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CPT Codes 90834 and 90837: Your Psychotherapy Billing Guide

“Psychotherapy Billing: Your Roadmap to CPT Codes 90834 & 90837”
CPT codes 90834 and 90837

Navigating the labyrinth of mental health billing can be a daunting task, particularly when it comes to understanding Current Procedural Terminology (CPT) codes. One such code that often surfaces in this context is CPT code 90834. This code is primarily used to bill for individual psychotherapy sessions. 

In this blog, we will demystify the key aspects and implications of CPT code 90834, including its comparison with other codes like CPT code 90837. 

We’ll also delve into their specific applications for 45-minute and 60-minute psychotherapy sessions. Read on to streamline your billing procedures and ensure effective reimbursement.

Understanding CPT Codes 90834 and 90837: Key Descriptions and Differences

When it comes to mental health billing, CPT codes 90834 and 90837 play a crucial role in accurately billing for psychotherapy sessions. Let’s break down the descriptions of these codes to better grasp their significance in the billing process.

Description of CPT Code 90834:

CPT code 90834 is specifically used to bill for individual psychotherapy sessions that typically last for 45 minutes. This code is essential for therapists and mental health practitioners who conduct standard therapy sessions for their patients. When utilizing this code, it is crucial to ensure the session’s duration aligns with the specified 45-minute time frame.

Description of CPT Code 90837:

In contrast, CPT code 90837 is designed for longer psychotherapy sessions, usually lasting for 60 minutes. This code is employed when therapists provide extended therapy services to their patients. It is essential to use this code accurately to avoid any discrepancies in billing and to ensure proper reimbursement for the extended session time.

Differences Between 90834 and 90837:

The primary difference between these two codes lies in the duration of the therapy sessions they represent. While 90834 is used for 45-minute sessions, 90837 is for longer, 60-minute sessions. Mental health practitioners must use the appropriate code based on the actual session duration to avoid billing errors and potential claim denials.
Differences Between 90834 and 90837 infographic

Reimbursement Rates(CPT Code 90834 & CPT Code 90837)

As mental health practitioners navigate the complexities of billing for psychotherapy sessions, understanding the reimbursement rates for specific CPT codes becomes vital. Two significant codes in this context are CPT Code 90834 and CPT Code 90837, which play a crucial role in accurately billing for individual psychotherapy sessions.

1- CPT Code 90834 Reimbursement:

CPT Code 90834 is specifically used to bill for individual psychotherapy sessions lasting approximately 45 minutes. Mental health practitioners must ensure that they use this code accurately when conducting standard therapy sessions with their patients. The reimbursement rate for CPT Code 90834 depends on various factors, including the payer geographical location. As an instance, in New York, the reimbursement rate for CPT Code 90834 is $98.39.

2- CPT Code 90837 Reimbursement:

On the other hand, CPT Code 90837 is designated for longer psychotherapy sessions, typically lasting around 60 minutes. Therapists use this code when providing extended therapy services to their patients. Just like CPT Code 90834, the reimbursement rate for CPT Code 90837 may vary depending on the payer, location, like in New York the reimbursement rate for CPT code 90837 is $144.83.

It’s essential for mental health practitioners to be aware of the reimbursement rates for these codes to ensure accurate billing and appropriate reimbursement for the services provided. 

Additionally, staying up-to-date with any changes in reimbursement policies and guidelines can help avoid claim denials and ensure smooth financial operations within a mental health practice.

Time Range and Application for 45-Minute Therapy Sessions (CPT Code 90834)

When it comes to billing for individual psychotherapy sessions, understanding the specific CPT codes and their applications is essential.
  • CPT Code 90834 is utilized for 45-minute therapy sessions, primarily for standard individual psychotherapy.
  • Therapists must ensure the session duration aligns with the specified 45-minute time frame.
  • Accurate tracking and documentation of session time are crucial to comply with the code’s requirements.
  • This code provides a standardized approach to billing for 45-minute therapy sessions, streamlining the reimbursement process.
  • Efficient use of CPT Code 90834 ensures proper reimbursement for the valuable mental health services provided.
By implementing CPT Code 90834 appropriately, mental health professionals can offer quality care while managing billing procedures for their 45-minute therapy sessions with confidence.

Understanding Extended 60-Minute Therapy Sessions (CPT Code 90837)

Navigating the reimbursement process for extended 60-minute therapy sessions requires a clear understanding of CPT Code 90837 and its implications.
  • CPT Code 90837 is specifically designed for psychotherapy sessions lasting approximately 60 minutes.
  • Therapists utilize this code when providing extended therapy services to their patients.
  • Accurate tracking and documentation of the session duration are essential to ensure proper billing compliance.
  • Reimbursement rates for CPT Code 90837 may vary based on the payer, geographical location, and any applicable modifiers used during billing.
  • Understanding the specific guidelines and requirements for this code is crucial to avoid claim denials and ensure successful reimbursement.
By mastering the reimbursement aspects of CPT Code 90837, therapists can provide extended therapy services with confidence, while effectively managing billing procedures for their 60-minute therapy sessions.

