A behavioral health group we work with added two therapists last year and, with them, a jump in 90837 claims. Nobody thought anything of it until a commercial payer sent a letter: the group's 90837 rate was 94 percent of all individual psychotherapy claims, against a network average the payer put near 50 percent, and the payer wanted 40 records. The records showed what we expected. Every session was scheduled for 50 minutes, every note said "50-minute session," and every claim said 90837. Not one of those visits met the 53-minute threshold.
That group was not padding anything. The therapists believed the "therapy hour" was an hour and that 90837 was the code for it. They had been billing that way at previous employers. The correction cost them a refund on the sampled claims, an extrapolated repayment demand they negotiated down, and six months of prepayment review on every psychotherapy claim.
This piece sets out the psychotherapy time thresholds for the timed codes, the add-on codes that go with an E/M visit, the crisis and family codes, what the note must say about time, and how to check your own utilization before a payer checks it for you.
Key takeaways
- Individual psychotherapy codes are chosen by documented face-to-face time: 90832 for 16 to 37 minutes, 90834 for 38 to 52 minutes and 90837 for 53 minutes or more; a 50-minute session is 90834.
- When a prescriber performs psychotherapy in the same visit as an E/M service, the add-on codes 90833, 90836 and 90838 use the same minute ranges, the E/M level is chosen by medical decision making only, and the psychotherapy time must be separate from the E/M work.
- Crisis psychotherapy (90839 and 90840), family therapy (90846 and 90847) and interactive complexity (90785) have their own rules and cannot be combined freely with the individual codes.
- Time must be documented as start and stop times or total minutes of psychotherapy, and a practice whose 90837 share is far above its peers should expect a records request.
The minute ranges for individual psychotherapy
CPT defines three individual psychotherapy codes by typical time: 90832 for 30 minutes, 90834 for 45 minutes and 90837 for 60 minutes. Because real sessions do not land on those numbers, CPT's time rule applies: a code is reported when the midpoint between it and the next code is passed. That produces the ranges every behavioral health biller should know by heart.
| Code | Descriptor | Minutes of psychotherapy | Add-on version with E/M |
|---|---|---|---|
| Not reportable | Psychotherapy under 16 minutes | 0 to 15 | Not reportable |
| 90832 | Psychotherapy, 30 minutes | 16 to 37 | 90833 |
| 90834 | Psychotherapy, 45 minutes | 38 to 52 | 90836 |
| 90837 | Psychotherapy, 60 minutes | 53 or more | 90838 |
| 90839 | Psychotherapy for crisis, first 60 minutes | 30 to 74 | Not applicable |
| 90840 | Crisis, each additional 30 minutes | 75 and beyond, per 30 | Not applicable |
| 90846 / 90847 | Family psychotherapy without / with patient, 50 minutes | 26 or more | Not applicable |
The time that counts is face-to-face psychotherapy time with the patient, or with family members when the family codes apply. It does not include the minutes the patient spends in the waiting room, the scheduling conversation at the end, the therapist's time writing the note afterward, or a phone call with the school the next day. A therapist who greets the patient at 2:00, begins therapeutic work at 2:04, ends at 2:52 and spends three minutes booking the next visit has 48 minutes of psychotherapy: 90834.
There is no ceiling on 90837. A 75-minute session is still 90837, and there is no add-on for extra individual psychotherapy time outside the crisis codes. A practice that runs genuine 60-minute sessions should bill 90837 and document the time; the code is not wrong, the undocumented 50-minute version of it is.
Psychotherapy with an E/M visit: the add-on codes
When a psychiatrist, psychiatric nurse practitioner or physician assistant sees a patient for medication management and also provides psychotherapy in the same visit, the visit is billed as an E/M code (99212 to 99215 for established patients) plus a psychotherapy add-on: 90833, 90836 or 90838, using the same minute ranges as the standalone codes. Three rules follow from that structure.
First, the E/M level is selected by medical decision making only. Time cannot be used to choose the E/M level when a psychotherapy add-on is billed, because the psychotherapy minutes would be counted twice. Second, the psychotherapy time must be distinct from the E/M work. The note needs to show medication review, assessment and plan as one part of the visit and a separately identifiable psychotherapy intervention with its own time as another. "Discussed medication side effects and coping strategies, 30 minutes" does not separate anything. Third, both services have to be medically necessary on their own; an add-on for a five-minute supportive conversation after a medication check is not psychotherapy under 16 minutes and is not reportable.
Here is a worked example. A psychiatric NP sees an established patient with major depressive disorder. She reviews the PHQ-9 score, adjusts sertraline from 100 to 150 mg and documents the decision, which supports a 99214 under moderate MDM (one chronic illness with progression, prescription drug management). She then provides 22 minutes of cognitive behavioral therapy focused on behavioral activation, documented with start and stop times and the intervention. The claim is 99214 plus 90833. If the therapy portion had run 40 minutes, the add-on would be 90836; the E/M level would not change.
