CPT code 90837 represents the gold standard for extended individual psychotherapy sessions, covering face-to-face time of 53 minutes or more. For therapists who conduct in-depth therapeutic work, mastering this billing code is essential to proper reimbursement and practice sustainability.
Whether you specialize in trauma processing, complex case conceptualization, or intensive therapeutic interventions, understanding the nuances of 90837 billing will help you get paid fairly for your clinical expertise while avoiding costly claim denials.
What Is CPT Code 90837?
CPT 90837 is the billing code for individual psychotherapy sessions lasting 53 minutes or more of face-to-face time with the patient. This code falls within the time-based psychotherapy code family (90832, 90834, 90837) and represents the longest standard individual therapy session.
The American Medical Association (AMA) defines 90837 as: "Psychotherapy, 53 minutes with patient when performed with an evaluation and management service, list the psychotherapy code first."
Key Characteristics of 90837
- Time requirement: 53 minutes or more of face-to-face psychotherapy
- Session type: Individual (one-on-one with patient)
- Setting: Outpatient, inpatient, or telehealth
- Provider types: Psychiatrists, psychologists, LCSWs, LPCs, LMFTs, and other qualified mental health professionals
- Billable activities: Therapeutic interventions, crisis intervention, behavior modification, supportive interactions
Important Time Clarification
The 53-minute threshold refers specifically to face-to-face psychotherapy time with the patient. Documentation time, phone calls, care coordination, and chart review do NOT count toward this requirement. If your session runs 60 minutes total but only 50 minutes is direct therapeutic contact, you should bill 90834 instead.
Face-to-Face Time Requirements Explained
Understanding the time thresholds for psychotherapy codes is critical for accurate billing. The psychotherapy code family uses specific time ranges, and selecting the wrong code based on session length is one of the most common billing errors.
Psychotherapy Code Time Ranges
| CPT Code | Time Range | Typical Session | 2024 Medicare Rate |
|---|---|---|---|
| 90832 | 16-37 minutes | 30-minute session | $68.90 |
| 90834 | 38-52 minutes | 45-minute session | $102.09 |
| 90837 | 53+ minutes | 60-minute session | $129.62 |
What Counts as Face-to-Face Time
Counts Toward 53 Minutes
- ✓ Direct therapeutic interventions
- ✓ Psychoeducation delivered to patient
- ✓ Crisis intervention
- ✓ Interactive feedback techniques
- ✓ Behavior modification strategies
- ✓ Supportive therapeutic interactions
- ✓ Treatment planning with patient present
- ✓ Telehealth video sessions (with patient visible)
Does NOT Count
- ✗ Chart review before session
- ✗ Documentation after session
- ✗ Phone calls with other providers
- ✗ Care coordination activities
- ✗ Insurance pre-authorization calls
- ✗ Waiting room time
- ✗ Scheduling discussions
- ✗ Payment processing
Medicare vs Commercial Reimbursement Rates
Reimbursement for CPT 90837 varies significantly based on payer type, geographic location, and your contracted rates. Understanding typical payment ranges helps you negotiate contracts and set realistic revenue expectations.
2024 Medicare Rates by Region
Medicare reimbursement for 90837 is based on the Medicare Physician Fee Schedule (MPFS) and adjusted by geographic practice cost indices (GPCIs). The national average rate is $129.62, but actual payments vary by locality.
| Location | Medicare Rate | Typical Commercial |
|---|---|---|
| National Average | $129.62 | $150-180 |
| New York City Metro | $143.28 | $175-220 |
| San Francisco Bay Area | $148.91 | $180-240 |
| Los Angeles Metro | $139.77 | $165-200 |
| Chicago Metro | $132.14 | $155-185 |
| Rural Areas | $118-125 | $130-160 |
Commercial Payer Comparison
Commercial insurance rates are negotiated individually and can vary dramatically based on your credentials, practice location, and bargaining leverage. Here are typical ranges:
Blue Cross Blue Shield
$145-185
Varies significantly by state
UnitedHealthcare
$140-175
Optum behavioral rates may differ
Aetna
$135-170
CVS acquisition impacted some rates
Cigna
$140-180
Evernorth rates competitive
Required Documentation Elements
Proper documentation is your best defense against claim denials and audits. Every 90837 session note must contain specific elements to support medical necessity and the time billed.
