CPT codes, or Current Procedural Terminology, are a standardized language developed by the American Medical Association (AMA) used by healthcare providers to describe medical services for billing and tracking purposes. Understanding these codes is essential for individuals seeking mental health treatment, as they relate directly to the service received and the associated cost. CPT 90834 is one of the most frequently used codes in behavioral health, representing the standard building block for individual psychotherapy.
The Specifics of the Service
CPT Code 90834 is designated for individual psychotherapy sessions lasting approximately 45 minutes. It covers the face-to-face time spent between a patient and a licensed mental health professional (e.g., psychiatrist, psychologist, or clinical social worker). To bill accurately using 90834, the documented session duration must fall within a precise range of 38 to 52 minutes. Administrative tasks, such as scheduling or collecting payment, are excluded from this therapeutic time count.
The service involves various therapeutic interventions aimed at treating a mental health condition, managing symptoms, or promoting behavioral change. These sessions utilize techniques such as insight-oriented, behavior-modifying, supportive, or interactive psychotherapy. The session must focus on the patient’s diagnosis or treatment and is not intended for non-therapeutic activities like recreational therapy. The goal is to address the patient’s emotional, behavioral, or mental health disorders through focused, one-on-one interaction.
How This Code Differs from Other Sessions
The primary distinction between CPT Code 90834 and other psychotherapy codes is the session duration, reflecting a time-based hierarchy in billing. This code is used for the common 45-minute appointment, while two other codes cover shorter and longer sessions. The choice of code is based on the provider’s clinical judgment regarding the necessary face-to-face time to address the client’s symptoms and therapeutic goals.
Shorter Sessions (CPT 90832)
CPT 90832 is reserved for individual psychotherapy lasting 30 minutes, which corresponds to a documented time range of 16 to 37 minutes.
Longer Sessions (CPT 90837)
For sessions that require a more in-depth therapeutic engagement, providers use the code CPT 90837. This code is designated for a 60-minute session, requiring a minimum face-to-face time of 53 minutes or longer.
Navigating Insurance and Billing
CPT Code 90834 is central to understanding the financial side of mental health care. While the reimbursement rate is generally standardized, the final cost is determined by the patient’s specific insurance plan. Federal laws, such as the Mental Health Parity and Addiction Equity Act (MHPAEA), require that financial requirements (copayments, deductibles, and coinsurance) for mental health services cannot be more restrictive than those applied to medical or surgical benefits.
Patient financial responsibility typically involves a deductible, the amount paid out-of-pocket before insurance coverage begins. Until the deductible is met, the patient is responsible for the full contracted rate of the 90834 session. Once satisfied, a flat copayment or a coinsurance percentage (a portion of the session’s allowed cost) applies to each visit.
The code 90834 may appear on a bill with additional procedural modifiers if the session included other services. For example, if the session included medication management by a psychiatrist, 90834 would be reported with a psychotherapy add-on code alongside an Evaluation and Management (E/M) code. If the session was delivered via a secure video platform, the modifier “95” is appended to indicate a telehealth service. Understanding these codes and modifiers helps patients track their benefits and navigate pre-authorization requirements.