CPT code 90833 is a psychotherapy add-on code designed specifically for prescribers who provide both medication management and psychotherapy during the same visit. Unlike standalone psychotherapy codes, 90833 cannot be billed alone. It must always accompany an Evaluation and Management (E/M) service, making it the go-to code for psychiatrists, psychiatric nurse practitioners, and other prescribing mental health providers.
This guide breaks down everything you need to know about 90833: the add-on code structure, time requirements, required base E/M codes, documentation standards, and strategies to maximize reimbursement while staying compliant.
What Is CPT 90833?
CPT 90833 represents psychotherapy services provided in conjunction with an Evaluation and Management service. The American Medical Association defines this code as:
"Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure)."
The key phrase here is "List separately in addition to" which designates this as an add-on code that cannot stand alone.
The "30 minutes" descriptor refers to the midpoint of the allowable time range. The actual billable range spans from 16 minutes at the minimum to 37 minutes at the maximum. This psychotherapy time must be distinct from the time spent on the E/M portion of the visit.
Understanding the Add-On Code Structure
Add-on codes work differently from standalone procedure codes. Here is what makes 90833 unique:
- Cannot Be Billed Alone: 90833 must always accompany a primary E/M code on the same claim
- No Modifier Required: Unlike some bundled services, 90833 does not typically require modifier -59
- Same Provider: The same clinician must perform both the E/M service and the psychotherapy
- Same Date of Service: Both services must occur during a single patient encounter
- Distinct Time: The psychotherapy minutes are counted separately from E/M time
Why Add-On Codes Exist
The add-on code structure recognizes that prescribers often provide both medication management and psychotherapy in integrated visits. Rather than forcing providers to choose one or the other, CMS created add-on codes (90833, 90836, 90838) to capture the full scope of services provided during psychiatric visits.
Time Requirements: The 16-37 Minute Window
Accurate time tracking is essential for 90833 billing. The psychotherapy portion must fall within specific boundaries, and this time is counted separately from the E/M component.
Time That Counts Toward 90833
- Face-to-face psychotherapy with patient
- Cognitive behavioral interventions
- Supportive therapy techniques
- Crisis counseling during the visit
- Psychoeducation about coping strategies
- Processing emotional responses to treatment
- Therapy addressing medication adherence barriers
Time That Does NOT Count
- Medication review and adjustment
- Taking vital signs or physical exam
- Discussing medication side effects
- Ordering labs or reviewing results
- Medical decision-making about prescriptions
- Documentation time
- Coordination of care with other providers
Psychotherapy Add-On Time Thresholds
| Add-On Code | Therapy Time Range | Descriptor | Medicare Rate |
|---|---|---|---|
| 90833 | 16-37 minutes | 30-minute add-on | ~$57-72 |
| 90836 | 38-52 minutes | 45-minute add-on | ~$86-105 |
| 90838 | 53+ minutes | 60-minute add-on | ~$128-155 |
Critical Time Boundary
If your psychotherapy time is 15 minutes or less, you cannot bill any add-on code. If it reaches 38 minutes, you must bill 90836 instead of 90833. Document your exact start and stop times for the psychotherapy portion to support your claim.
Required Base E/M Codes
CPT 90833 can only be billed alongside specific Evaluation and Management codes. The base code captures the medical/psychiatric evaluation portion, while 90833 captures the psychotherapy portion.
Approved Primary E/M Codes for 90833
| E/M Code | Description | Typical Use |
|---|---|---|
| 99202-99205 | New patient office visits | Initial psychiatric evaluation with therapy |
| 99211-99215 | Established patient office visits | Follow-up med management + therapy |
| 99221-99223 | Initial hospital care | Inpatient psychiatric admission with therapy |
| 99231-99233 | Subsequent hospital care | Inpatient follow-up with therapy |
| 99281-99285 | Emergency department visits | Psychiatric emergency with crisis therapy |
Codes You Cannot Use with 90833
CPT 90833 cannot be billed with standalone psychotherapy codes (90832, 90834, 90837) or psychiatric diagnostic codes (90791, 90792). If you perform a psychiatric diagnostic evaluation, bill 90792 which already includes the interactive component. Do not add 90833 on top.
Who Can Bill CPT 90833?
Because 90833 requires a base E/M code, only providers who can bill E/M services alongside psychotherapy are eligible to use this code. This typically limits 90833 to prescribing providers.
Providers Who CAN Bill 90833
- ✓ Psychiatrists (MD/DO) performing integrated med management + therapy
- ✓ Psychiatric Nurse Practitioners with prescriptive authority
- ✓ Physician Assistants in psychiatric settings
- ✓ Primary Care Physicians providing behavioral health services
- ✓ Clinical Nurse Specialists with E/M billing privileges
Providers Who CANNOT Bill 90833
- ✗ Psychologists (PhD/PsyD) unless they have prescriptive authority in their state
- ✗ Licensed Clinical Social Workers who do not bill E/M codes
- ✗ Licensed Professional Counselors without E/M billing rights
- ✗ Marriage and Family Therapists providing standalone therapy
- ✗ Any provider when E/M is not part of the encounter
State-Specific Considerations
In states where psychologists have prescriptive authority (Louisiana, New Mexico, Illinois, Iowa, Idaho), qualified psychologists may be able to bill E/M codes and therefore use 90833. Always verify your state scope of practice and payer credentialing requirements.