Essential Documentation Checklist for 90837
Medical Necessity Justification
For extended 53+ minute sessions, payers expect clear justification for why the longer session time was clinically appropriate. Strong medical necessity language includes:
- Complexity of presenting issues requiring extended processing time
- Trauma work that requires adequate time for stabilization
- Crisis intervention that could not be adequately addressed in shorter session
- EMDR or exposure therapy requiring full protocol completion
- Treatment-resistant symptoms requiring intensive intervention
- Co-occurring disorders necessitating integrated treatment approach
Pro Tip: Time Documentation
Always document time in a way that clearly supports 90837. Instead of writing "60-minute session," write: "Face-to-face psychotherapy time: 57 minutes (10:02 AM - 10:59 AM). Total session time including brief administrative discussion: 62 minutes." This leaves no ambiguity for auditors.
Common Modifiers for 90837
Modifiers provide additional information about the service rendered and are often required for proper claim processing. Using incorrect modifiers is a leading cause of claim denials.
Telehealth Modifiers
| Modifier | Description | When to Use |
|---|---|---|
| 95 | Synchronous telemedicine service | Real-time video sessions (most commercial payers) |
| GT | Via interactive audio and video telecommunications | Medicare telehealth claims |
| FQ | Telehealth service furnished using audio-only | Audio-only sessions (limited acceptance) |
Place of Service Codes
The Place of Service (POS) code must match your session location and is especially important for telehealth claims:
- POS 11: Office (in-person sessions at your practice)
- POS 02: Telehealth provided other than patient's home
- POS 10: Telehealth provided in patient's home
- POS 12: Patient's home (in-person home visits)
Medicare Telehealth Alert
As of 2024, Medicare requires modifier GT for telehealth claims along with the appropriate POS code. Using modifier 95 instead may result in claim denial. Always verify current Medicare requirements as telehealth policies continue evolving post-pandemic.
Other Common Modifiers
Modifier HO
Master's level clinician - Required by some Medicaid programs
Modifier AH
Clinical psychologist - Medicare requirement for PhD/PsyD
Modifier AJ
Clinical social worker - Medicare requirement for LCSW
Modifier XE
Separate encounter - Same day E/M with psychotherapy
Payer-Specific Billing Rules
Each major payer has unique requirements and quirks for 90837 billing. Knowing these nuances prevents unnecessary denials and speeds up reimbursement.
Medicare
- Accepts 90837 from psychiatrists, psychologists (with AH modifier), clinical social workers (with AJ modifier), and other qualified providers
- Requires GT modifier for all telehealth sessions
- No prior authorization typically required for outpatient psychotherapy
- Incident-to billing rules apply for services in physician practices
- Watch for MIPS quality reporting requirements
Blue Cross Blue Shield
- Rules vary significantly by state (Anthem, Premera, CareFirst, etc. have different policies)
- Some plans limit frequency of 90837 (e.g., max 4 per month without authorization)
- Pre-authorization sometimes required after certain number of sessions
- Modifier 95 typically required for telehealth
- Watch for medical necessity reviews on extended session frequency
UnitedHealthcare / Optum
- Optum manages behavioral health for many UHC plans
- Often requires outpatient treatment reports (OTRs) after initial sessions
- May request concurrent review for ongoing 90837 usage
- Telehealth parity generally maintained
- Electronic claim submission strongly preferred
Aetna
- Pre-certification required for some plans after initial evaluation
- Accepts most licensed mental health provider types
- Documentation requests common - keep records thorough
- Network adequacy issues may allow out-of-network at in-network rates
Cigna / Evernorth
- Generally competitive reimbursement rates
- Treatment plans required and must be updated regularly
- May audit high-volume 90837 billers
- Telehealth coverage consistent across most plans
Common Denial Reasons and Prevention Strategies
Understanding why 90837 claims get denied helps you prevent issues before they occur. Here are the most common denial reasons and how to address them.
