CPT 90836 is the billing code psychiatrists and other prescribing providers use when they combine medication management with extended psychotherapy. If you provide 38-52 minutes of therapy alongside an evaluation and management (E/M) service, this add-on code is essential for capturing the full value of your work. Yet many providers either underutilize it or bill it incorrectly, leaving significant revenue on the table.
This guide covers everything you need to know about CPT 90836: when to use it versus standalone psychotherapy codes, which E/M codes it pairs with, documentation requirements that prevent denials, and the real-world scenarios where this code applies. Whether you are a psychiatrist managing complex cases or a practice manager optimizing billing workflows, you will find actionable guidance here.
What is CPT 90836?
CPT 90836 is a Current Procedural Terminology add-on code used to bill for psychotherapy services lasting 38 to 52 minutes when provided in conjunction with an evaluation and management (E/M) service. Unlike standalone psychotherapy codes (90832, 90834, 90837), this code cannot be billed alone. It must always accompany a primary E/M code.
The official AMA description reads: "Psychotherapy, 45 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 "in addition to." This code captures the psychotherapy component when a provider performs both medical evaluation and therapeutic intervention in the same encounter.
Who Uses CPT 90836?
This code is most commonly used by providers who can bill both E/M services and psychotherapy:
- Psychiatrists providing medication management combined with therapy
- Psychiatric nurse practitioners in states with prescriptive authority
- Physician assistants working in psychiatric settings
- Primary care physicians with behavioral health training addressing mental health needs
- Clinical psychologists in certain integrated care settings where E/M services are appropriate
Non-prescribing therapists (LCSWs, LPCs, LMFTs) typically use standalone psychotherapy codes (90834 for 38-52 minutes) because they do not perform E/M services. The add-on codes exist specifically for situations where medical evaluation and psychotherapy occur together.
Understanding the Add-On Structure
Think of 90836 as the therapy portion of a combined visit. The E/M code (like 99214) captures your medical evaluation work: reviewing symptoms, adjusting medications, assessing side effects, ordering labs. The 90836 captures the psychotherapy work: processing emotions, teaching coping skills, addressing cognitive distortions. Together, they represent the full clinical picture of what happened in the visit.
Time Requirements: The 38-52 Minute Window
The psychotherapy portion of your visit must last between 38 and 52 minutes to bill 90836. This is time spent actively engaged in therapeutic interventions, separate from and in addition to the time spent on E/M activities.
What Counts Toward Psychotherapy Time
Only direct therapeutic activities count toward your 38-52 minute requirement:
- Cognitive behavioral interventions such as identifying and challenging negative thought patterns
- Supportive psychotherapy including empathic listening and validation
- Psychoeducation about coping strategies, diagnosis, or treatment approaches
- Motivational interviewing to address ambivalence about change
- Crisis intervention addressing acute emotional distress
- Processing emotions related to life events, relationships, or trauma
- Treatment planning discussions that are therapeutic in nature
What Counts Toward E/M Time (Not Psychotherapy)
The following activities are part of your E/M service, not the psychotherapy add-on:
- Medication review including discussing current medications and side effects
- Prescribing decisions such as adjusting dosages or adding medications
- Reviewing lab results or other diagnostic information
- Physical or mental status examination as part of medical assessment
- Medical history taking focused on symptom evaluation
- Risk assessment when purely evaluative (not therapeutic safety planning)
- Coordination of care communications with other providers
Critical Time Distinction
The E/M time and psychotherapy time must be tracked separately. If your total encounter is 60 minutes, you cannot simply bill 90836 for the whole thing. You must determine how much time was spent on medical evaluation versus therapeutic intervention. For example: 15 minutes on medication review and prescribing (E/M) plus 45 minutes of CBT and processing (psychotherapy) equals a properly documented combined service.