90833 vs 90836 vs 90838: Choosing the Right Add-On
All three psychotherapy add-on codes follow the same structure but represent different amounts of therapy time. Your choice depends entirely on documented face-to-face psychotherapy minutes.
| Factor | 90833 | 90836 | 90838 |
|---|---|---|---|
| Psychotherapy Time | 16-37 minutes | 38-52 minutes | 53+ minutes |
| 2024 Medicare Rate | ~$57-72 | ~$86-105 | ~$128-155 |
| Work RVU | 1.23 | 1.87 | 2.79 |
| Typical Visit Length | 30-45 min total | 50-65 min total | 70+ min total |
| Common Scenario | Med check + brief therapy | Extended therapy with meds | Intensive integrated visit |
| Frequency of Use | Most common add-on | Moderate use | Less common |
Medicare vs Commercial Reimbursement Rates
As an add-on code, 90833 adds incremental revenue to your base E/M reimbursement. Understanding these rates helps you assess the financial impact of integrated psychiatric visits.
2024-2025 Medicare Rates for 90833
Combined E/M + 90833 Reimbursement Examples
| E/M Code | E/M Rate | + 90833 | Combined Total |
|---|---|---|---|
| 99213 | ~$97 | $57 | ~$154 |
| 99214 | ~$143 | $57 | ~$200 |
| 99215 | ~$193 | $57 | ~$250 |
| 99205 | ~$224 | $57 | ~$281 |
Commercial Insurance Rates
Commercial payers typically reimburse 110-150% of Medicare rates for add-on codes:
- Blue Cross Blue Shield: $65-85 for 90833
- Aetna: $60-80 for 90833
- United Healthcare: $62-78 for 90833
- Cigna: $58-75 for 90833
Documentation Requirements
Because 90833 involves two distinct services (E/M + psychotherapy), your documentation must clearly support both components. Auditors will look for evidence that both services were medically necessary and separately performed.
90833 Documentation Checklist
Sample Documentation Structure
E/M Component (99214):
"Patient presents for follow-up of Major Depressive Disorder, currently on sertraline 100mg daily. Reports partial response with improved sleep but continued low motivation. No suicidal ideation. Discussed increasing sertraline to 150mg daily. Reviewed potential side effects. Labs ordered to monitor. Approximately 12 minutes spent on medication evaluation and medical decision-making."
Psychotherapy Component (90833):
"Following medication review, provided 22 minutes of individual psychotherapy (start time: 10:15 AM, stop time: 10:37 AM). Utilized cognitive behavioral techniques to address negative thought patterns contributing to low motivation. Identified cognitive distortions including all-or-nothing thinking regarding work performance. Patient engaged in collaborative development of behavioral activation plan. Demonstrated improved insight by session end. Will continue CBT focus next visit."
Payer-Specific Rules and Restrictions
Different insurance payers have varying policies around E/M add-on codes. Understanding these nuances helps prevent unexpected denials.
Medicare
Covers 90833 when billed with appropriate E/M codes. Documentation must clearly distinguish E/M time from psychotherapy time. Same provider must perform both services.
Medicaid (Varies by State)
Coverage varies significantly. Some states cover add-on codes, others require standalone psychotherapy codes only. Check your state Medicaid manual before billing.
Blue Cross Blue Shield
Generally covers 90833 with E/M. Some plans require prior authorization if add-on codes are billed frequently. May request documentation if E/M + add-on exceeds 60 minutes total.
United Healthcare
Covers add-on codes with E/M. May review claims where 90833 is billed with high-level E/M codes (99215, 99205) to verify medical necessity for both services.
Aetna
Standard coverage for add-on codes. Requires clear documentation of distinct E/M and psychotherapy components. May audit if add-on frequency exceeds typical patterns.
Common Denial Reasons and Prevention
Understanding why 90833 claims get denied helps you build compliant billing practices from the start.
Missing Primary E/M Code
Prevention: Always bill 90833 with an appropriate E/M code. Never submit 90833 as a standalone charge.
Insufficient Time Documentation
Prevention: Document exact start and stop times for the psychotherapy portion. Ensure total is 16-37 minutes.
Bundling with Psychiatric Diagnostic Codes
Prevention: Do not bill 90833 with 90791 or 90792. These diagnostic codes already include interactive components.
Lack of Medical Necessity
Prevention: Document why psychotherapy was needed in addition to medication management. Link to treatment goals.
Provider Credential Issues
Prevention: Verify your credentials allow billing both E/M codes and psychotherapy add-ons. Ensure proper credentialing with each payer.