Time Documentation Insufficient
Denial reason: Session notes do not support 53+ minutes of face-to-face time.
Prevention: Always document start time, stop time, and total face-to-face minutes explicitly. Use phrases like "53 minutes of individual psychotherapy provided."
Medical Necessity Not Established
Denial reason: Payer questions why 53+ minutes was required vs. shorter session.
Prevention: Document clinical rationale for extended session - complexity of issues, crisis level, treatment modality requirements, or symptom severity requiring intensive intervention.
Missing or Incorrect Modifier
Denial reason: Telehealth claim missing required modifier or wrong modifier used.
Prevention: Verify payer-specific modifier requirements before billing. Medicare uses GT; most commercial payers use 95. Double-check POS code matches modifier.
Frequency Limits Exceeded
Denial reason: Too many 90837 sessions billed in authorization period.
Prevention: Track authorized sessions carefully. Request authorization extensions before limits reached. Document clinical necessity for intensive frequency.
Duplicate Claim
Denial reason: Same service date and code already paid.
Prevention: Implement robust tracking to prevent duplicate submissions. If legitimately seeing patient twice in one day, use modifier XE and document separate encounters clearly.
Appeal Strategies
When claims are denied, a well-crafted appeal can often reverse the decision:
- Review the denial reason carefully - Address the specific issue cited
- Gather supporting documentation - Session notes, treatment plan, clinical assessments
- Write a clear appeal letter - Reference the claim number, date of service, and specific denial reason
- Cite clinical guidelines - APA practice guidelines, AACAP parameters, or other relevant standards
- Include peer-reviewed literature - Studies supporting your treatment approach duration
- Request peer-to-peer review - Speak directly with payer's medical director if needed
- Track appeal deadlines - Most payers require appeals within 60-180 days of denial
90837 vs 90834 vs 90832: Which Code to Use
Choosing the correct psychotherapy code depends entirely on face-to-face time. Here's how to determine which code applies to your session.
Best For:
- Brief check-in sessions
- Medication management follow-ups
- Stable patients requiring monitoring
- Sessions cut short by patient factors
Best For:
- Standard "therapy hour" sessions
- Most ongoing psychotherapy
- Skill-building and processing work
- Moderate complexity cases
Best For:
- Complex trauma processing
- Crisis intervention
- EMDR or exposure therapy
- Intensive treatment phases
Billing Integrity Warning
Never "upcode" to 90837 when your actual face-to-face time falls in the 90834 range. This constitutes billing fraud and can result in audits, repayment demands, exclusion from insurance panels, and legal consequences. Always bill the code that accurately reflects the time spent.
Real-World Billing Scenarios
Let's walk through common situations therapists encounter when billing 90837.
Scenario 1: Standard 60-Minute Session
Situation: You schedule a 60-minute session. Patient arrives on time. You spend 55 minutes in face-to-face psychotherapy, then 5 minutes scheduling the next appointment.
Correct billing: 90837 - The 55 minutes of face-to-face time exceeds the 53-minute threshold.
Scenario 2: Patient Arrives Late
Situation: 60-minute session scheduled. Patient arrives 15 minutes late. You provide 48 minutes of face-to-face therapy before the hour ends.
Correct billing: 90834 - The 48 minutes falls in the 38-52 minute range. You cannot bill 90837 despite scheduling a 60-minute slot.
Scenario 3: Extended Crisis Session
Situation: Patient presents in acute crisis. Session extends to 75 minutes of face-to-face crisis intervention and stabilization.
