CPT Code 90845: Psychoanalysis

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• 90845

CPT Code 90845: Psychoanalysis

CPT code 90845 for psychoanalysis therapy. Billing rates, documentation requirements, and compliance for behavioral health providers.

Quick Reference

Code

90845

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

7 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 90845: Psychoanalysis

CPT code 90845 covers psychoanalysis, a specialized and intensive form of psychotherapy based on psychoanalytic theory. While less commonly used in behavioral health treatment centers than standard psychotherapy codes, 90845 serves an important role for providers who are trained in psychoanalytic technique and offer this modality to patients with complex mental health conditions. Understanding how to properly bill 90845 ensures that psychoanalytic services are appropriately reimbursed.

Psychoanalysis has a long history in mental health treatment and remains a recognized therapeutic modality for certain patient populations. In behavioral health settings, psychoanalytic approaches may be particularly relevant for patients with personality disorders, complex trauma histories, treatment-resistant depression, and other conditions where deeper exploration of unconscious processes and relational patterns can support recovery.

Definition and Purpose

CPT code 90845 is defined as psychoanalysis. This code covers the provision of formal psychoanalytic therapy, which involves intensive, insight-oriented treatment based on the principles and techniques of psychoanalysis as developed by Sigmund Freud and subsequent psychoanalytic theorists.

The purpose of 90845 is to provide a distinct billing code for psychoanalysis, recognizing it as a separate therapeutic modality from general psychotherapy. Psychoanalysis differs from standard psychotherapy in its theoretical framework, technique, session frequency, treatment duration, and therapeutic goals.

Key characteristics of 90845 include:

• Service type: Psychoanalysis (distinct from general psychotherapy)
• Provider requirements: Must be performed by a provider trained in psychoanalytic technique
• Session structure: Typically involves the patient lying on a couch with the analyst seated behind
• Frequency: Often conducted three to five times per week
• Techniques: Free association, dream analysis, interpretation of transference and resistance
• Treatment duration: Often extends over months or years

When to Use 90845 in Behavioral Health

90845 is appropriate in behavioral health settings when formal psychoanalysis is being provided by a trained psychoanalyst.

Personality disorders: Psychoanalysis is recognized as an effective treatment for certain personality disorders, particularly where understanding unconscious patterns, defense mechanisms, and early relational experiences is central to the treatment approach. Patients with borderline, narcissistic, or avoidant personality disorders may benefit from psychoanalytic treatment.

Complex trauma: For patients with complex developmental trauma that has not responded adequately to other therapeutic approaches, psychoanalysis offers a framework for exploring the deep-seated impact of early adverse experiences on current functioning and relationships.

Treatment-resistant conditions: When patients with depression, anxiety, or other mental health conditions have not responded to standard psychotherapy approaches or medication alone, psychoanalysis may be considered as an alternative or adjunctive treatment modality.

Characterological issues: Patients whose difficulties are rooted in enduring patterns of thinking, feeling, and relating rather than acute symptom presentations may be candidates for psychoanalytic treatment.

Providers should not bill 90845 for psychotherapy sessions that incorporate psychodynamic concepts but do not constitute formal psychoanalysis. Sessions using psychodynamic psychotherapy techniques without the full psychoanalytic framework should be billed under the appropriate standard psychotherapy codes (90832, 90834, or 90837).

Documentation Requirements

Documentation for 90845 must reflect the psychoanalytic nature of the treatment and support the medical necessity of this specialized modality.

Treatment justification: The initial evaluation and treatment plan must clearly articulate why psychoanalysis is the appropriate treatment modality for this patient. Document the patient’s diagnosis, the clinical rationale for psychoanalytic treatment, and why other therapeutic approaches may be insufficient.

Psychoanalytic formulation: Include a psychoanalytic formulation that describes the patient’s unconscious conflicts, defense mechanisms, relational patterns, and developmental history as they relate to the presenting condition. This formulation should evolve over the course of treatment.

