Psychoanalysis
CPT code 90845 is used for psychoanalysis sessions, a specialized form of psychotherapy that explores unconscious thoughts and patterns through in-depth conversation over an extended period.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Verify psychoanalytic training credentials are on file with payer before initiating treatment, as many require pre-credentialing for 90845 separate from general mental health provider enrollment
Impact: Prevents 100% denial due to credential issues; credential verification can prevent loss of $99.30 per session across entire treatment episode
Document session frequency (e.g., 3-4 times weekly) and theoretical orientation clearly in treatment plan, as frequency and psychoanalytic framework distinguish 90845 from 90834/90837
Impact: Reduces downcoding to lower-paying psychotherapy codes; prevents $20-30 loss per session when incorrectly billed as standard therapy
Bill only one unit per session regardless of session length; 90845 is not time-tiered like standard psychotherapy codes
Impact: Prevents automatic denials for billing multiple units; avoids compliance flags for overbilling
Obtain prior authorization when required by commercial payers, typically needed for initial authorization and every 12-24 sessions thereafter for this intensive treatment
Impact: Prior authorization denial can result in $0 reimbursement; authorization compliance ensures payment of full $99.30 per session
Use diagnosis codes that support medical necessity for intensive psychoanalytic treatment (personality disorders, chronic treatment-resistant conditions) rather than acute symptom codes
Impact: Prevents medical necessity denials; appropriate diagnosis coding supports approval of 2-4 sessions weekly vs. denial or reduction to once-weekly therapy
For Medicare patients, verify that psychoanalysis meets the definition of 'psychiatric services' covered under Part B, as some MACs have restrictive interpretations
Impact: Some Medicare carriers have limited or denied 90845; verification prevents surprise denials of $99.30 Medicare payment
Common denials
Lack of specialized psychoanalytic training credentials on file with payer
How to appeal: Submit certificate of completion from accredited psychoanalytic institute, transcript showing psychoanalytic coursework, and membership documentation from recognized psychoanalytic organization (APsaA, IPA). Include letter explaining distinction between general psychotherapy training and psychoanalytic specialization.
Medical necessity denial for frequency of sessions (multiple times weekly)
How to appeal: Provide treatment plan documenting psychoanalytic treatment rationale, patient's chronic condition unresponsive to standard weekly therapy, and clinical literature supporting intensive frequency for psychoanalytic treatment. Include prior treatment history showing inadequate response to less intensive interventions.
Downcoded to 90837 (standard psychotherapy) due to lack of documentation distinguishing psychoanalytic approach
How to appeal: Submit session notes demonstrating psychoanalytic technique (transference interpretation, dream analysis, free association, resistance analysis) and treatment plan specifying psychoanalytic theoretical framework. Include letter explaining clinical differences between psychoanalysis and supportive/cognitive-behavioral psychotherapy.
Denial as 'experimental' or 'not evidence-based' treatment
How to appeal: Provide peer-reviewed research supporting psychoanalysis efficacy for patient's specific diagnosis, cite APA practice guidelines recognizing psychoanalytic treatment, and include expert letter from supervising analyst. Reference payer's own medical policy if it includes psychoanalysis as covered service.
Frequently asked questions
What is the difference between CPT 90845 and regular psychotherapy codes?
CPT 90845 is specifically for psychoanalysis, which requires specialized psychoanalytic training beyond standard mental health licensure and employs distinct techniques like transference interpretation and free association. Standard psychotherapy codes (90834, 90837) are used for other therapeutic approaches like CBT, DBT, or supportive therapy and are time-based, while 90845 is not time-tiered.
How much does Medicare pay for CPT code 90845 in 2025?
Medicare pays $99.30 for CPT 90845 in non-facility settings and $87.34 in facility settings based on the 2025 Physician Fee Schedule national average. Actual payment may vary by geographic locality based on local wage index adjustments.
Can psychologists bill CPT 90845 for psychoanalysis?
Yes, clinical psychologists can bill 90845 if they have completed specialized psychoanalytic training from an accredited psychoanalytic institute. The provider must hold an appropriate mental health license plus psychoanalytic certification or extensive graduate-level psychoanalytic education beyond their doctoral degree.
How many times per week can you bill CPT 90845?
There is no specific limit on frequency for 90845, as psychoanalysis traditionally occurs 3-4 times weekly. However, payers typically require medical necessity documentation and prior authorization for multiple sessions per week. Each session must be separately documented and meet all billing requirements.
Does CPT 90845 require prior authorization?
Most commercial insurance plans require prior authorization for CPT 90845 due to the intensive frequency and higher cost compared to standard psychotherapy. Medicare typically does not require prior authorization, but Medicare Advantage plans often do. Always verify authorization requirements with the specific payer before beginning treatment.
Can CPT 90845 be billed via telehealth?
Yes, CPT 90845 can be billed via telehealth using modifier GT or 95 when telehealth is permitted by the payer. During the COVID-19 public health emergency, Medicare expanded telehealth coverage for mental health services. Check current payer policies as telehealth coverage varies by plan and state regulations.
What diagnosis codes are appropriate for billing CPT 90845?
Diagnosis codes supporting medical necessity for psychoanalysis typically include personality disorders (F60.x), chronic depression (F33.x), treatment-resistant anxiety disorders, and complex trauma-related conditions. The diagnosis should reflect a chronic condition where intensive, insight-oriented treatment is clinically appropriate. Acute, simple symptom presentations may face medical necessity denials.