Correct billing: 90837 - Document the crisis thoroughly, including risk assessment, interventions used, and stabilization achieved. The extended time is justified by clinical necessity.
Scenario 4: Telehealth Session
Situation: You conduct a 58-minute video therapy session with a patient at their home.
Correct billing: 90837 with modifier 95 (or GT for Medicare), POS 10 (telehealth in patient home). Document that session was conducted via HIPAA-compliant video platform.
Scenario 5: Same-Day E/M Service
Situation: You provide a psychiatric evaluation (90792) at 9 AM and then a 55-minute therapy session at 2 PM for the same patient.
Correct billing: Bill both 90792 and 90837 with modifier XE on the 90837 to indicate separate encounter. Document each session independently with clear separation of services.
Frequently Asked Questions
Can I bill 90837 for a 53-minute session?
Yes. The minimum face-to-face time for 90837 is exactly 53 minutes. Any session where you provide 53 or more minutes of direct psychotherapy qualifies for this code. Document the exact time clearly in your notes.
Is there a maximum time limit for 90837?
There is no defined maximum time for 90837. However, sessions significantly exceeding 60 minutes may trigger payer scrutiny. If you regularly conduct 90+ minute sessions, ensure thorough documentation of clinical necessity and consider whether crisis codes might be more appropriate.
Can I bill 90837 for telehealth sessions?
Yes, 90837 is billable for telehealth sessions. Use modifier 95 for most commercial payers or modifier GT for Medicare. Ensure you use the correct Place of Service code (02 for telehealth not at patient's home, 10 for telehealth at patient's home). Document that the session was conducted via HIPAA-compliant video platform.
What if my session runs exactly 52 minutes?
A 52-minute session should be billed as 90834, not 90837. The 90837 threshold is 53 minutes, and billing must reflect actual face-to-face time. If you consistently find yourself at 52 minutes, consider whether a few more minutes of therapeutic work would be clinically beneficial and allow accurate 90837 billing.
Do I need prior authorization for 90837?
Prior authorization requirements vary by payer. Medicare typically does not require prior auth for outpatient psychotherapy. Many commercial plans allow a certain number of sessions before requiring authorization. Check each patient's specific benefits and maintain authorization tracking to avoid denials.
Can I bill 90837 with an E/M code on the same day?
Yes, but only when medically necessary and appropriately documented. If you provide a separately identifiable E/M service (like medication management) along with 90837, bill both with appropriate modifiers (typically XE for separate encounter or modifier 25 on the E/M code). The services must be distinct and documentation must support both.
What diagnosis codes support 90837?
Most mental health diagnosis codes (F-codes in ICD-10) support 90837 billing. Common diagnoses include major depressive disorder (F32-F33), anxiety disorders (F40-F41), PTSD (F43.1), adjustment disorders (F43.2), and personality disorders (F60-F69). The diagnosis must support the medical necessity for psychotherapy treatment.
Key Takeaways
- CPT 90837 requires a minimum of 53 minutes of face-to-face psychotherapy time
- Document start time, stop time, and total face-to-face minutes in every session note
- Use modifier 95 for commercial telehealth claims, GT for Medicare
- 2024 Medicare reimbursement averages $129.62 nationally, commercial rates range $150-180
- Include clinical rationale for extended session time to support medical necessity
- Know your payer-specific rules to prevent denials before they happen
Streamline Your 90837 Billing with TheraFocus
Managing CPT codes, time tracking, and documentation requirements can consume hours of your week. TheraFocus practice management software automates session time tracking, generates compliant documentation, and streamlines the entire billing process so you can focus on what matters most: your clients.
Our built-in time tracking automatically captures session start and stop times, ensuring accurate code selection every time. Smart documentation templates include all required elements for 90837 billing, reducing denial rates and audit risk.
Ready to simplify your billing workflow? Discover how TheraFocus can help your practice run more efficiently while maintaining billing compliance.
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TheraFocus Team
Practice Management Experts
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.