How to use CPT code 90837
The 90837 CPT code is often understood to be the standard of a therapy session among providers. However, insurers have a tendency to flag 90837 more frequently than other codes.
The “45 minute” session is a core element of mental health care, so it’s vital that every provider knows how to apply the 90834 code to their work.
Code 90834 represents a 45-minute session of psychotherapy (i.e. talk therapy), with between 38 and 52 minutes of documented face-to-face time.
Some colloquially “hour-long” therapy sessions fit inside the upper limit of 90834’s 52-minute window, once you subtract time spent on pleasantries and administrative work (like comparing calendars to schedule an upcoming session), which don’t count towards therapeutic time.
This is is how the American Medical Association defines 90834 in the official CPT codebook:
Psychotherapy, 45 minutes with patient
Psychotherapy is the treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.
The psychotherapy service codes include ongoing assessment and adjustment of psychotherapeutic interventions, and may include involvement of informants in the treatment process. These codes describe psychotherapy for the individual patient, although times are for face-to-face services with patient and may include informant(s). The patient must be present for all or a majority of the service.
Your documentation for this code should include all the standard elements of a progress note, including:
It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code.
The 90834 code is directly associated with a length of time: As the “45 minute” code, any session billed with 90834 should last between 38 and 52 minutes in duration, as documented by the start and stop times in your progress notes and EMR/EHR records (it’s important that session times in your notes and tools are consistent with each other.
The time requirement of the 90834 code should reflect only the face-to-face time spent on therapy, not any of the administrative work related to the session, like writing notes, scheduling future sessions, or collecting payment.
Reimbursement rates for sessions billed with 90834 will vary depending on the plan, your contract, your location, and your license type.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
The 90837 CPT code is often understood to be the standard of a therapy session among providers. However, insurers have a tendency to flag 90837 more frequently than other codes.
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