Diagnosis Code for CPT Code 90834 and CPT Code 90837

When billing for psychotherapy sessions using CPT Code 90834 and CPT Code 90837, mental health practitioners must also include the appropriate diagnosis codes to accurately reflect the patient’s condition and justify the therapeutic services provided.

Diagnosis Code for 90834:

For sessions billed under CPT Code 90834, therapists should select the diagnosis code that best represents the patient’s mental health condition being addressed during the 45-minute therapy session. 

The diagnosis code should be chosen from the appropriate code set, such as the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Selecting the precise diagnosis code ensures alignment between the therapy session’s purpose and the patient’s documented condition.

Diagnosis Code for 90837:

Similarly, when using CPT Code 90837 for extended 60-minute therapy sessions, mental health practitioners must select an accurate diagnosis code that justifies the need for longer therapy services. This diagnosis code should reflect the patient’s specific mental health condition that requires intensive therapy over the extended session duration.

By correctly associating the relevant diagnosis codes with CPT Code 90834 and CPT Code 90837, mental health professionals ensure appropriate billing and enhance the chances of successful reimbursement.

Accurate diagnosis coding provides valuable information to insurance payers about the necessity and appropriateness of the therapy services rendered, supporting the overall transparency and integrity of the billing process.

Using Modifier 95 with CPT Code 90834 and CPT Code 90837 for Telehealth Services

CPT Code 90834 and CPT Code 90837 for Telehealth infographic

Using Modifier 95 for Telehealth Services with CPT Code 90834

In the rapidly evolving landscape of healthcare, telehealth services have become increasingly prevalent, offering a convenient and accessible way for patients to receive mental health support remotely. When providing psychotherapy sessions via telehealth using CPT Code 90834, mental health practitioners must understand the significance of using Modifier 95.

Purpose of Modifier 95:

Modifier 95 is specifically designed to indicate that psychotherapy sessions were conducted via telehealth. By appending Modifier 95 to CPT Code 90834, therapists communicate to insurance payers that the services were delivered through a secure and HIPAA-compliant telehealth platform, ensuring reimbursement eligibility for these remote sessions.

Ensuring Reimbursement Eligibility:

Properly using Modifier 95 with CPT Code 90834 is crucial to ensure that telehealth sessions are eligible for reimbursement. With the growing importance of virtual care, accurate billing for telehealth services is essential for mental health practices’ financial viability.

Compliance with Telehealth Guidelines:

Different insurance companies and payers may have specific policies and requirements regarding telehealth billing with CPT Code 90834. Understanding and adhering to these guidelines are essential to avoid claim denials and ensure smooth reimbursement processes.

Using Modifier 95 for Telehealth Services with CPT Code 90837

As telehealth services gain popularity in the healthcare landscape, mental health practitioners are increasingly embracing this mode of delivering therapy services remotely using CPT Code 90837. Understanding the importance of using Modifier 95 with this code is crucial for accurate billing and documentation.

Purpose of Modifier 95:

Modifier 95 serves the same purpose when used with CPT Code 90837. It indicates that psychotherapy sessions were conducted via telehealth, providing a remote and secure means of delivering extended therapy services.

Securing Payment Eligibility:

Accurately using Modifier 95 with CPT Code 90837 is essential to ensure the eligibility of telehealth sessions for reimbursement. Proper billing practices are critical for mental health practices’ financial stability.

Adhering to Telehealth Guidelines:

Mental health practitioners must be aware of the telehealth billing guidelines specific to CPT Code 90837 for different insurance companies and payers. Staying informed about these policies is crucial to facilitate successful reimbursement for virtual therapy sessions.
Utilizing Modifier 95 appropriately with CPT Code 90834 and CPT Code 90837 is instrumental in accurately billing for telehealth psychotherapy sessions.

Final thoughts

Understanding and correctly utilizing CPT codes 90834 and 90837 are essential for mental health practitioners to navigate the complexities of billing for psychotherapy sessions. CPT code 90834 is used for standard 45-minute individual therapy sessions, while CPT code 90837 is employed for extended 60-minute sessions. Ensuring accurate session duration and appropriate code selection are crucial to avoid billing errors and maximize reimbursement.

Adding Modifier 95 indicates that psychotherapy sessions were conducted via telehealth, enabling proper reimbursement eligibility for remote sessions. 

Being aware of the reimbursement rates for these codes, as well as the specific diagnosis codes, is vital to ensure proper billing and successful reimbursement. Practitioners should stay informed about any changes in reimbursement policies and guidelines to maintain smooth financial operations within their mental health practice.

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