CPT 90834 covers individual psychotherapy for 38 to 52 minutes of direct face-to-face contact. This is the mid-range duration code, commonly used for regular weekly therapy sessions. Sessions under 38 minutes use 90832; sessions 53+ minutes use 90837. Most payers require prior authorization after initial therapy sessions, with reimbursement often set at 70-90% of the 90837 rate.
Bill CPT 90834 only for sessions documented as 38-52 minutes. Time documentation must be exact; do not round times to meet minimum requirements. If a session runs 37 minutes, bill 90832. If it reaches 53 minutes, bill 90837. Do not bill multiple sessions on the same date as a single 90834 code. Each session is a separate billable unit. Administrative time or clinical team discussions without patient presence do not count toward session length.
Most commercial payers require prior authorization after the first or second session, with annual session limits (typically 20-30 sessions). Medicare covers medically necessary psychotherapy without session limits. Medicaid varies by state. Some payers use relative value units (RVUs) or monthly limits instead of session counts. After reaching limits, request authorization with clinical documentation showing ongoing medical necessity and treatment progress.
Use modifier 25 if billing an E/M service (99213-99215) on the same day as therapy. Modifier 95 indicates telehealth. Modifier 93 indicates audio-only delivery (where payer-approved). Do not bill psychiatric evaluation codes (90791, 90792) on the same date without modifier 25 on the E/M component. Therapy codes do not require modifier 59 for bundling purposes.
Document exact start and stop times in patient records. Note therapeutic approach (CBT, DBT, psychodynamic, etc.), specific interventions provided, patient presentation and mood, progress toward treatment goals, and clinical response. Time documentation to the minute is required. Incomplete time records are the primary cause of denials for therapy billing.
Use CPT 90834 for sessions lasting 38-52 minutes. If under 38 minutes, use 90832. If 53+ minutes, use 90837.
Yes, most commercial payers require prior authorization after initial sessions, often with annual session limits (20-30 sessions per year). Medicare typically covers ongoing medically necessary therapy without session limits.
No. Document actual session time. A 37-minute session must use 90832, not 90834. Rounding results in CO-16 denials.
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