Required Base E/M Codes
CPT 90836 cannot stand alone. It must be billed with one of the following primary E/M codes:
| E/M Code | Description | Typical Use Case | 2024 Medicare Rate |
|---|---|---|---|
| 99202 | New patient, straightforward MDM | Initial psych eval, mild presentation | $74.67 |
| 99203 | New patient, low MDM | New patient with one stable condition | $110.46 |
| 99204 | New patient, moderate MDM | New patient, multiple conditions or Rx decision | $169.48 |
| 99205 | New patient, high MDM | Complex new patient, high-risk decisions | $211.20 |
| 99212 | Established patient, straightforward MDM | Stable patient, simple med refill | $56.55 |
| 99213 | Established patient, low MDM | Routine follow-up, minor adjustment | $93.14 |
| 99214 | Established patient, moderate MDM | Most common: med management + therapy | $132.70 |
| 99215 | Established patient, high MDM | Complex patient, high-risk decisions | $178.66 |
The most common pairing is 99214 + 90836. This combination represents a typical psychiatric follow-up where the provider manages medications (moderate complexity medical decision making) and provides substantial psychotherapy (38-52 minutes). Together, these codes reimburse approximately $213 from Medicare, reflecting the full scope of services provided.
90836 vs 90833 vs 90838: Add-On Code Comparison
The psychotherapy add-on codes form a family based on time spent in therapy during a combined E/M visit. Understanding when to use each code ensures accurate billing and maximum appropriate reimbursement.
Best for: Brief therapy with primary focus on medication management. Short supportive interventions during med checks.
Best for: Balanced visits with substantial therapy alongside medical management. Standard combined psychiatric care.
Best for: Extended therapy sessions with E/M. Complex cases requiring intensive therapeutic intervention plus medical care.
Add-On vs Standalone Code Comparison
Here is how the add-on codes compare to their standalone equivalents:
| Time Range | Standalone Code | Add-On Code | When to Use Add-On |
|---|---|---|---|
| 16-37 minutes | 90832 | 90833 | When billed with E/M service |
| 38-52 minutes | 90834 | 90836 | When billed with E/M service |
| 53+ minutes | 90837 | 90838 | When billed with E/M service |
Revenue Optimization Tip
Combined E/M + add-on billing often yields higher reimbursement than standalone therapy codes alone. For example, 99214 ($132.70) + 90836 ($80.42) = $213.12, compared to just 90834 ($114.53) for the same therapy time. If you are legitimately performing both medical evaluation and psychotherapy, use the add-on structure to capture the full value of your work.
Medicare vs Commercial Reimbursement Rates
Reimbursement for CPT 90836 varies by payer and geographic location. Here are current benchmarks to help you estimate revenue:
2024 Medicare Rates for 90836
| Setting | National Average | High-Cost Areas | Low-Cost Areas |
|---|---|---|---|
| Non-Facility (Office) | $80.42 | $88-95 | $72-78 |
| Facility (Hospital) | $67.15 | $74-82 | $60-66 |
Combined Visit Total Reimbursement (Medicare Examples)
| Code Combination | E/M Rate | Add-On Rate | Total |
|---|---|---|---|
| 99213 + 90836 | $93.14 | $80.42 | $173.56 |
| 99214 + 90836 | $132.70 | $80.42 | $213.12 |
| 99215 + 90836 | $178.66 | $80.42 | $259.08 |
| 99204 + 90836 | $169.48 | $80.42 | $249.90 |
Commercial Payer Rates
Commercial insurance typically reimburses 15-45% above Medicare rates for the add-on codes:
- Blue Cross Blue Shield typically pays $95-120 for 90836 depending on state
- Aetna generally reimburses $90-115 for in-network providers
- Cigna usually falls in the $85-110 range
- UnitedHealthcare pays approximately $90-115 depending on network tier
- Out-of-network reimbursement varies widely based on your fee schedule and the plan's UCR calculations
Documentation Requirements
Proper documentation for 90836 requires clearly distinguishing between E/M activities and psychotherapy activities. Auditors look for evidence that both components of the visit actually occurred.
