Guide
90834 vs 90837: Choosing the Right Psychotherapy Code (and the Add-On Codes)
90834 vs 90837 explained: time thresholds, documentation, 90837 audit scrutiny, and the 90833/90836/90838 add-on codes.
Code Selection
Time Is the Deciding Factor
When you provide individual psychotherapy, the code you bill is driven by one thing above all: the documented face-to-face time of the session. The most common decision is between 90834 and 90837, and getting it right matters for both compliance and reimbursement. Pick the code that matches the time you actually spent and documented, then make sure your note backs it up. This guide walks through the time thresholds, the documentation that supports each code, the add-on codes you use when therapy happens alongside medication management, and the diagnostic and group codes that round out the set. Throughout, remember that payer rules vary, so treat this as a framework, not a substitute for your specific contracts and local coverage policies.
The Thresholds
90832 vs 90834 vs 90837
The three time-based individual psychotherapy codes form a continuous ladder. There are no gaps and no overlaps between them, so every session length maps to exactly one code. You code to the documented time of face-to-face psychotherapy, not to a habit or a default. The table below shows the standard time ranges.
| Code | Time |
|---|---|
| 90832 | 16–37 minutes |
| 90834 | 38–52 minutes |
| 90837 | 53 minutes or more |
Only count time spent in face-to-face psychotherapy. Time spent on unrelated activities, documentation after the patient leaves, or non-psychotherapy services does not count toward the threshold. Time below 16 minutes is generally not separately reportable as a psychotherapy code.
Documentation
What Your Note Has to Show
The code is only as defensible as the documentation behind it. Two things have to be clear in every note: the time of the session and the medical necessity of the service. A clean note answers an auditor’s questions before they are asked. The cards below break down what reviewers look for.
Session Time
Record start and stop times, or the total face-to-face minutes. The documented time has to support the code you billed. “Approximately an hour” is weaker than a precise start and stop.
Medical Necessity
Tie the session to a covered diagnosis and explain why therapy is needed. The note should connect the patient’s condition to the treatment being provided, not just state a code.
Interventions and Response
Describe the therapeutic interventions you used and how the patient responded. Specific clinical detail demonstrates that real psychotherapy occurred during the documented time.
Plan
State the plan going forward, including next steps and any changes to the treatment approach. A forward-looking plan shows continuity of care and supports ongoing medical necessity.
Payer Scrutiny
Why 90837 Draws Extra Attention
Because 90837 represents the longest session and typically carries the highest reimbursement of the three, it attracts more payer scrutiny than 90834. That is not a reason to avoid it. If your session ran 53 minutes or more and you documented it well, 90837 is the correct code. The right response to scrutiny is strong documentation, not reflexive down-coding.
Down-coding a legitimate 53-minute session to 90834 is its own problem: it misrepresents the service you actually provided, just as up-coding does. The goal is accuracy in both directions. Bill the code that matches the documented time, and keep notes that would hold up if the claim is reviewed.
- Document precise start and stop times for longer sessions.
- Make the clinical rationale for a longer session explicit in the note.
- Never down-code a documented 90837 to “stay under the radar” — that misrepresents the service.
- Check each payer’s policy: some have specific extended-session or frequency rules, and a few require additional review for routine 90837 use.
Some payers maintain specific policies on extended sessions and on how often 90837 may be billed. Verify the rules in your individual payer contracts and local coverage determinations before assuming a code will be reimbursed.
Add-On Codes
Therapy Alongside Medication Management
When a prescriber provides both an evaluation and management (E/M) service and psychotherapy in the same visit — the common medication-management-plus-therapy encounter — the psychotherapy is reported with an add-on code rather than a standalone 90832/90834/90837. The add-on is billed in addition to the E/M code. Critically, you count only the time spent on psychotherapy, which must be separate and distinct from the time spent on the E/M service. The E/M is selected on its own merits; the psychotherapy add-on reflects only the therapy minutes.
| Add-On Code | Psychotherapy Time |
|---|---|
| 90833 | ~16–37 minutes |
| 90836 | ~38–52 minutes |
| 90838 | ~53 minutes or more |
The add-on time ranges mirror the standalone psychotherapy codes, but the time counted is only the psychotherapy portion of the visit — distinct from the E/M work. Document the two services separately so the split is clear. These codes are reported in addition to the appropriate E/M code, not on their own.
Related Codes
Diagnostic Evaluations and Group Therapy
Two diagnostic evaluation codes anchor the start of care, and the right one depends on whether medical services are part of the evaluation. A third code covers group psychotherapy. These often appear on the same fee schedule as the time-based codes above, so it helps to keep them straight.
- 90791 — Psychiatric diagnostic evaluation without medical services. Used by psychologists, clinical social workers, counselors, and other non-prescribing clinicians.
- 90792 — Psychiatric diagnostic evaluation with medical services. Used by PMHNPs, psychiatrists, and other physicians who can provide the medical component.
- 90853 — Group psychotherapy. Reported per participant for therapy delivered in a group setting.
If you want the broader picture of how these fit together with the rest of your encounters, our guide to behavioral health CPT codes maps the full set, and our overview of mental health billing covers how clean coding flows through to clean claims.
FAQ
Frequently asked questions
Can I bill 90837 for every session?
You can bill 90837 whenever the documented face-to-face psychotherapy time is 53 minutes or more and the service is medically necessary. There is no rule against using it routinely if your sessions genuinely run that long and your notes support it. That said, frequent 90837 billing can prompt payer review, and some payers have specific policies on extended sessions, so verify your contracts and keep precise time documentation.
What happens if a session falls right at 52 or 53 minutes?
The codes are designed without gaps or overlaps, so the boundary is clean: 38–52 minutes is 90834 and 53 minutes or more is 90837. Code to the documented time. If the note says 52 minutes, bill 90834; if it says 53, bill 90837. The honest answer is to document the actual time and let it select the code.
Do I count the whole appointment toward the time threshold?
No. Only face-to-face psychotherapy time counts. Time spent writing notes after the patient leaves, on administrative tasks, or on non-psychotherapy services is excluded. When therapy is paired with an E/M service, the psychotherapy add-on time must be distinct from the E/M time.
Is down-coding from 90837 to 90834 a safe way to avoid audits?
No. Down-coding a session that was documented as 53 minutes or more misrepresents the service you provided, just as up-coding does. Both are inaccurate. The better protection against audits is thorough documentation of time and medical necessity, not coding to a lower level to stay inconspicuous.
Which evaluation code should a nurse practitioner use, 90791 or 90792?
A PMHNP who provides medical services as part of the diagnostic evaluation generally uses 90792, the evaluation with medical services. 90791 is the evaluation without medical services, typically used by psychologists, social workers, and counselors who do not provide the medical component. Match the code to the services actually delivered and to scope of practice.
Not Sure Which Code Fits?
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