CPT 90834 is the workhorse of psychotherapy billing. If you provide individual therapy sessions lasting between 38 and 52 minutes, this is likely your most frequently billed code. Yet even experienced therapists make costly mistakes with documentation, time tracking, and modifier usage that lead to denied claims and lost revenue.
This guide breaks down everything you need to know about CPT 90834: the exact time requirements, current reimbursement rates, documentation essentials, and the common pitfalls that trigger audits. Whether you are new to private practice or looking to tighten up your billing processes, you will find actionable guidance here.
What is CPT 90834?
CPT 90834 is a Current Procedural Terminology code used to bill for individual psychotherapy sessions lasting 38 to 52 minutes. The code specifically covers face-to-face time spent with the patient delivering therapeutic interventions.
The official AMA description reads: "Psychotherapy, 45 minutes with patient." While the descriptor says 45 minutes, the actual billable range spans from 38 minutes to 52 minutes of direct patient contact. This is not the total appointment length but rather the time spent actively engaged in therapeutic work.
What Counts as Face-to-Face Time
Understanding what qualifies as face-to-face time is critical for accurate billing. The following activities count toward your 38-52 minute requirement:
- Direct therapeutic interventions - CBT exercises, processing emotions, exploring thought patterns
- Clinical assessment - Evaluating symptoms, monitoring progress, assessing risk
- Treatment planning discussions - Collaboratively setting goals with the client
- Psychoeducation - Teaching coping skills, explaining diagnoses, discussing treatment approaches
- Crisis intervention - Addressing immediate safety concerns or acute distress
Time That Does NOT Count
Administrative activities do not count toward face-to-face time: scheduling future appointments, collecting copays, completing intake paperwork, reviewing forms, or chatting casually before the session begins. If you spend 5 minutes on scheduling and paperwork during a 50-minute appointment, your billable time is 45 minutes.
The 38-52 Minute Time Range Explained
CPT codes for psychotherapy are time-based, and the ranges are strict. Here is how the three main individual therapy codes break down:
| CPT Code | Description | Time Range | Midpoint |
|---|---|---|---|
| 90832 | Psychotherapy, 30 min | 16-37 minutes | 30 minutes |
| 90834 | Psychotherapy, 45 min | 38-52 minutes | 45 minutes |
| 90837 | Psychotherapy, 60 min | 53+ minutes | 60 minutes |
Why Time Tracking Matters
Insurance auditors scrutinize time-based codes more than almost any other billing element. If your documentation shows a 50-minute session but you billed 90837 (which requires 53+ minutes), you have a compliance problem. Consistent patterns of billing at the top of time ranges also raise red flags.
Best practice: Document your actual start and stop times for the therapeutic portion of each session. Many EHR systems automate this, but if yours does not, make it a habit to note "Therapy began at 10:05, concluded at 10:52" in your progress notes.
Pro Tip: The 37-Minute Problem
If your session runs 37 minutes of face-to-face time, you must bill 90832, not 90834. There is no rounding up. This single-minute difference can mean $30-50 less per session. Consider building in buffer time to ensure you consistently hit the 38-minute threshold when scheduling 45-minute appointments.
Medicare vs Commercial Reimbursement Rates
Reimbursement for CPT 90834 varies significantly depending on the payer, your geographic location, and whether you are in-network or out-of-network. Here are current benchmarks:
2024 Medicare Rates
Medicare reimbursement is based on the Medicare Physician Fee Schedule and varies by geographic locality. The national average for CPT 90834 in 2024 is approximately $114.53 for non-facility settings (private practice) and $95.37 for facility settings (hospital-based).
| Setting | National Average | High-Cost Areas | Low-Cost Areas |
|---|---|---|---|
| Non-Facility (Office) | $114.53 | $125-140 | $100-110 |
| Facility (Hospital) | $95.37 | $105-115 | $85-95 |
Commercial Insurance Rates
Commercial payers typically reimburse 10-40% higher than Medicare, though this varies widely by payer and region:
- Blue Cross Blue Shield - Typically $120-160 depending on state and plan
- Aetna - Usually $115-150 for in-network providers
- Cigna - Generally $110-145 range
- UnitedHealthcare - Approximately $115-155 depending on network tier
- Out-of-Network - You set your rate; reimbursement to client is typically 50-80% of "usual and customary"
Maximize Your Reimbursement
Request fee schedules from every payer you contract with. Many therapists never ask and leave money on the table. Some payers will negotiate rates, especially if you can demonstrate expertise in high-demand specialties like trauma, eating disorders, or child therapy.
Required Documentation Elements
Proper documentation protects you in audits and ensures claims are paid. Every 90834 session note should include the following elements:
90834 Documentation Checklist
Medical Necessity Language
Your notes must demonstrate that psychotherapy is medically necessary for this specific client. Generic statements like "Client benefited from session" are insufficient. Instead, connect your interventions directly to the diagnosis and treatment goals:
Weak: "Discussed anxiety. Client felt better after session."
