may also have different policies for coverage of telehealth, documentation requirements, and which modifiers can be used. Payers and practices that do not account for various policies tend to have higher claim denial rates. To adjust to the documentation requirements of the payer, the practice must frequently monitor payer policies and guidance.
Denial Risks and Common Billing Errors
There are several reasons why claims involving the CPT code 90834 get denied and most of these reasons are easily avoidable. Therapists perhaps may be charging to a code even when the duration of the session is below the necessary time limit. Meaning, if a therapy session is 30 minutes long, billing for 90834 could lead to an automatic denial of the claim.
Billing issues can also arise involving incorrect telehealth modifiers, incorrect place of service codes, insufficient documentation, and diagnosis codes that do not defend the medical necessity of the psychotherapy. These issues disproportionately affect practices that don’t regularly audit claims, and also may not have staff training that incorporates the most recent billing updates.
Best Practices for Billing CPT 90834
Accurate Time Documentation
The most critical factor in billing 90834 is time tracking. Providers need to document exact session start and end times in the medical record. This practice aids in code selection and provides adequate documentation for payers to defend against the potential for denials and audits.
Correct Use of Modifiers and Place of Service Codes
When providing psychotherapy services via telehealth, the appropriate telehealth modifier and the correct place of service code must be included in the claim. This area is one of the most common to cause claim denials, and reporting is done incorrectly most of the time. Managing payer-specific reference guides is the best way to report accurately.
Alignment With ICD-10 Diagnosis Codes
In submitting claims for 90834, one of the primary requirements is providing one of the diagnosis codes that validates the medical necessity for the treatment. Service Providers must regularly update the diagnosis in the medical record to reflect the current state of the patient. When the diagnosis, treatment plan, and progress notes are all in sync, it significantly increases the chances of getting a claim paid.
Verification of Payer Policies
Payers constantly update their policies, especially in the area of behavioral health. Practices need an assigned person to manage monitoring the payers for any updates and communicating them to the billing and clinical staff. This is the best way to reduce claim rework and avoid out of date payment delays.
Ongoing Staff Training and Audits
Training updates and frequent internal audits help focus staff attention on documentation issues, billing discrepancies, and workflows to ensure there are no issues with payers or compliance gaps.
Impact on Practice Revenue and Compliance
The revised CPT 90834 billing guidelines focus on both compliance and revenue. When documentation and claims billing are done correctly, there is a decrease in denials and quicker payments for the practice. Creating standards for documentation improves compliance for audits and regulatory factors for the long term.
From a reimbursement perspective, the documentation compliance improves quality of care and reimbursement, as well as the continuity of care since the documentation gives a more detailed account of the patient’s condition over the time.
Conclusion
Mental health billing will always include CPT code 90834, but changing payer/employment regulations means billing will need to be done with ever-increasing accuracy. New requirements in the industry mean that detailed documentation, correct billing modifiers, accurate telehealth modifiers, and an appropriate diagnosis are prerequisites to reimbursement. Being up to date with CPT codes and the industry’s new billing requirements will enable mental health practitioners to alleviate the number of denied claims, streamline revenue, and minimize the risk of being subjected to an audit. Training employees, monitoring billing cycles, and reviewing payer policies will allow mental health practitioners to continue to provide psychotherapy to their patients.
Make An Appintment With A2ZFAQs
Billing for CPT 90834 is appropriate for psychotherapy sessions that last between 38 and 52 minutes. Use a different code for sessions that fall outside of this range.
Yes. 90834 can be billed for telehealth services, depending on the payer, and with the appropriate place of service and modifier.
Shorter sessions than 45 minutes may need to be billed with CPT 90832, and sessions that last longer than 52 minutes will typically need to be billed with CPT 90837.
Yes, claims must always have a diagnosis code that justifies the necessity of the psychotherapy service.
The most common reasons include the incorrect duration of the session, missing required modifiers, incorrect place of service codes, and gaps in documentation and diagnosis.