The American Medical Association issues CPT codes to standardize billing and reporting for psychotherapy services across the healthcare industry.
CPT Code 90837 is used to bill for 60-minute individual psychotherapy sessions conducted by non-prescribing mental health providers. This code applies specifically to individual psychotherapy, not group therapy, where patients receive in-depth counseling to address mental and behavioral health disorders.
Since CPT 90837 represents a longer and more intensive therapy session, it is essential to select the correct CPT code based on the session type and duration to ensure billing accuracy and compliance.
CPT Code 90837 Description
CPT Code 90837 is officially defined as:
Psychotherapy, 60 minutes with the patient.
This code is used to report individual psychotherapy sessions that are time-based and typically require 53 minutes or more of face-to-face or telehealth interaction with the patient.
It reflects extended psychotherapy services that involve in-depth therapeutic work addressing complex mental health conditions. Documentation must support the total time spent and the clinical necessity of a prolonged session.
Billing Guidelines For CPT Code 90837
Proper billing is essential to prevent claim denials and ensure compliance with insurance regulations. Here are the key requirements for billing CPT 90837:
- Eligible Providers: This code can be used by licensed mental health providers and mental health providers, including:
- Licensed Clinical Social Workers (LCSWs)
- Licensed Professional Counselors (LPCs)
- Licensed Marriage and Family Therapists (LMFTs)
- Licensed Mental Health Counselors (LMHCs)
- Clinical Psychologists
CPT 90837 may also be billed incident to a physician in certain settings, following applicable regulations.
- Session Duration: CPT 90837 applies to therapy sessions lasting 60 minutes with patient. The session time must be at least 53 minutes of face-to-face time to meet the billing criteria.
- Documentation Requirements: Proper documentation is essential to avoid claim denials. Session notes must include:
- Start and stop times of the session
- Actual time and total time spent (in minutes with the patient)
- Therapeutic techniques used
- Mental health conditions being treated
- Patient’s progress and response to therapy
- Pre-authorization and Coverage Verification: Some insurance companies require pre-authorization before providers can bill CPT 90837. Verify insurance coverage and collect any patient co-payments before the session.
- Billing Frequency Limitations: Some insurers limit how often CPT 90837 can be used per patient. Payer rules and required modifiers may affect billing frequency and circumstances. Always check payer-specific policies to avoid reimbursement issues.
How to Properly Document CPT Code 90837
Accurate documentation is key to preventing claim denials and ensuring full reimbursement. The following elements should be included in each session note:
- Start and End Times: Always document the exact start and end times of the session.
- Treatment Techniques Used: List the psychotherapy techniques applied during the session. Common approaches include:
- Cognitive Behavioral Therapy (CBT) for anxiety and depression
- Dialectical Behavior Therapy (DBT) for emotional regulation
- Exposure Therapy for PTSD and phobias
- Mindfulness-Based Stress Reduction (MBSR) for stress and anxiety
- Patient’s Mental Health Status: Include details about the patient’s mood, thoughts, and behavior.
- Progress and Treatment Goals: Document how the patient responded to treatment, including patient response to specific interventions, and any adjustments made to the therapy plan.
- Session Summary: Provide a brief overview of the session’s focus, discussions, and takeaways.
Administrative tasks, such as scheduling or documentation, should not be included in the session time for CPT code 90837. If extra time is spent during the session due to complex cases or crisis intervention, clearly document and justify the additional time in the session note, explaining the clinical necessity for the extended duration.
Common Billing Mistakes to Avoid for CPT 90837
Avoiding common billing errors can prevent claim denials and refund requests. Here are some key mistakes to watch out for:
- Failing to Document Start and End Times: Many refund requests happen because providers forget to include session times. Always document both start and end times to ensure compliance.
- Not Verifying Insurance Coverage: Some insurers require pre-authorization for CPT 90837. Always check the patient’s coverage before the session.
- Incomplete Session Notes: Insurance payers require detailed documentation. Missing or vague notes can lead to claim rejections.
- Ignoring Telehealth Documentation Rules: If billing for virtual therapy, include audio/video documentation and patient location details.
- Audit Risk with Sessions Billed: High numbers of sessions billed, especially when using the same psychotherapy code (such as CPT 90837) on the same day as other codes, can increase audit risk. Insurers may flag patterns like consistent session lengths, billing multiple psychotherapy sessions on the same day, or overlapping codes for the same patient.
- Overlapping Codes on the Same Day: Avoid billing overlapping psychotherapy codes or other codes for the same patient on the same day unless payer policies specifically allow it. Always review payer guidelines and ensure documentation supports the services provided.
2026 Reimbursement Rate for CPT Code 90837
The Medicare reimbursement rate for CPT 90837 varies based on location and insurance provider policies. Reimbursement rates and coverage may also differ depending on payer rules and the specific procedure codes used for the service. Typically, Medicare reimburses between $148.25 and $214.72 for CPT 90837.
However, private insurers may have different reimbursement rates depending on contract agreements and regional fee schedules.
To determine the exact reimbursement rate, providers should check the Medicare Administrative Contractor (MAC) fee schedule or contact the insurance payer directly. Providers should also review payer rules for each procedure code and service to ensure accurate reimbursement.
Tips for Maximizing Reimbursement with CPT Code 90837
To ensure full reimbursement and minimize claim issues, follow these best practices:
- Verify Insurance Coverage and Authorization: Some insurers require pre-approval or limit the use of CPT 90837. Confirm the patient’s benefits before the appointment to prevent claim denials.
- Keep Documentation Templates Updated: Regularly update session note templates to meet payer requirements. Include essential details like treatment plans, patient progress, and therapy techniques used.
- Ensure Compliance with Telehealth Sessions: For virtual visits, always document audio/video usage (e.g., “Session conducted via secure video platform”), the location of both provider and patient, and the HIPAA-compliant platform used.
- Double-check Claims for Accuracy: Ensure the correct CPT codes and modifiers are used for billing. Submit claims within the insurance provider’s deadline to avoid delays or denials.
When billing for psychotherapy, it’s important to distinguish between standard therapy sessions (such as CPT 90834 for 45 minutes) and longer sessions (CPT 90837 for 53 minutes or more). Use time-based codes accurately by documenting the exact session duration, start and end times, and clinical justification, especially for complex cases that require extended therapy.
Is CPT Code 90837 Billable for Telehealth?
Yes, CPT 90837 is billable for telehealth, but coverage depends on the payer.
Most insurers reimburse 90837 for telehealth psychotherapy when requirements are met. You must use the correct telehealth modifier, commonly 95 for real-time audio-video services. Some payers still require GT, so payer rules must be checked.
Reimbursement may match in-person rates or be lower, depending on the insurance policy. Proper documentation is essential and should clearly state that the session was conducted via live audio and video, along with the session duration. Always verify payer-specific telehealth rules before billing.
Conclusion
CPT code 90837 is used by healthcare providers to bill for psychotherapy 60 minutes sessions, representing individual face-to-face psychotherapy as a medical service. This code is not used for sessions involving family members or for medication management; it is specific to individual psychotherapy.
However, accurate documentation, verification of insurance coverage, and adherence to billing guidelines are essential for successful reimbursement.
By ensuring thorough session notes, billing & coding best practices, and following payer-specific requirements, providers can maximize reimbursements, avoid claim denials, and deliver high-quality mental health care.