Strong: "Client presented with elevated anxiety (GAD-7 score 14, up from 11 last week) related to upcoming job interview. Used cognitive restructuring to challenge catastrophic thinking patterns about interview performance. Client identified three core negative beliefs and generated evidence-based alternative thoughts. Assigned thought record homework to continue challenging automatic negative thoughts. Session supports treatment goal 2: Reduce GAD-7 score to below 10 within 8 weeks."
Common Modifiers for CPT 90834
Modifiers provide additional information about the service rendered. Using the correct modifier ensures proper reimbursement and avoids claim denials.
| Modifier | Description | When to Use |
|---|---|---|
| 95 | Synchronous Telehealth | Real-time video telehealth sessions |
| GT | Via Interactive Telecommunications | Some payers require this instead of 95 |
| HO | Masters Level Clinician | Required by some Medicaid programs for LCSWs, LPCs |
| 59 | Distinct Procedural Service | When billing multiple services on same day |
| XE | Separate Encounter | Distinct encounter on same date |
Telehealth Modifier Alert
Post-pandemic telehealth rules vary by payer. Medicare currently accepts modifier 95 for telehealth services. However, some commercial payers still require GT, and others use place of service code 02 (Telehealth) instead of a modifier. Always verify with each payer before billing telehealth sessions. Also include the appropriate place of service code: 02 for telehealth or 11 for office-based services.
When to Use 90834 vs 90837 vs 90832
Choosing the correct psychotherapy code is straightforward once you understand the time boundaries. The deciding factor is always face-to-face time with the patient.
Best for: Brief check-ins, medication follow-ups with therapy, clients in maintenance phase
Best for: Standard weekly sessions, most ongoing therapy, the "standard" therapy hour
Best for: Complex presentations, trauma processing, crisis sessions, intensive therapy
The 90837 Scrutiny Issue
Many payers heavily scrutinize 90837 claims. Some require prior authorization. Others have policies stating 90834 is the "expected" code and will only reimburse 90837 if documentation clearly justifies the extended time. If you regularly bill 90837, ensure your notes explicitly explain why the longer session was clinically necessary.
Common justifications for 90837:
- Complex trauma processing requiring extended stabilization
- Crisis intervention with safety planning
- Multiple presenting problems requiring comprehensive attention
- Intensive EMDR or exposure therapy protocols
- Initial intake session with extensive history gathering
Payer-Specific Rules and Quirks
Every insurance company has its own policies that affect how you bill 90834. Here are some common variations to watch for:
Medicare
- Requires licensed clinical social workers, psychologists, or physicians (no LPCs in traditional Medicare)
- Incident-to billing allowed under certain conditions
- Telehealth permanently expanded post-pandemic for behavioral health
- No prior authorization required for psychotherapy
Medicaid
- Varies significantly by state
- Often requires HO modifier for masters-level clinicians
- May have lower reimbursement caps
- Some states require specific credentials not accepted by others
Blue Cross Blue Shield
- Policies vary by state (each BCBS is independent)
- Some require treatment plans on file before authorizing ongoing sessions
- May have annual session limits (check member benefits)
UnitedHealthcare/Optum
- Uses Optum for behavioral health management
- May require outpatient treatment reports every 8-12 sessions
- Strong preference for 90834 over 90837
Always Verify Benefits
Never assume coverage. Before the first session, verify: Is the client eligible? Is behavioral health covered? Are there session limits? Do you need prior authorization? What is the copay/coinsurance? Is telehealth covered at the same rate as in-person? Taking five minutes to verify can prevent weeks of payment delays.
Common Denial Reasons and How to Prevent Them
Denied claims cost you twice: once in lost revenue and again in administrative time to appeal. Here are the most common reasons 90834 claims are denied and how to avoid them:
1. Time Documentation Missing or Insufficient
Problem: Notes do not specify how long the therapy portion lasted.
Solution: Always document start time, stop time, and total face-to-face minutes. Example: "Session began 2:05pm, concluded 2:50pm. Total face-to-face time: 45 minutes."
2. Diagnosis Does Not Support Medical Necessity
Problem: Using Z-codes (like Z71.9 counseling) instead of clinical diagnoses, or diagnosis does not match presenting problem.
Solution: Use specific ICD-10 codes that justify psychotherapy. F32.1 (Major depressive disorder, single episode, moderate) is appropriate; Z71.9 (Counseling, unspecified) often is not covered.
3. Wrong Place of Service Code
Problem: Billing with place of service 11 (office) for telehealth sessions.
Solution: Use place of service 02 for telehealth. Some payers now allow 10 (telehealth in patient home) as well.
4. Missing or Incorrect Modifier
Problem: Telehealth session billed without 95 or GT modifier.
Solution: Know each payer's modifier requirements. Create a quick reference guide for your most common payers.
5. Duplicate Claim
Problem: Resubmitting a claim that was already paid or is in process.
Solution: Track claim status before resubmitting. Use your clearinghouse or practice management system to check claim status.
6. Client Not Eligible on Date of Service
Problem: Insurance was inactive on the session date.
Solution: Verify eligibility before every session, especially at the start of each month and calendar year.