90836 Documentation Checklist
Sample Documentation Structure
Here is an effective note structure for a combined E/M + 90836 visit:
Chief Complaint: Follow-up for depression and anxiety, medication management, and ongoing therapy.
E/M PORTION (15 minutes):
History: Patient reports improved sleep with current trazodone dose. Denies side effects from sertraline. Appetite has normalized. No recent panic attacks.
Medications Reviewed: Sertraline 100mg daily, Trazodone 50mg QHS, Lorazepam 0.5mg PRN (reports using 1-2x monthly)
Examination: Alert and oriented. Appropriate grooming. Speech normal rate and rhythm. Mood "better." Affect congruent, reactive. Thought process linear. No SI/HI.
Medical Decision Making: Stable on current regimen. Continue sertraline 100mg, trazodone 50mg. Discussed eventual lorazepam taper; patient amenable when anxiety management skills are stronger. Ordered thyroid panel for routine monitoring.
PSYCHOTHERAPY PORTION (45 minutes):
Focus: Cognitive restructuring for anticipatory anxiety about upcoming work presentation.
Interventions: Used CBT approach to identify automatic negative thoughts ("I will embarrass myself," "Everyone will think I am incompetent"). Guided Socratic questioning to evaluate evidence for and against these thoughts. Developed alternative balanced thoughts. Practiced brief relaxation technique. Assigned thought record homework for anxious situations this week.
Response: Patient engaged actively in cognitive work. Identified core belief about competence that warrants further exploration. Demonstrated ability to generate alternative thoughts with support. Expressed feeling "more prepared" to manage presentation anxiety.
Progress: Treatment Goal 2 (Reduce anticipatory anxiety, GAD-7 from 14 to below 8): Making progress. Patient applying techniques learned in session.
Time: Total encounter 60 minutes. E/M activities: 15 minutes. Psychotherapy: 45 minutes.
Diagnoses: F32.1 Major depressive disorder, single episode, moderate; F41.1 Generalized anxiety disorder
Billing: 99214, 90836
Payer-Specific Rules
Each payer has unique requirements for billing E/M with psychotherapy add-on codes. Understanding these nuances prevents denials and ensures proper reimbursement.
Medicare
- Requires clear documentation separating E/M and psychotherapy components
- Medical decision making (MDM) should reflect genuine medical complexity, not just the time spent
- Psychotherapy time must be face-to-face with the patient
- Telehealth allowed with modifier 95 and appropriate place of service
- Accepts billing from psychiatrists, psychologists (in some contexts), NPs, and PAs
Medicare Advantage Plans
- May have different documentation requirements than traditional Medicare
- Some require prior authorization for ongoing psychiatric services
- Check individual plan policies for specific coverage rules
Commercial Payers (General)
- Most follow CMS guidelines for E/M plus add-on billing
- Some require the E/M and add-on codes to be billed on the same claim line with appropriate modifiers
- Others require separate lines with linking modifiers
- Documentation standards vary; verify with individual payers
Medicaid
- Varies significantly by state
- Some states do not allow same-day E/M and psychotherapy billing
- Others require specific modifiers or prior authorization
- Always verify state-specific Medicaid rules before billing
Verify Before You Bill
Before billing 90836 to any payer for the first time, verify their specific requirements. Some payers bundle E/M and psychotherapy differently, and others have unique modifier requirements. A quick call to provider services or review of the provider manual can prevent systematic denials.
Common Denial Reasons and Prevention
Understanding why claims are denied helps you prevent problems before they occur. Here are the most common issues with 90836 claims:
1. Missing or Invalid Primary E/M Code
Problem: Billing 90836 without an accompanying E/M code, or with an E/M code that is not on the approved list.
Solution: Always bill 90836 with a valid E/M code (99202-99205 for new patients, 99212-99215 for established patients). Verify the E/M code is appropriate for the level of medical decision making documented.
