In Medical Billing and Coding navigating the complexities of psychotherapy billing can be a daunting task for mental health professionals. Accurate use of Current Procedural Terminology (CPT) codes is essential to ensure proper reimbursement and compliance with insurance requirements. Among the most commonly used codes in psychotherapy are 90834 and 90837, each corresponding to different session lengths and clinical scenarios. Understanding the nuances of these codes is crucial for effective billing practices.
Understanding CPT Code 90834
Individual psychotherapy sessions which usually last 45 minutes are coded with CPT 90834. When a therapist offers a patient in-person psychotherapy services with the goal of enhancing emotional, behavioral or psychological functioning this code is used.
- Session Duration Requirements
Sessions billed under 90834 should last between 38 to 52 minutes. It’s important to note that the actual time spent in direct patient contact is the determining factor for code selection.
- Appropriate Use Cases
90834 is suitable for routine psychotherapy sessions that deal with problems including behavioral difficulties depression, or anxiety. It is frequently employed when the session doesn’t need to go longer than the usual 45 minutes.
- Reimbursement Rates
As of 2025, the reimbursement rate for CPT code 90834 varies depending on the payer and geographic location. On average providers can expect reimbursement rates around $104.16 per session. It’s advisable to consult with specific insurance carriers for exact rates.
Understanding CPT Code 90837
CPT code 90837 is used for individual psychotherapy sessions that last 60 minutes. This code is applicable when extended time is necessary to address complex clinical issues requiring more in-depth therapeutic intervention.
- Session Duration Requirements
Sessions must last at least 53 minutes in order to be billed under 90837. Supporting the use of this code requires accurate recording of the start and end timings of sessions.
- Appropriate Use Cases
90837 is appropriate for intense treatment sessions for disorders including severe depression, trauma, or situations where several concerns need to be thoroughly addressed in one session.
- Reimbursement Rates
For CPT code 90837, the average reimbursement rate in 2025 is around $154.29 per session. Insurance companies and geographical variables may have an impact on rates.
Key Differences Between 90834 and 90837
| Feature | CPT Code 90834 | CPT Code 90837 |
| Session Duration | 38–52 minutes | 53 minutes or longer |
| Typical Session Length | Approximately 45 minutes | Approximately 60 minutes |
| Clinical Use | Standard psychotherapy sessions for moderate issues | Intensive sessions addressing complex or multiple issues |
| Reimbursement Rate (2025) | $104.16 | $154.29 |
| Documentation Requirements | Document session duration and therapeutic interventions | Detailed documentation including session duration, clinical necessity, and interventions |
| Insurance Scrutiny | Generally less scrutiny | May require prior authorization or additional documentation due to higher reimbursement |
| Add-On Codes | +90785 (interactive complexity), +99050 (after-hours), +99051 (evening/weekend/holiday) | +90785, +99354 (prolonged services), +99355 (additional prolonged services), +99050, +99051 |
| Telehealth Eligibility | Eligible with appropriate modifiers and payer guidelines | Eligible with appropriate modifiers and payer guidelines |
| Common Use Cases | Routine therapy sessions for ongoing issues | Sessions requiring in-depth intervention, such as trauma or crisis management |
Time Range and Application for CPT Code 90834
Knowing the precise CPT codes and how they are used is crucial when it comes to billing for individual psychotherapy sessions.
- For 45-minute treatment sessions, mostly for conventional individual psychotherapy, CPT Code 90834 is used.
- Therapists need to make sure that their sessions last the allotted forty-five minutes.
- To meet the requirements of the code, precise session time monitoring and documentation are essential.
- This code streamlines the reimbursement process by offering a uniform method of billing for 45-minute treatment sessions.
- Making effective use of CPT Code 90834 guarantees appropriate payment for the worthwhile mental health services rendered.
Mental health practitioners may confidently handle billing processes for their 45-minute treatment sessions while providing high-quality service by correctly utilizing CPT Code 90834.
Time Range and Application for CPT Code 90837
It is essential to comprehend CPT Code 90837 and its consequences in order to navigate the reimbursement procedure for prolonged 60-minute treatment sessions.
- CPT Code 90837 is intended especially for around 60-minute psychotherapy sessions.
- When offering their patients additional treatment sessions, therapists use this code.
- To guarantee correct invoicing compliance, precise tracking and documentation of the session length are crucial.
- Depending on the payer, the payer’s location, and any applicable modifiers used during billing, CPT Code 90837 reimbursement rates may change.
- To prevent claim denials and guarantee proper reimbursement, it is essential to comprehend the particular requirements and standards for this code.
Therapists may confidently offer longer treatment services while efficiently handling billing processes for their 60-minute therapy sessions if they understand the reimbursement components of CPT Code 90837.
Billing Best Practices
Accurate Time Tracking
To support the chosen CPT code, make sure that the start and finish timings of the sessions are precisely recorded. Direct patient interaction should be reflected in the amount of time spent.
Proper Documentation
Keep thorough records of the therapeutic treatments, patient reaction, and clinical justification throughout the duration of the session.
Navigating Insurance Requirements
Verify with insurance providers regarding prior authorization requirements, especially for 90837, and adhere to their specific billing guidelines.
Common Billing Errors to Avoid
- Billing 90837 for sessions under 53 minutes
- Inadequate documentation to support extended sessions
- Failing to obtain necessary authorizations
Using Modifier 95 for Telehealth Services with CPT Code 90834
Telehealth services are increasingly popular in healthcare, providing convenient access to mental health support. When delivering psychotherapy sessions via telehealth with CPT Code 90834, practitioners must recognize the importance of using Modifier 95.
- Modifier 95 indicates that psychotherapy sessions were conducted via telehealth. By appending this modifier to CPT Code 90834, therapists inform insurance payers that services were delivered through a secure, HIPAA-compliant platform, ensuring reimbursement eligibility for remote sessions.
- Using Modifier 95 with CPT Code 90834 is crucial for ensuring telehealth sessions are eligible for reimbursement. Accurate billing for virtual care is essential for the financial viability of mental health practices.
- Insurance companies have specific policies for telehealth billing with CPT Code 90834. Adhering to these guidelines is crucial to avoid claim denials and ensure smooth reimbursements.
Using Modifier 95 for Telehealth Services with CPT Code 90837
As telehealth services gain popularity in the healthcare sector mental health providers are using them increasingly often, using CPT Code 90837. Understanding the need of using Modifier 95 with this code is crucial for accurate invoicing and documentation.
- The use of Modifier 95 in conjunction with CPT Code 90837 guarantees secure remote treatment services by certifying that psychotherapy sessions were carried out via telehealth.
- Using Modifier 95 with CPT Code 90837 is crucial for telehealth session reimbursement eligibility. Proper billing is vital for the financial stability of mental health practices.
- Mental health professionals must understand the telehealth billing requirements for CPT Code 90837 across various insurers to ensure compensation for virtual sessions. Correctly charging for telehealth psychotherapy requires using Modifier 95 with CPT Codes 90834 and 90837.
Conclusion
Mental health practitioners must be aware of the differences between CPT codes 90834 and 90837 in order to guarantee proper billing and payment. Providers may successfully handle the Medical Billing Services in California by following the guidelines for session time, keeping accurate records, and remaining up to date on insurance regulations. Embracing these best practices not only supports the financial health of a practice but also upholds the integrity of patient care.
