Guide
90834 vs 90837: Choosing the Right Psychotherapy Code (and the Add-On Codes)
The session time you document picks the code: 90834 for 38 to 52 minutes, 90837 for 53 or more. This guide covers documentation, audit scrutiny and when 90833, 90836 or 90838 applies. If you want us to run your medical billing, Ongoing Billing covers that work.
Code Selection
Time Is The Deciding Factor
For individual psychotherapy, the documented face-to-face time picks the code. 90834 covers 38 to 52 minutes and 90837 covers 53 minutes or more, so a 53 minute session documented as such is a 90837. Get it wrong and it costs you either way, in unbilled money or an unneeded payer review.
The Thresholds
90832 Vs 90834 Vs 90837
The three time-based codes for individual psychotherapy form one continuous ladder with no gaps and no overlaps, so every session length lands on exactly one code. You code the face-to-face time you documented, not the code you usually pick or whatever the EHR template defaults to.
| 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 services that aren’t psychotherapy. Under 16 minutes, you generally can’t report a separate psychotherapy code.
Documentation
What Your Note Has To Show
A code is only as defensible as the note behind it. Every note has to show, 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.
Session Time
Write down start and stop times, or at least the total face-to-face minutes, because the recorded time 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 alone doesn’t establish medical necessity. The note has to connect the patient’s condition to the treatment you gave, clearly enough for a reviewer to follow.
Interventions And Response
Name the interventions and how the patient responded. Specific clinical detail proves real psychotherapy happened during the documented time. Boilerplate can’t.
Plan
Close with the plan. Note the next steps and any change in treatment approach, since a forward looking plan shows continuity of care and keeps supporting medical necessity for later sessions.
Payer Scrutiny
Why 90837 Draws Extra Attention
90837 is the longest session and usually pays the most of the three, so payers scrutinize it more than 90834. That’s no reason to avoid it. If the session ran 53 minutes or more and the note shows it, 90837 is the correct code. Answer scrutiny with strong documentation, because reflexive down-coding hands back money you earned.
Down-coding a real 53-minute session to 90834 misrepresents the service you provided just as up-coding does, only in the other direction. Bill what the documented time supports and write every note as if the claim will be pulled for review.
- Precise start and stop times, especially on longer sessions.
- The clinical reason a session ran long, written in 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 have specific policies on extended sessions and on how often you can bill 90837, so read your own contracts and the local coverage determinations before assuming a code will pay. Finding out from denials costs 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 (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.
The counting 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 only.
| 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. You count 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. 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, depending 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.
- 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.
Our guide to behavioral health CPT codes maps the full set, and our overview of mental health billing follows clean coding through to claims that get paid.
If your codes are right and claims still come back, we can take the billing on. We price Ongoing Billing by practice size, from 7% of collections with a $300 monthly minimum for a solo provider down to 4.5% at 26 to 50 providers (see medical billing prices by practice size).
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. No rule bars 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 records.
What Happens If A Session Falls Right At 52 Or 53 Minutes?
There aren’t any gaps or overlaps in the codes, 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 record the time the session ran.
Do I Count The Whole Appointment Toward The Time Threshold?
No. Only face-to-face psychotherapy time counts. Notes written after the patient leaves don’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, just as up-coding does, and it costs you the difference in reimbursement on each claim. The real protection is thorough documentation of time and medical necessity, not coding lower to stay inconspicuous.
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, which psychologists, social workers and counselors typically use because they don’t provide the medical component. Code what you delivered, within your scope of practice.
See Medical Billing And A/R Options
Ongoing medical billing is priced by practice size. Billing Cleanup And A/R Recovery is based on what we collect. Compare the work, price, and next step before you choose.