2. Time Documentation Issues
Problem: Notes do not clearly separate E/M time from psychotherapy time, or psychotherapy time falls outside the 38-52 minute range.
Solution: Explicitly document total encounter time, E/M time, and psychotherapy time as separate elements. Example: "Total encounter: 65 minutes. E/M activities: 18 minutes. Psychotherapy: 47 minutes."
3. Insufficient E/M Documentation
Problem: The E/M portion lacks required elements (history, exam, MDM) to support the billed level.
Solution: Ensure your E/M documentation meets the requirements for the specific code. For 99214, you need moderate complexity MDM with appropriate documentation of the problem, data reviewed, and risk of treatment.
4. Insufficient Psychotherapy Documentation
Problem: Notes show medication management but lack evidence of actual psychotherapeutic intervention.
Solution: Document specific therapeutic techniques used, topics addressed, patient's response to interventions, and connection to treatment goals. Vague statements like "provided supportive therapy" are insufficient.
5. Provider Type Not Eligible
Problem: Some payers restrict which provider types can bill combined E/M and psychotherapy.
Solution: Verify that your license type and credentials are eligible for both E/M and psychotherapy billing with each specific payer.
6. Modifier Errors
Problem: Missing or incorrect modifiers when telehealth is involved or when payer requires specific modifier usage.
Solution: Know each payer's modifier requirements. For telehealth, typically use modifier 95 on both the E/M and add-on codes with place of service 02.
Real-World Billing Scenarios
These scenarios illustrate correct billing for common clinical situations involving 90836:
Scenario 1: Standard Psychiatric Follow-Up
Situation: Established patient with depression. You spend 12 minutes reviewing medications, assessing side effects, and adjusting sertraline dose. Then you spend 42 minutes doing cognitive behavioral therapy for negative thought patterns.
Answer: Bill 99214 + 90836. The medication adjustment with new prescription supports moderate MDM (99214), and 42 minutes of psychotherapy falls within the 38-52 minute range for 90836.
Scenario 2: New Patient Evaluation with Therapy
Situation: New patient with anxiety. Comprehensive psychiatric evaluation takes 30 minutes (history, MSE, diagnosis, treatment planning, prescribing). You then provide 45 minutes of psychoeducation and initial CBT work.
Answer: Bill 99204 or 99205 (depending on complexity) + 90836. New patient evaluation with prescribing typically supports at least moderate complexity, and 45 minutes of therapy qualifies for 90836.
Scenario 3: Brief Therapy Component
Situation: Established patient. Medication management takes 15 minutes. You provide 30 minutes of supportive psychotherapy.
Answer: Bill 99214 + 90833 (not 90836). Only 30 minutes of psychotherapy was provided, which falls in the 16-37 minute range for 90833.
Scenario 4: Extended Therapy Session
Situation: Established patient in crisis. Brief 10-minute medication review (continue current meds, no changes). Extended 58-minute session processing recent trauma and developing safety plan.
Answer: Bill 99213 + 90838. The straightforward medication review (no changes, low complexity) supports 99213, while 58 minutes of therapy requires 90838 (53+ minutes).
Scenario 5: Telehealth Visit
Situation: Established patient seen via secure video. 15 minutes of medication management, 48 minutes of psychotherapy.
Answer: Bill 99214-95 + 90836-95. Both codes get the telehealth modifier. Use place of service 02 (or 10 if patient is at home, depending on payer). Document the platform used and that the session was conducted via real-time audiovisual technology.
Scenario 6: Therapy Only, No E/M
Situation: Established patient. Medications are stable, no review needed today. Entire 50-minute session is devoted to psychotherapy.
Answer: Bill 90834 (standalone), not 90836. Since no E/M service was provided, you cannot use the add-on code. Use the standalone psychotherapy code instead.
Frequently Asked Questions
Can a non-prescribing therapist use CPT 90836?