Crisis, family and interactive complexity
Psychotherapy for crisis, 90839, is for an urgent assessment of a patient in high distress with a life-threatening or complex situation requiring immediate attention, and it includes the assessment, mobilization of resources and implementation of interventions to reduce the danger. It covers the first 30 to 74 minutes; 90840 is added for each additional 30 minutes beyond 74. It cannot be billed on the same day as 90832 through 90838 by the same provider. Reviewers look hard at 90839 because its payment is higher than 90837, so the note must describe the crisis, not just the length of the session.
Family psychotherapy codes are defined at 50 minutes with a 26-minute floor. 90847 is family therapy with the patient present; 90846 is without the patient, for example a session with the parents of an adolescent in treatment. The patient in both cases is the identified patient whose diagnosis supports the service, and the claim goes under that patient's name. Couples therapy without a diagnosed patient is generally not a covered service, which is a conversation for the front desk before the first session, not the billing office afterward.
Interactive complexity, 90785, is an add-on for sessions made harder by specific factors: maladaptive communication among participants that complicates delivery of care, caregiver emotions or behavior that interfere with the treatment plan, a sentinel event requiring mandated reporting with discussion of the event during the session, or the need for play equipment or other devices to communicate with a patient who cannot use ordinary language. It attaches to 90791, 90792, the individual codes, the E/M add-ons and group therapy, but not to the crisis codes. It is not for "the patient was difficult," and payers deny it when the note does not name the factor.
What the note has to show
Every timed psychotherapy note needs the time stated in a way a reviewer can verify: start and stop times of the psychotherapy, or total minutes with a statement that they are face-to-face psychotherapy minutes. Medicare contractors and most commercial payers ask for exactly this in their behavioral health documentation policies, and "50-minute session" written in a template header is what gets practices into the situation in our opening.
Beyond time, the note should record the diagnosis being treated, the therapeutic modality and specific interventions used, the patient's response, progress toward the goals in the treatment plan, and the plan for the next session. A treatment plan with measurable goals, reviewed and updated at intervals, sits behind every claim; payers ask for it in nearly every behavioral health records request. Cloned notes that repeat the same interventions and the same response week after week are the second most common finding after time, and the fix is a template that forces the therapist to write something specific in each field rather than accept the default. The documentation modules in our training courses use redacted real-world notes to show the difference.
Watching your own utilization
Payers profile behavioral health providers on the share of individual psychotherapy billed as 90837, and the profiles are simple enough to reproduce. Run a report by rendering provider for the past 12 months: count of 90832, 90834 and 90837, and the 90837 share. There is no correct number, but a provider at 90 percent or more will eventually be asked to prove it. A group where one clinician is at 45 percent and another at 95 percent with similar patients has a documentation and coding conversation to have internally before anyone else raises it.
Do the same for 90839 as a share of all sessions and for 90785 as a share of eligible codes. Then pull ten notes per provider and check that the documented minutes support the code on the claim. When they do not, correct the pattern going forward and talk to counsel about whether the past claims need a voluntary refund. Our coding audits for behavioral health groups start with exactly these three reports, because they predict the payer letters.
Questions we hear
Our therapists schedule 55-minute sessions. Is that 90837?
Only if the documented psychotherapy time is 53 minutes or more. A 55-minute appointment slot that includes greeting, settling in and scheduling the next visit often yields 48 to 50 minutes of therapy, which is 90834. Document the actual minutes and let the code follow.
Can a therapist bill 90837 for telehealth sessions?
Yes, with the same time rules. Medicare covers psychotherapy by audio-video telehealth to patients at home, and audio-only when the patient cannot or will not use video, with the appropriate place of service code and modifier. Congress has repeatedly postponed the requirement for a periodic in-person visit for mental health telehealth at home; check the current status before assuming it applies or does not.
Does the diagnostic evaluation have a time threshold?
No. 90791 (psychiatric diagnostic evaluation) and 90792 (with medical services) are not timed, although the note should still be thorough enough to justify a full evaluation. Most payers allow one per provider per episode of care and expect the treatment plan to come out of it.
What to do this week
- Run the 12-month code distribution report by provider for 90832, 90834, 90837, 90839 and 90785 and compute each provider's 90837 share.
- Pull ten notes per provider and check the documented psychotherapy minutes against the code billed.
- Replace any "50-minute session" template text with required start and stop time fields for psychotherapy.
- Add a separately labeled psychotherapy section with its own time to the note template for prescribers who bill E/M plus add-on codes.
- Schedule a one-hour session with clinicians on the minute ranges, using the table in this article, and put the table on the wall of the billing office.
