Psytx w pt 60 minutes
CPT code 90837 covers a 60-minute psychotherapy session between a mental health provider and patient, focusing on treating mental health conditions through talk therapy. This is one of the most commonly billed codes for individual therapy sessions.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times in clinical notes. Medicare and most payers require minimum 53 minutes for 90837; 38-52 minutes downgrades to 90834, losing $19.73 per session.
Impact: Underdocumented time costs practices $19.73 per session if downgraded to 90834. Over 200 sessions annually, this equals $3,946 in lost revenue.
Bill non-facility rate ($154.29) when service is provided in freestanding office. Facility rate ($134.56) applies only in hospital outpatient departments, reducing payment by $19.73.
Impact: Incorrect place of service coding costs $19.73 per claim. Using POS 11 (office) versus POS 22 (hospital outpatient) determines which rate applies.
For telehealth sessions, verify patient location is in eligible area and use modifier 95. Post-PHE (Public Health Emergency), many states have geographic restrictions restored.
Impact: Missing modifier 95 on telehealth claims triggers automatic denials. Billing telehealth from non-covered location results in 100% denial with appeal difficulty.
Link to specific ICD-10 diagnosis codes demonstrating medical necessity. Vague codes like Z71.9 (counseling NOS) have higher denial rates than specific diagnoses like F33.1 (major depressive disorder, recurrent, moderate).
Impact: Specific diagnosis coding reduces denial rates by approximately 15-20%. Unspecified codes trigger medical review and payment delays.
Do not bill 90837 same day as E/M codes (99202-99215) without exceptional documentation. Most payers consider psychotherapy inclusive of evaluation services.
Impact: Same-day E/M with 90837 results in 85-100% denial rate without modifier 59 and crystal-clear documentation of separate medical necessity. Audit risk is extremely high.
Verify patient insurance covers licensed professional counselor (LPC) or licensed marriage family therapist (LMFT) services. Some Medicare Advantage and commercial plans restrict to PhD/PsyD/MD/LCSW only.
Impact: Credential verification prevents 100% denials. LPC/LMFT services denied by some payers become patient responsibility, creating collection issues and patient dissatisfaction.
Common denials
Time documentation insufficient or session duration below 53-minute threshold. Payer downcodes to 90834 (45-minute session) or denies entirely if time not documented.
How to appeal: Submit appeal with complete session note showing documented start/stop times totaling 53+ minutes. Include statement: 'Session met CPT time threshold of 53 minutes per AMA guidelines for 90837.' Highlight timestamp documentation in clinical note.
Medical necessity not established or diagnosis code does not support psychotherapy intensity. Payers deny when diagnosis appears too mild or resolved for ongoing therapy.
How to appeal: Provide clinical rationale for continued treatment at this intensity. Submit treatment plan showing specific symptoms, functional impairments, measurable goals, and progress documentation. Include clinical literature supporting therapy duration for specific diagnosis if available.
Frequency limits exceeded - many payers limit 90837 to specific number of sessions per calendar year or require prior authorization after threshold (commonly 20-30 sessions).
How to appeal: Submit prior authorization retroactively if possible, with clinical documentation showing ongoing medical necessity. Provide outcome measures (PHQ-9, GAD-7 scores) demonstrating continued need. Request peer-to-peer review with medical director to discuss clinical complexity.
Provider credential or supervision issues - claims denied when rendered by pre-licensed clinician without proper supervising provider NPI or when provider type is non-covered.
How to appeal: Resubmit claim with correct supervising provider information if applicable. If provider credential issue, verify enrollment status with payer and resubmit. For non-covered provider types, appeal is rarely successful; may need to write off or bill patient if they were notified via ABN.
Frequently asked questions
How many minutes is required for CPT code 90837?
CPT code 90837 requires a minimum of 53 minutes of direct face-to-face psychotherapy with the patient. The code represents a typical 60-minute session, but per AMA guidelines, billing is appropriate when time falls within the range of 53+ minutes. Sessions of 38-52 minutes should be billed as 90834 instead.
What is the Medicare reimbursement rate for 90837 in 2025?
The 2025 Medicare national average reimbursement for CPT 90837 is $154.29 for non-facility settings (private offices) and $134.56 for facility settings (hospital outpatient departments). Actual reimbursement varies by geographic location due to locality adjustments. These rates are based on the 2025 Medicare Physician Fee Schedule with a conversion factor of 32.3465.
Can I bill 90837 for telehealth sessions?
Yes, CPT 90837 can be billed for telehealth psychotherapy sessions when delivered via live, interactive audio-video technology. You must append modifier 95 (or GT, depending on payer) to indicate synchronous telehealth service delivery. The reimbursement rate is the same as in-person sessions at $154.29 for Medicare non-facility. Verify patient location eligibility and state licensure requirements for telehealth.
What is the difference between 90837 and 90834?
The difference is session length and reimbursement. CPT 90834 covers 38-52 minutes of psychotherapy (typical 45-minute session) while 90837 covers 53+ minutes (typical 60-minute session). Medicare pays $154.29 for 90837 versus approximately $134.56 for 90834 in non-facility settings, a difference of about $19.73. Accurate time documentation is essential to bill the correct code.
Do I need prior authorization for CPT code 90837?
Prior authorization requirements vary by payer. Medicare typically does not require prior authorization for 90837, but many Medicare Advantage and commercial insurance plans require authorization after a specific number of sessions (commonly 20-30 per year). Always verify authorization requirements with the specific payer before providing services to avoid denials.
Can I bill 90837 and an E/M code on the same day?
Generally no. Medicare and most commercial payers consider psychotherapy to include evaluation and management, making same-day billing inappropriate in most circumstances. The only exception is when a separately identifiable, medically necessary E/M service occurs (such as acute medical issue requiring distinct evaluation), which requires modifier 25 or 59 and exceptional documentation. This carries very high audit risk.
What diagnosis codes are appropriate for billing 90837?
CPT 90837 can be billed with any mental health diagnosis code from the F chapter of ICD-10 (mental, behavioral, and neurodevelopmental disorders). Common examples include F33.1 (major depressive disorder, recurrent), F41.1 (generalized anxiety disorder), F43.10 (PTSD), and F31.x (bipolar disorders). Use the most specific diagnosis code available and ensure the diagnosis supports the medical necessity for ongoing psychotherapy at this intensity level.