Generally no. CPT 90836 is an add-on to E/M services, which typically involve medical evaluation and prescribing. Non-prescribing therapists (LCSWs, LPCs, LMFTs) should use standalone psychotherapy codes like 90834 for 38-52 minute sessions. However, in some integrated care settings where a therapist provides psychotherapy during a physician's E/M visit, the coding may differ. Consult with your billing specialist for unusual arrangements.
What if my psychotherapy time is exactly 38 minutes?
Yes, 38 minutes is the minimum threshold for 90836. If your psychotherapy portion is exactly 38 minutes, you can appropriately bill 90836 as an add-on to your E/M code. Document the specific time clearly in your note. If you fall short at 37 minutes, you must use 90833 instead.
Can I bill 90836 with every E/M visit?
Only when you actually provide 38-52 minutes of psychotherapy during the visit. If your visits are primarily medication management with minimal or no therapy, you should bill only the E/M code. Routine addition of 90836 to all psychiatric visits without corresponding therapy documentation is a red flag for auditors and could constitute fraud.
How do I handle documentation in the EHR?
Most EHR systems allow structured note templates with separate sections for E/M and psychotherapy components. Create a template that includes distinct areas for medication review and medical decision making (E/M portion) and therapy interventions and progress (psychotherapy portion). Include time tracking fields for each component. This structure makes it easy for auditors to see that both services were genuinely provided.
Is 90836 reimbursed the same as 90834?
No. CPT 90836 typically reimburses less than standalone 90834 because it represents only the therapy component of a combined visit. However, when you add 90836 reimbursement to the E/M code reimbursement, the total is usually higher than 90834 alone. For example, Medicare pays approximately $80 for 90836 versus $115 for 90834, but 99214 ($133) + 90836 ($80) = $213 total, which exceeds standalone 90834.
Can I use 90836 for telehealth visits?
Yes. Both the E/M code and 90836 can be provided via telehealth when appropriate. Use modifier 95 on both codes for most payers, and ensure your place of service reflects telehealth (typically 02). Document that services were provided via real-time audiovisual technology using a HIPAA-compliant platform. Verify telehealth coverage with individual payers, as some have specific requirements.
What diagnoses support billing 90836?
Any mental health diagnosis that warrants both medication management and psychotherapy can support 90836. Common examples include major depressive disorder (F32.x, F33.x), anxiety disorders (F41.x), bipolar disorder (F31.x), PTSD (F43.1x), and ADHD (F90.x). The diagnosis must justify medical necessity for both the E/M component (medication management) and the psychotherapy component (therapeutic intervention).
Key Takeaways
CPT 90836 Summary
- 1.CPT 90836 is an add-on code for 38-52 minutes of psychotherapy provided with an E/M service. It cannot be billed alone.
- 2.Always pair 90836 with a valid E/M code (99202-99205 for new patients, 99212-99215 for established patients). The most common combination is 99214 + 90836.
- 3.Document E/M time and psychotherapy time separately. Your note must clearly show both components were provided with sufficient detail for each.
- 4.Medicare reimburses approximately $80 for 90836 alone. Combined with 99214, total reimbursement is approximately $213, higher than standalone 90834.
- 5.If you only provide medication management without substantial therapy, bill only the E/M code. If you only provide therapy without E/M, use standalone codes (90834).
- 6.For telehealth, add modifier 95 to both codes and use appropriate place of service. Verify specific requirements with each payer.
Mastering CPT 90836 billing allows you to capture the full value of combined psychiatric visits where you provide both medication management and meaningful psychotherapy. The key is accurate time tracking, thorough documentation of both components, and understanding which E/M code matches your level of medical decision making. When billed correctly, the E/M plus add-on structure properly reflects the comprehensive care you provide and ensures appropriate reimbursement for your time.
Looking for a practice management platform that simplifies combined billing? TheraFocus helps you track E/M and therapy time separately, generates compliant documentation, and streamlines your claims workflow. Learn how TheraFocus can help your practice.
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The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.