CPT code 90834 refers to an evaluation and management service for a patient’s mental health. This code applies to individual psychotherapy services that are provided in an outpatient setting. The service includes a detailed evaluation of the patient’s mental health and a personalized treatment plan.

Which Providers can use CPT 90834?

Psychiatrists (MD)

Medical doctors (MDs) who specialize in mental health and have completed a residency in psychiatry.

Psychologists (Ph.D. or Psy.D)

Doctoral-level mental health professionals who hold either a Ph.D. (Doctor of Philosophy) or Psy.D (Doctor of Psychology) degree.

Licensed Clinical Social Workers (LCSW)

Master’s-level mental health professionals who have a master’s degree in social work (MSW) and are licensed by their state to provide mental health services.

Licensed Professional Counselors (LPC, LCSW, LMFT)

Master’s-level mental health professionals who have a master’s degree in counseling or a related field and are licensed by their state to provide mental health services.

Nurse Practitioners (NP) and Physician Assistants (PA)

Advanced practice clinicians who have completed a master’s degree or higher in nursing or physician assistant studies, respectively, and are licensed to practice under the supervision of a licensed physician or psychiatrist.

CPT Code 90837 Fee Schedule

The fee schedule or reimbursement for CPT code 90837 varies depending on the insurance company and location. Providers should check with their insurance companies to determine the allowed rate for this code. It is important to note that some insurance companies may not cover CPT code 90837 when billed alone and may require other codes to be billed with it. (Remember there is a difference between the bill rate and what is “allowed” by an insurance carrier).

List of major Healthcare private insurance companies in the US

Aetna (a subsidiary of CVS Health), Beacon Health Options, BCBS, or Blue Cross (Anthem, Inc, Empire BlueCross BlueShield, Carefirst, Health Care Service Corporation, Highmark, Premera, Cambia, Wellmark), Bright Health, Centene Corporation, Cigna or Evernorth Health, Harvard Pilgrim Health CareHealthfirst, Humana, Kaiser Permanente, Meridian Health Services, Molina Healthcare, Oscar Health, Tufts Health Plan, United Healthcare (Optum or UHC), WellCare Health Plans. 

CPT Code 90834 Fee Schedule

The fee schedule for CPT code 90834 varies depending on the location and the healthcare provider. The allowed rate is determined by the Centers for Medicare and Medicaid Services (CMS) and is based on the geographic location of the provider. Private insurers also have their own fee schedules for this code.

CPT Codes and Medical Billing

CPT codes are essential in medical billing, as they allow healthcare providers to document and bill for their services accurately. Psychotherapy services fall under the category of Evaluation and Management (E/M) codes. E/M codes are used to describe the time and effort a healthcare provider spends on a patient’s care.

Other related codes include CPT code 90791, which is used for psychiatric evaluations. This code is used for an initial evaluation of a patient’s mental health, including their medical history and symptoms. CPT code 90837 is used for longer psychotherapy sessions lasting between 53 and 60 minutes.

What is the difference between 90834 and 90837?

The difference between 90834 and 90837 is the duration of the psychotherapy session. 90834 is used for sessions lasting between 45-50 minutes, while 90837 is used for sessions lasting between 53-60 minutes. It’s essential to ensure that the appropriate code is used to bill accurately for the services provided.

What is the difference between 90834 and 90791?

The difference between 90834 and 90791 is that 90791 is used for the initial diagnostic evaluation, while 90834 is used for ongoing individual psychotherapy sessions. It’s essential to ensure that the appropriate code is used to bill accurately for the services provided.

Telehealth and CPT Code 90834

Telehealth services have become more prevalent in recent years, especially in the mental health field. Telehealth allows patients to receive mental health services from the comfort of their homes, increasing accessibility to care. CPT code 90834 can be used for telehealth sessions, as long as certain requirements are met.

Telehealth services must comply with HIPAA regulations and require audio and visual communication between the patient and the healthcare provider. Cigna, Blue Cross Blue Shield, and Aetna are among the private insurers that cover telehealth services.

CPT Code 90834: The Most Common CPT for Psychotherapy

CPT code 90834 is the most commonly used CPT code for psychotherapy services. The code is used for individual therapy sessions and applies to outpatient settings. The code’s popularity is due to its versatility in covering different lengths of therapy sessions and its use in telehealth services.

CPT code 90834 is an essential service code used in mental health billing. It applies to individual psychotherapy sessions in an outpatient setting and can be used for telehealth services. Understanding this code and its related codes is crucial for healthcare providers who offer psychotherapy services. Accurately documenting and billing for services ensures that patients receive the care they need and providers are reimbursed fairly for their work.