Real-World Billing Scenarios
Let us walk through several common situations and how to handle billing correctly:
Scenario 1: The Session That Runs Long
Situation: You schedule 45-minute sessions, but today's session went 55 minutes due to a crisis.
Answer: Bill 90837, not 90834. You provided 53+ minutes of face-to-face therapy. Document why the extended time was necessary: "Session extended due to acute suicidal ideation requiring comprehensive safety planning. Crisis stabilization and safety plan development required additional time."
Scenario 2: The Late-Starting Session
Situation: Client arrived 15 minutes late to a 50-minute scheduled appointment. You provided 35 minutes of therapy.
Answer: Bill 90832 (30-minute code). You only provided 35 minutes of face-to-face time, which falls into the 16-37 minute range. Document the late arrival and actual service time.
Scenario 3: Telehealth Session
Situation: Regular client seen via video for 45-minute session from their home.
Answer: Bill 90834 with modifier 95 (or GT depending on payer). Use place of service 02 (or 10 for patient home, depending on payer). Document that services were provided via HIPAA-compliant video platform.
Scenario 4: Same-Day Medical and Therapy Visit
Situation: Client sees the psychiatrist for medication management, then sees you for therapy, same day.
Answer: You can bill 90834 (with modifier 59 or XE if required by payer) since these are distinct services provided by different providers. Ensure documentation clearly shows separate encounters.
Scenario 5: Therapy with E/M Service
Situation: You are a clinical psychologist who also conducts psychological testing. Same day, you provide 45 minutes of therapy and 30 minutes of testing.
Answer: Bill 90834 for the therapy and the appropriate testing code (96130, etc.) for the evaluation. Document each service separately with distinct time tracking.
Frequently Asked Questions
Can I bill 90834 if my session was exactly 38 minutes?
Yes. The billable range for 90834 is 38-52 minutes of face-to-face time. A 38-minute session is at the low end of the range but is fully appropriate for this code. Just make sure you document the exact time in your notes.
What if my session is 37 minutes? Can I round up?
No. A 37-minute session must be billed as 90832 (30-minute code, range 16-37 minutes). There is no rounding in CPT time-based billing. Billing 90834 for a 37-minute session would be incorrect coding and could be flagged as fraud in an audit.
Does the 38-52 minutes include note writing time?
No. The time requirement is for face-to-face therapeutic interaction only. Time spent writing notes, reviewing records, consulting with other providers, or completing paperwork does not count toward the 38-52 minute threshold. This is a common source of confusion and audit findings.
Can I bill 90834 for couples therapy?
No. CPT 90834 is specifically for individual psychotherapy. For couples or family therapy, use 90847 (family psychotherapy with patient present) or 90846 (family psychotherapy without patient present). Some payers also accept 90834 billed for each individual in the session, but this is payer-specific and less common.
Is modifier 95 required for all telehealth sessions?
Most payers now accept modifier 95 for synchronous telehealth. However, some still require the older GT modifier, and others use only place of service code changes without a modifier. Always check with each specific payer. Also ensure you are using the correct place of service code (typically 02 for telehealth).
How many 90834 sessions can I bill per day?
You can bill as many 90834 sessions as you legitimately provide to different patients. There is no daily limit for seeing multiple patients. However, you generally cannot bill multiple psychotherapy codes for the same patient on the same day unless there are truly separate encounters (morning and afternoon, for example) with distinct clinical needs, documented separately, and using appropriate modifiers.
What ICD-10 codes work best with 90834?
Any mental health diagnosis that requires psychotherapy can support 90834. Common codes include F32.x (major depressive disorder), F41.x (anxiety disorders), F43.x (trauma and stressor-related disorders), and F34.1 (dysthymia). Avoid Z-codes (like Z71.9 counseling) as primary diagnoses since many payers do not consider them medically necessary for psychotherapy reimbursement.
Key Takeaways
CPT 90834 Summary
- 1.90834 covers individual psychotherapy sessions lasting 38-52 minutes of face-to-face time with the patient.
- 2.Document exact start and stop times in every progress note. Time spent on paperwork, scheduling, or note-writing does not count.
- 3.Medicare reimburses approximately $114.53 for non-facility settings. Commercial rates typically run 10-40% higher.
- 4.Use modifier 95 for telehealth sessions with most payers. Verify specific requirements with each insurance company.
- 5.Prevention is the best medicine for denials: verify eligibility, document thoroughly, use correct codes, and know your payers' quirks.
- 6.When in doubt, consult your payer's provider manual or contact their provider services line for clarification on specific billing questions.
Mastering CPT 90834 billing is not just about getting paid correctly, though that certainly matters for your practice's financial health. Accurate billing also demonstrates professionalism, reduces audit risk, and ensures you can continue providing the therapeutic services your clients need. Take the time to build solid billing habits now, and you will save yourself countless hours of corrections and appeals down the road.
Looking for a practice management platform that makes billing easier? TheraFocus automates time tracking, generates compliant documentation, and streamlines your claims submission process. Learn how TheraFocus can help your practice.
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TheraFocus Team
Practice Management Experts
The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.