TL;DR, CPT code 90834 is for a psychotherapy session 38 - 52 minutes in length. It’s one of the most commonly used CPT codes for a psychotherapy session. It pays substantially less than CPT code 90837 which is for sessions 53+ minutes.
CPT code 90834 is a common, frequently used CPT code used by mental health professionals along with 90837 and 90791. Its typical use is for a normal psychotherapy session with a client. Insurers will reimburse this code only once per day, and some only as frequently as twice per week.
CPT Code 90834 is defined as:
Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 38 - 52 minutes with the patient and/or family member in an outpatient setting
The clock-time of 38 - 52 minutes is considered to be actual face-to-face time conducting therapy with a patient or family member not including scheduling, collecting payment, patients running late, etc.
If your session with a patient is complicated by interpreters, maladaptive communication, or the presence of other third-parties, you might be able to use the add-on 90785 for interactive complexity.
If your session goes over 52 minutes, you should use CPT code 90837 instead. It’s for psychotherapy sessions 53+ minutes long.
There are addons for working outside business hours. One is 99050. It’s used when you do a session outside of your normal business hours. For example, if you meet with a client on a Saturday, you can use 99050 unless that is your normal schedule. If your normal schedule is to work on Saturdays, you would use addon 99051 since it’s still outside of “normal” office hours.
A common modifier used with CPT code 90834 is modifier 95. This is the modifier for teletherapy. Before using this modifier or scheduling teletherapy with a patient, make sure their plan covers this modifier. Many plans do, especially since COVID-19, but some plans require you to conduct teletherapy with their special system. There might also be other limitations so check each plan.
The typical document that accompanies a therapy session that you will bill using CPT code 90834 is a case note. The case note relates to the diagnosis, treatment plan, and how the therapy session related to the biopsychosocial considerations impacting the client. Case notes might include reasons for using any add-ons and also why the 38 - 42-minute session is medically necessary.
CPT code 90834 doesn’t have to be billed by a licensed medical doctor. It’s mainly used by licensed mental health professionals. Typically, Licensed Clinical Social Workers, Licensed Professional Clinical Counselors, Licensed Marriage and Family Therapists, and Clinical Psychologists will bill CPT code 90834.
It depends. Some insurance plans do and some insurance plans don’t (many insurance plans don’t). I probably sound like a broken robot, but it’s always best to call the client’s payer and make certain that an 90834 session is covered without pre-authorization.