CPT 90834 + ICD-10 F84.0: Autistic disorder
Psychotherapy, 45 minutes billed with Autistic disorder — documentation requirements, denial reasons, modifiers, and reimbursement context.
Compatibility Notes
Used for 45-minute psychotherapy sessions with ASD patients. Therapy may target anxiety, social skills, adaptive behaviors, or co-occurring mental health conditions. Most commercial plans cover ASD psychotherapy without prior authorization for standard outpatient sessions.
Documentation Required
- ✓Session start and stop times confirming 38–52 minutes
- ✓ASD diagnosis (F84.0) confirmed with clinical basis
- ✓Treatment targets and therapeutic approach specific to ASD documented
- ✓Coordination with other ASD service providers (speech, OT) noted if applicable
- ✓Safety screen for self-injurious behaviors
Common Denial Reasons
- ✗Scope of practice concern if provider lacks ASD-specific training
- ✗Notes describe behavioral support rather than psychotherapy
- ✗Session time outside 38–52 minute range
Applicable Modifiers
Reimbursement Notes
OON UCR $100–$165. ASD therapy coverage varies widely by plan and state. Some states have ASD insurance mandates that require comprehensive coverage; verify state-specific requirements.
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