The 90837 CPT code is a specific medical billing code used for a 60-minute individual psychotherapy session.This code is essential for mental health professionals as it allows them to bill for extended therapy sessions, which are often necessary for in-depth therapeutic work. You should consider using the 90837 code when a session's duration is at least 53 minutes. This code is not just for a 60-minute session but for any session that lasts 53 minutes or longer.It is one of the most frequently used codes in mental health billing and is intended for services that are insight-oriented, behavior-modifying, supportive, or interactive.
The primary distinction between the 90837 and 90834 CPT codes is the duration of the psychotherapy session.The 90837 code is designated for sessions that are 53 minutes or longer, while the 90834 code is used for sessions that last between 38 and 52 minutes.This difference in time also translates to a difference in reimbursement, with the 90837 code typically yielding a higher payment to account for the extended service time.For instance, the reimbursement for a 90837 session can be $9 to $20 more than a 90834 session.
Accurate and thorough documentation is crucial when billing with the 90837 CPT code to avoid claim denials.Your documentation should clearly state the start and end times of the session to justify the use of the 60-minute code.It's also important to document the content of the session, including the therapeutic interventions used, the patient's progress, and any updates to the treatment plan.For Medicare, specifically, there are additional services that can be included when billing for 90837, such as teaching grooming skills, monitoring activities of daily living (ADL), recreational therapy, and social interaction.
The 90837 CPT code is defined as a 60-minute psychotherapy session; however, the American Medical Association (AMA) allows for some flexibility. To properly bill for this code, the session must last a minimum of 53 minutes.Any session that extends beyond this 53-minute mark can be billed using the 90837 code.It is imperative to accurately record the duration of each session to ensure compliance and proper reimbursement.
Reimbursement rates for the 90837 CPT code can vary depending on the payer, your geographic location, and your credentials.However, due to the extended session length, the 90837 code generally has a higher reimbursement rate than shorter session codes like the 90834.For example, the 2025 Medicare reimbursement rate for 90837 is approximately $147.07.On average, you can expect to receive between $9 and $20 more for a 60-minute session compared to a 45-minute session.
To bill for services using the 90837 CPT code, you must be a licensed mental health provider.The specific licenses that are typically accepted include Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Marriage and Family Therapists (LMFT), Clinical Psychologists (PsyD or PhD), and Psychiatrists (MD).It is essential to ensure that your license is active and in good standing to be eligible for reimbursement.
For psychotherapy sessions that extend beyond the 60-minute mark, such as those required for exposure therapy, you should still use the 90837 CPT code.The CPT manual does not have a separate code for sessions longer than 60 minutes.Therefore, regardless of whether the session is 60 minutes or 90 minutes, the billing will be based on the 90837 code, and the reimbursement will be the amount associated with that code.
Insurance companies and Medicare may have policies that limit the frequency with which you can bill for the 90837 CPT code compared to the 45-minute 90834 code.These limitations are often outlined in the Local Coverage Determinations (LCDs) issued by Medicare Administrative Contractors (MACs) and in the coverage policies of private insurance plans. It is advisable to check the websites of your specific MAC and the private insurance plans you work with to understand their policies on the utilization of psychotherapy codes.
The 90837 CPT code is intended for individual psychotherapy sessions.While family members may be present occasionally, the focus of the service must be on the individual patient.If the primary focus of the therapy is the family unit, then the family psychotherapy codes (90846 and 90847) should be used instead.
To minimize the risk of claim denials for the 90837 CPT code, it is crucial to have a solid understanding of the billing requirements and to maintain meticulous documentation.Ensure that your session notes accurately reflect the start and end times, the medical necessity of the extended session, and the specific therapeutic interventions provided.Denial rates for the 90837 code are relatively low, with Medicaid at 5.9% and Medicare at 4.12%, but proper documentation is key to keeping them that way.Consider exploring how AI scribes can help streamline your documentation process and ensure accuracy.
What is the minimum time required for billing a 90837 CPT code, and how does it differ from a 90834 session?
To bill using the 90837 CPT code, the psychotherapy session must last a minimum of 53 minutes. This code is designated for sessions that are considered 60 minutes in length. The key difference between the 90837 and the 90834 code is the time duration; the 90834 code is used for sessions that are between 38 and 52 minutes long. This time difference also results in a higher reimbursement rate for the 90837 code, making accurate time tracking essential for proper billing. Consider implementing tools that can help you accurately document session times to ensure you are billing correctly for these longer, more in-depth sessions.
What are the essential documentation requirements to avoid a 90837 CPT code denial?
To prevent claim denials when using the 90837 CPT code, your documentation must be thorough and specific. It is critical to record the exact start and end times of the session to justify the 53-minute minimum requirement. Your clinical notes should also detail the therapeutic interventions used, the patient's response to treatment, and how the session's content aligns with the overall treatment plan goals. For payers like Medicare, you may also need to document additional services provided, such as monitoring activities of daily living or social interaction. Explore how AI scribes can help you capture these details accurately and efficiently, strengthening your documentation against potential audits.
Can I use the 90837 CPT code for crisis intervention or other complex cases requiring more than 60 minutes?
Yes, the 90837 CPT code is the appropriate code to use for individual psychotherapy sessions that extend beyond 60 minutes, including those for crisis intervention, EMDR therapy, or complex trauma processing. The CPT manual does not offer a separate code for sessions longer than 60 minutes, so 90837 is used for any session lasting 53 minutes or more. It is crucial to document the clinical justification for the extended session length, outlining why the patient's specific needs required the additional time. Learn more about how to effectively document the medical necessity for these extended sessions to ensure proper reimbursement.