90834 — Individual Psychotherapy, 38-52 minutes
The most commonly billed individual therapy code. Covers sessions lasting 38-52 minutes, which aligns with the standard "therapy hour." This is the workhorse code for outpatient mental health, appropriate for individual therapy using any evidence-based modality.
Time Requirements
38-52 minutes face-to-face with the client. This is the most commonly billed therapy time range.
Modifiers
| Code | Description |
|---|---|
| 95 | Synchronous telemedicine service. |
| HO | Master's level clinician (some Medicaid plans). |
| XE | Separate encounter — used if billing with E/M on the same day. |
When to Use
- Standard individual therapy sessions lasting 38-52 minutes
- Regularly scheduled outpatient therapy appointments
- Any psychotherapy modality (CBT, DBT, psychodynamic, humanistic, etc.)
- Sessions with the standard "therapy hour" duration
When Not to Use
- Sessions under 38 minutes — use 90832
- Sessions over 52 minutes — use 90837
- Family or couples therapy — use 90846 or 90847
- Group therapy — use 90853
Common Denial Reasons
- Session time documented outside the 38-52 minute range
- Documentation lacks evidence of psychotherapeutic intervention
- Billed concurrently with E/M without appropriate modifier and documentation
- Prior authorization required but not obtained
Payer Notes
This is the standard outpatient therapy code. Most payers cover without prior authorization for an initial treatment period (varies by plan). Some plans limit sessions per year (e.g., 20-52 sessions). Check benefits.
Frequently Asked Questions
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