Unclear Separation of Services
Prevention: Structure your note to clearly distinguish what was done during E/M vs psychotherapy portions.
Real-World Billing Scenarios
These examples illustrate how 90833 is properly billed in common clinical situations.
Scenario 1: Routine Psychiatric Follow-Up with Brief Therapy
Situation: Dr. Chen, a psychiatrist, sees an established patient for a 40-minute visit. She spends 15 minutes reviewing medications, adjusting dosages, and addressing side effects. She then provides 25 minutes of supportive psychotherapy addressing the patient anxiety about returning to work.
Correct Billing: 99214 + 90833
Rationale: The E/M portion (15 min) supports 99214 based on medical decision-making complexity. The psychotherapy time (25 min) falls within the 90833 range (16-37 minutes).
Scenario 2: New Patient Psychiatric Evaluation with Therapy
Situation: Dr. Patel sees a new patient for a 75-minute comprehensive psychiatric evaluation. After completing the medical evaluation and prescribing an initial medication regimen (45 minutes), she provides 30 minutes of crisis-focused therapy to address the patient active suicidal ideation with a safety plan.
Correct Billing: 99205 + 90833
Rationale: New patient E/M (99205) for high complexity. Psychotherapy add-on (90833) for the 30-minute therapy component. This is preferred over 90792 when distinct E/M documentation is warranted.
Scenario 3: NP Medication Management with CBT
Situation: A psychiatric nurse practitioner sees a patient with ADHD and comorbid anxiety. She spends 10 minutes on medication review and adjustment, then 20 minutes teaching CBT techniques for managing anxiety symptoms related to ADHD.
Correct Billing: 99213 + 90833
Rationale: The CBT component is distinct from medication management and represents genuine psychotherapy. The 20-minute therapy time qualifies for 90833.
Scenario 4: When NOT to Bill 90833
Situation: A psychiatrist sees a stable patient for a 20-minute medication check. The conversation includes discussing how the patient is feeling, addressing questions about the medication, and providing brief encouragement.
Incorrect Billing: 99213 + 90833
Correct Billing: 99213 only
Rationale: General supportive conversation during medication management is part of E/M, not separate psychotherapy. There were no distinct psychotherapeutic interventions or modalities applied.
Frequently Asked Questions
Can I bill 90833 with a 99211 E/M code? ▼
Technically yes, but this combination is uncommon and may trigger audits. 99211 is typically a nurse visit without physician involvement, yet 90833 requires the same provider to perform both services. If the situation warrants a 99211-level E/M and 16+ minutes of psychotherapy by a physician, document thoroughly to explain the clinical context.
Do I need modifier -25 when billing 90833 with E/M? ▼
No, modifier -25 is not required for 90833 because it is already defined as an add-on code to E/M services. The add-on designation inherently indicates the services are separately identifiable. Adding -25 is unnecessary and some payers may reject claims with redundant modifiers.
Can I bill 90833 for telehealth visits? ▼
Yes, 90833 can be billed for telehealth visits with the appropriate modifier (-95 or -GT depending on payer). Apply the telehealth modifier to both the E/M code and 90833. Use place of service code 02 (telehealth) or 10 (telehealth in patient home) as required by the payer.
What if my psychotherapy time is exactly 38 minutes? ▼
At exactly 38 minutes of psychotherapy, you should bill 90836 instead of 90833. The time ranges are precise: 90833 covers 16-37 minutes, and 90836 begins at 38 minutes. Document your exact time and bill accordingly.
Can two different providers bill E/M and 90833 on the same day? ▼
No. The same provider must perform both the E/M service and the psychotherapy to bill 90833. If a psychiatrist does the medication evaluation and a therapist provides psychotherapy, they bill separately: the psychiatrist bills E/M only, and the therapist bills a standalone psychotherapy code (90832, 90834, or 90837).
Is 90833 covered for Medicare patients with depression screening? ▼
Yes, Medicare covers 90833 for patients with depression and other mental health diagnoses when medical necessity is established. The add-on captures the psychotherapy component of an integrated psychiatric visit. Ensure your documentation supports both the E/M and therapy services as distinct and necessary.
How do I count time when therapy and med management overlap? ▼
Time cannot be double-counted. If you are discussing medication adherence using motivational interviewing (therapy), that time goes toward psychotherapy. If you are reviewing side effects and adjusting dosages (E/M), that time goes toward E/M. The key is to document what you were actually doing during each portion of the visit.
Key Takeaways
Master CPT 90833 Billing
CPT 90833 enables prescribing mental health providers to capture the full value of integrated psychiatric visits. When you provide both medication management and genuine psychotherapy in the same encounter, this add-on code ensures you are reimbursed for both services.
The key to successful 90833 billing is clear documentation that distinguishes the E/M and psychotherapy components, accurate time tracking, and ensuring your clinical practice genuinely involves both services. When used appropriately, this code supports the integrated care model that benefits both providers and patients.
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