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Billing and coding

How to use CPT code 90837

Text on an orange background: Billing 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.

CPT code 90837 description

Code 90837 represents a 60-minute session of psychotherapy (i.e. talk therapy), with at least 53 minutes of documented face-to-face time.

This is is how the American Medical Association defines 90837 in the official CPT codebook:

Psychotherapy, 60 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:

  • Session details: Including start and stop times, and the date and place of service
  • Person-centered details
  • Patient-centered observations
  • Progress towards goals
  • Risk assessment
  • Clinical path forward

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. 

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Working with insurance can be confusing at times. Headway has developed easy and simple tools to help you stay compliant, handle claims quickly, and operate your practice with confidence.

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CPT code 90837 time frame

The 90837 code is directly associated with a length of time: As the “60 minute” code, any session billed with 90837 is required to be at least 53 minutes in duration, as documented by the start and stop times in your progress notes. 

The time requirement of the 90837 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.

Will I get audited for using 90837?

Insurers are more likely to flag and place scrutiny on the use of 90837 codes. This can result in payment delays, requests for clinical documentation to support use of the 90837, and other confusion for what seems like a typical billing selection.

Ultimately, insurers are looking for evidence that the additional time was needed.

“It’s about the amount of effort you have to offer the patient to meet the goal for that session,” says Innocent Turner, LCSW, Headway’s Clinical Quality and Strategy Manager. “If you're talking about anything therapeutic for that 53 minutes, then it can be billed with a 60 minute code. You just need to justify why.”

Every insurer is different, but most typically look for the following supporting conditions in 90837 documentation:

  • Did the nature of the treatment justify the time length of the session? Insurers might be wondering whether the provider could have offered the same quality of treatment in a shorter session, in which case, 90834 should be used instead.
  • Was the treatment rendered medically necessary? Insurers want to verify the care you give is clinically appropriate and that there is no less costly, equally effective service available to meet treatment goals and improve the client’s symptoms as it relates to their diagnosis.

To meet these expectations, your documentation can include more details about the client’s need for additional clinical intervention, as evidenced by:

  • Severity of symptoms: Like recent suicidal ideation, traumatic event, etc.
  • Acuteness of issues: Such as a recent panic attack, recent loss, etc.
  • Diagnosis with modality combination: For example, PTSD with EMDR intervention.
  • Chronic conditions impacting functioning: For example, GAD interfering with their health or vocation.  

“Therapists might think: ‘I don't want to get audited. I'm just going to bill 45 minutes because it feels safe’ — but that might not be an accurate reflection of what you offered as a clinician,” says Innocent. “The fallacy is that you don't paint a good picture of the patient's actual needs of therapy.”

CPT code 90837 reimbursement rates

Reimbursement rates for sessions billed with 90837 will vary depending on the plan, your contract, your location, and your license type.

What’s the difference between 90837, 90834, and 90832?

90837, 90834, and 90832 are three different time-based codes for psychotherapy sessions with individuals. The only difference is the amount of time that was required to address the client’s presenting symptoms.

  • 90837: Psychotherapy, 60 minutes with patient (53+ minutes of documented face-to-face time) 
  • 90834: Psychotherapy, 45 minutes with patient (38-52 minutes of documented face to face time)
  • 90832: Psychotherapy, 30 minutes with patient (16-37 minutes of documented face to face time)

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.

Billing and coding

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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.

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How to use CPT code 90832

If your client demonstrates a clinical need for shorter therapy sessions — or you need to end a session earlier than planned — 90832 might be the right way to bill.

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Code 90847 represents a session where the identified patient actively participates, giving the provider important visibility into the ways family interactions can contribute to or alleviate a patient’s condition.

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