Understanding Individual Therapy and CPT Code 90834: What You Need to Know

Understanding Individual Therapy and CPT Code 90834: What You Need to Know

In the world of mental health services, accurate billing and coding are crucial for ensuring that therapists are reimbursed for their work. One of the most commonly used codes for individual therapy sessions is CPT Code 90834. In this blog post, we'll break down what CPT Code 90834 is, when it's used, and how it plays a significant role in the healthcare system.

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What is CPT Code 90834?

CPT Code 90834 is a standardized code used by mental health professionals, including psychologists, social workers, counselors, and other licensed therapists, to represent a 45-minute individual psychotherapy session. This code is part of the Current Procedural Terminology (CPT) system, a set of codes created and maintained by the American Medical Association (AMA). These codes are used by healthcare providers for insurance billing and administrative purposes.

CPT codes are critical because they help insurance companies understand the nature of the service provided, ensuring that therapists are paid correctly and promptly for the care they offer.

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When is CPT Code 90834 Used?

CPT Code 90834 is typically used when a therapist provides psychotherapy to an individual in a face-to-face session lasting approximately 45 minutes. This code is appropriate for a wide range of therapeutic modalities, including but not limited to cognitive-behavioral therapy (CBT), psychodynamic therapy, and other individual therapy techniques.

However, it’s essential to note that the duration of the session should generally fall within a specific range of time. While 45 minutes is the general guideline, some insurance companies may accept sessions that are slightly longer or shorter, but it's essential for therapists to document the time accurately.

CPT Code 90834 is used for non-crisis situations where ongoing therapy is needed to address mental health issues like:

• Anxiety
• Depression
• Trauma
• Relationship issues
• Stress management
• Self-esteem and identity concerns

This code applies to therapy that is focused on treating mental health disorders in a one-on-one setting, without a group or family component.

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Key Features of CPT Code 90834

‍Here are some important features to remember about CPT Code 90834:

1. Session Duration: As mentioned, the session duration should be around 45 minutes. This can vary slightly based on the specifics of the session.
   
   
2. Therapeutic Focus: The therapy should be focused on addressing the client's emotional and mental health needs through talk therapy, not physical treatment.
   
   
3. Individual Sessions: CPT Code 90834 applies specifically to individual therapy sessions. Group therapy or family therapy has its own set of codes.
   
   
4. Reimbursement: Insurance companies use CPT codes to determine the level of reimbursement for services rendered. The therapist’s practice or clinic will submit the code to the insurance provider, and the provider will then reimburse for the service based on the terms of the patient’s insurance plan.
   
   

Why is CPT Code 90834 Important?‍

CPT Code 90834 is crucial for both therapists and clients for several reasons:

1. Accurate Billing and Reimbursement: For therapists, accurate use of CPT codes is essential to ensure proper reimbursement for the services provided. Without the correct code, there could be delays in payment or even denial of claims.
   
   
2. Consistency Across Providers: Since CPT codes are used universally, they help maintain consistency across the healthcare system. This makes it easier for insurance providers to evaluate claims, track treatment progress, and understand the services being delivered. It also helps mental health professionals collaborate and communicate across different treatment settings.
   
   
3. Insurance Coverage: Insurance companies rely on CPT codes to determine what services are covered under a client’s plan. CPT Code 90834 helps insurance providers understand the specifics of the therapy being provided, ensuring that individual therapy sessions are covered as part of the patient’s mental health benefits.
   
   
4. Documentation of Progress: By using standardized codes like 90834, mental health professionals can easily track and document a patient's treatment over time. This also ensures that there is a record of the services provided, which is essential for both treatment continuity and legal purposes.
   
   

How to Bill for CPT Code 90834‍

Billing for CPT Code 90834 requires accurate documentation of the service. To correctly bill for this service, therapists must include:

1. Time of Service: Clearly document that the session lasted approximately 45 minutes, as well as any variations in session length.
   
   
2. Treatment Plan: A detailed treatment plan should outline the patient’s goals and progress during therapy.
   
   
3. ICD-10 Diagnosis Code(s): These codes are used to indicate the mental health conditions being treated during the session. The ICD-10 codes should match the specific diagnosis for which therapy is being provided.
   
   
4. Therapist’s Credentials: Include the appropriate credentials and licensing information for the therapist providing the service.
   
   
5. Patient Information: Ensure that the patient’s personal and insurance details are correct for billing purposes.
   
   

Once this information is compiled, the claim can be submitted to the insurance company for reimbursement. If the claim is denied, therapists may need to follow up with the insurance provider or appeal the decision.‍

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The Relevance

CPT Code 90834 plays a pivotal role in the practice of individual therapy, providing a clear, standardized way to document and bill for 45-minute psychotherapy sessions. Whether you're a therapist or a client, understanding this code is essential for navigating the world of mental health billing and reimbursement.For therapists, using the correct code ensures timely and accurate payments. For clients, it ensures that the therapy they receive is covered by their insurance plan. By keeping these factors in mind, both therapists and clients can better manage their mental health care journey.

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Grouport Offers All Kinds of Therapy Options

Grouport Therapy provides online group therapy, individual therapy, couples therapy, family therapy, intensive outpatient program, teen therapy, and a DBT-Self Guided Program. All our sessions are therapist-led, held virtually, and meet over video chat at the same time each week. All our sessions are therapist-led and are held virtually and meet over video chat at the same time each week. For group therapy, we have groups on many topics including Dialectical Behavior Therapy "DBT", Cognitive Behavioral Therapy, Anxiety & Depression, Trauma & PTSD, Anger Management, OCD, Borderline Personality Disorder, Bipolar Disorder, Relationship Issues, Divorce, Narcissistic Abuse, Self-Compassion, Grief & Loss, Parenting, Substance Abuse, Supporting A Loved one with BPD, among others. Each group is led by a licensed therapist that typically has over a decade of experience treating a wide range of specialties, and the group meets at the same time each week for an hour with the same members and therapist.
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As reported by our members, 70% experienced significant progress within 8 weeks, including reduced anxiety & depression symptoms.
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Our care coordinators can help assist you to craft the perfect treatment plan for you that's tailored to your needs. We provide speedy matches to quality care, and also provide the flexibility to switch your therapist or group at anytime ensuring that you're always meeting with the right therapist fit at a time that's convenient for your schedule. Whatever type of therapy you’re seeking, Grouport offers a range of options to suit your schedule and preferences. Explore our programs to find the support you need. If you need help finding the right type of therapy, schedule a free call with a care coordinator here.

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