Session documentation: For each session, document the primary themes explored, significant free associations or dream material, transference and countertransference dynamics, interpretations offered, the patient’s response to interpretations, and any shifts in the patient’s psychological functioning.

Treatment progress: Periodically document progress toward treatment goals, including changes in the patient’s insight, relational functioning, symptom presentation, and overall psychological adaptation. Psychoanalytic treatment progress may be measured differently than standard psychotherapy outcomes.

Frequency justification: If sessions occur more frequently than standard psychotherapy (which is typical for psychoanalysis), document the clinical rationale for the session frequency and how it relates to the patient’s treatment needs.

Billing and Reimbursement

As of March 2026, reimbursement for 90845 varies by payer and may require additional verification compared to standard psychotherapy codes.

Medicare: Medicare recognizes 90845 as a covered service when medically necessary. Reimbursement rates are determined by the Medicare Physician Fee Schedule and are generally comparable to standard psychotherapy rates. Geographic locality adjustments apply.

Medicaid: Coverage for psychoanalysis under Medicaid varies by state. Some states include 90845 in their covered services while others do not recognize it as a distinct billable service. Verify coverage with the state Medicaid program before initiating treatment.

Commercial payers: Coverage for 90845 varies widely among commercial payers. Some payers cover psychoanalysis under their mental health benefits, while others may exclude it or require prior authorization. Providers should verify coverage and benefit limitations, including session frequency caps and annual visit limits, before beginning treatment.

Billing tips:

• Verify coverage for 90845 specifically, as some payers who cover psychotherapy may not cover psychoanalysis
• Obtain prior authorization when required, particularly for high-frequency treatment schedules
• Document the distinction between psychoanalysis and general psychotherapy in the treatment plan
• Be prepared to provide clinical justification for the frequency and duration of treatment
• Monitor benefit utilization to ensure the patient is aware of any coverage limitations

Common Modifiers

Modifiers that may be used with 90845 include:

Verify payer-specific modifier requirements. Given the specialized nature of psychoanalysis, some payers may have unique billing policies.

• Modifier 95: Synchronous telemedicine service — applicable when psychoanalysis is conducted via real-time audio and video telehealth, though traditional psychoanalysis is typically conducted in person
• Modifier 59: Distinct procedural service — used when psychoanalysis needs to be distinguished from other services on the same date
• Modifier 25: Significant, separately identifiable E&M service — append to an E&M code if an E&M service is also provided on the same date by the same provider
• Modifier HE: Mental health program — some payers require this for behavioral health services

Compliance Considerations

Billing 90845 involves several compliance considerations unique to psychoanalytic treatment.

Appropriate code selection: Ensure that the service being provided is genuine psychoanalysis, not psychodynamic psychotherapy or insight-oriented therapy that uses some psychoanalytic concepts. The distinction is important for accurate coding. If the treatment does not meet the criteria for formal psychoanalysis, use the appropriate standard psychotherapy code instead.

Provider qualifications: Verify that the billing provider has appropriate training and credentials in psychoanalysis. While there is no single required certification, providers should have completed formal psychoanalytic training that qualifies them to practice psychoanalysis within their scope of licensure.

Medical necessity: Establish and maintain documentation of medical necessity throughout the course of treatment. Because psychoanalysis is often a long-term treatment, periodic reassessment of medical necessity is important. Document ongoing treatment goals, progress, and the clinical rationale for continuing treatment.

Session frequency justification: If the treatment involves higher-than-standard session frequency, maintain clear documentation of why the frequency is clinically necessary. Payers may question high-frequency billing patterns without adequate justification.

Scope of practice: Ensure that the provider’s license permits the practice of psychoanalysis in the relevant jurisdiction. State licensing laws and scope of practice regulations vary and may affect who can bill for psychoanalytic services.

Related Billing Codes

• 90838
• 90839
• 90840
• 90846
• 90847
• 90849

Common questions

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