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
For individual psychotherapy, one thing picks the code: the face-to-face time you documented. Most days you’re choosing between 90834 and 90837, and getting it wrong costs you in either direction, whether that’s money you earned and didn’t bill or a payer review you didn’t need. Bill the time you actually spent and wrote down. Then make sure the note backs it up. We’ll cover the time thresholds, what the note has to show for each code, the add-on codes for therapy done alongside medication management, and the diagnostic and group codes that often share a fee schedule with them. Payer rules vary, so use this as a framework and check it against your own contracts and local coverage policies.
The Thresholds
90832 Vs 90834 Vs 90837
The three time-based codes for individual psychotherapy form one continuous ladder. There are no gaps and no overlaps, so every session length lands on exactly one code. That means you code the face-to-face time you documented, not the code you usually pick or whatever the EHR template defaults to. The ranges are below.
| Code | Time |
|---|---|
| 90832 | 16 to 37 minutes |
| 90834 | 38 to 52 minutes |
| 90837 | 53 minutes or more |
Only face-to-face psychotherapy time counts. Notes you finish after the patient leaves don’t count toward the threshold, and neither does time on unrelated activities or on services that aren’t psychotherapy. Under 16 minutes, you generally can’t report a separate psychotherapy code at all.
Documentation
What Your Note Has To Show
A code is only as defensible as the note behind it. Every note has to make two things obvious to someone reading it months later: how long the session ran, and why the service was medically necessary. A clean note answers the auditor’s questions before anyone asks them. Here’s what reviewers look for.
Session Time
Write down start and stop times, or at least the total face-to-face minutes, because the time you record is what has to support the code you billed. “Approximately an hour” is weak support.
Medical Necessity
Tie the session to a covered diagnosis and say why therapy is needed. A code on its own doesn’t establish medical necessity. The note has to connect the patient’s condition to the treatment you gave, clearly enough that a reviewer can follow the thread without asking you.
Interventions And Response
Name the interventions you used and how the patient responded. Specific clinical detail is the proof that real psychotherapy happened during the documented time, and a note built from boilerplate can’t show that.
Plan
Close with the plan. Note the next steps and anything you’re changing in the treatment approach, since a forward-looking plan is what shows continuity of care and keeps supporting medical necessity for the sessions after this one.
Payer Scrutiny
Why 90837 Draws Extra Attention
90837 is the longest session and usually pays the most of the three, so payers look at it harder than they look at 90834. That’s not a reason to avoid it. If the session ran 53 minutes or more and the note shows it, 90837 is the correct code. Answer the scrutiny with strong documentation. Reflexive down-coding just hands back money you earned.
Down-coding a real 53-minute session to 90834 is its own problem, because it misrepresents the service you actually provided just as up-coding does, only in the other direction. Accuracy cuts both ways. Bill what the documented time supports and write every note as if that claim will get pulled for review.
- Precise start and stop times, especially on the longer sessions.
- The clinical reason a session ran long, written into the note where a reviewer will see it.
- Don’t down-code a documented 90837 to “stay under the radar.” That misrepresents the service too.
- Payer policy, checked payer by payer, because some have specific extended-session or frequency rules and a few require additional review for routine 90837 use.
Some payers keep specific policies on extended sessions and on how often you can bill 90837, so read your own contracts and the local coverage determinations before you assume a code will pay. Finding out from the denials costs a lot more.
Add-On Codes
Therapy Alongside Medication Management
When a prescriber does an evaluation and management (E/M) service and psychotherapy in the same visit, which is the usual med management plus therapy encounter, the therapy goes on an add-on code instead of a standalone 90832/90834/90837. The add-on is billed with the E/M code. Here’s the part that trips people up: you count only the psychotherapy minutes, and they have to be separate and distinct from the E/M time. You pick the E/M level on its own merits, and the add-on covers therapy minutes and nothing else.
| Add-On Code | Psychotherapy Time |
|---|---|
| 90833 | ~16 to 37 minutes |
| 90836 | ~38 to 52 minutes |
| 90838 | ~53 minutes or more |
The add-on ranges mirror the standalone codes. The difference is what you count, which is only the psychotherapy portion of the visit, kept distinct from the E/M work, so document the two services separately and make the split obvious to anyone reading the note. They’re billed with the appropriate E/M code, never on their own.
Related Codes
Diagnostic Evaluations And Group Therapy
Two diagnostic evaluation codes cover the start of care, and which one you use depends on whether the evaluation includes medical services. A third covers group psychotherapy. All three often sit on the same fee schedule as the time-based codes, so it’s worth keeping 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.
For the bigger picture, our guide to behavioral health CPT codes maps the full set. Our overview of mental health billing picks up from there and follows clean coding through to claims that actually get paid.
FAQ
Frequently Asked Questions
Can I Bill 90837 For Every Session?
You can bill 90837 any time the documented face-to-face psychotherapy time is 53 minutes or more and the service is medically necessary. There’s no rule against using it routinely if your sessions really run that long and your notes support it. Expect some attention, though. Frequent 90837 billing can prompt payer review, and some payers have specific extended-session policies, so check your contracts and keep precise time documentation.
What Happens If A Session Falls Right At 52 Or 53 Minutes?
The codes have no gaps or overlaps, so the line is clean: 38 to 52 minutes is 90834, and 53 minutes or more is 90837. You code to the documented time. A note that says 52 minutes gets 90834 and one that says 53 gets 90837, so write down the time the session actually ran and let that pick the code.
Do I Count The Whole Appointment Toward The Time Threshold?
No. Only face-to-face psychotherapy time counts. Writing notes after the patient leaves doesn’t count, and neither do administrative tasks or services that aren’t psychotherapy. If therapy is paired with an E/M service, the psychotherapy add-on time has to 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 documented at 53 minutes or more misrepresents the service you provided, just as up-coding does, and it costs you the difference in reimbursement on every one of those claims. The real protection against audits is thorough documentation of time and medical necessity. Coding lower to stay inconspicuous isn’t protection.
Which Evaluation Code Should A Nurse Practitioner Use, 90791 Or 90792?
A PMHNP who provides medical services during the diagnostic evaluation generally bills 90792, the evaluation with medical services. 90791 is the version without them, and psychologists, social workers and counselors typically use it because they don’t provide the medical component. Match the code to what you actually delivered and to your scope of practice.
Next Step
Know What This Would Cost For Your Practice.
Every service has a published price and a written scope. If you are not sure which one fits, ask and you will be pointed at the right one.