CPT Code 90837: Psychotherapy, 60 Minutes

Learn how to utilize the 90837 CPT code effectively to maximize therapy session reimbursements. Read the article for practical insights and strategies.

Use Code

What is code 90837?

CPT Code 90837 is used for 60-minute individual psychotherapy sessions provided by a licensed mental health provider. This code is crucial for mental health providers offering extended sessions for patients with complex mental disorders. These therapy sessions are designed for thorough psychological assessment, therapeutic intervention, and treatment planning. The therapy may include evidence-based approaches such as cognitive-behavioral therapy (CBT), psychodynamic therapy, and dialectical behavior therapy (DBT).

CPT 90837 is typically utilized for patients with severe or intricate mental health diagnoses, including post-traumatic stress disorder (PTSD), generalized anxiety disorder, major depressive disorder, and personality disorders. It is particularly used for longer therapy sessions, requiring a more comprehensive and in-depth approach. The session's duration must meet the minimum time requirement of 53 minutes for this code to be billed correctly; any session shorter than 53 minutes should be billed under CPT 90834, which covers 45-minute psychotherapy sessions.

Adhering to insurance guidelines and ensuring that the session duration is documented accurately is essential in the mental health billing process. Mental health providers must be aware of insurance companies' prior authorization requirements to bill extended sessions like those coded under CPT 90837. Accurate and timely documentation of progress notes, including the patient's medical record, is crucial for correct billing practices and securing appropriate reimbursement.

When billing for CPT 90837, mental health practitioners must follow administrative tasks related to add-on codes and ensure that the billing practices align with the specific requirements outlined by insurance payers. The reimbursement rates for this code may vary depending on the insurance company and the patient's mental health diagnosis.

CPT code 90837 documentation requirements

To meet the documentation standards for CPT Code 90837, providers must ensure the following elements are thoroughly documented:

Patient’s primary diagnosis and symptoms: Clearly outline the patient's mental health diagnosis and specific symptoms that necessitate extended psychotherapy sessions.
Therapeutic modality used: Specify the techniques or modalities employed, such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), or psychoanalysis.
Duration of session: Document that the session duration meets the minimum requirement of 53 minutes.
Therapeutic goals and progress updates: Include detailed descriptions of the therapeutic goals, objectives, and any progress made during the session. This is essential for accurate billing and assessing the effectiveness of therapy.
Patient’s response to treatment: Record how the patient responded to the treatment, including any significant behavioral or emotional changes observed.
Medical necessity: Justify the need for prolonged psychotherapy based on the medical necessity of the extended session. This is vital for securing appropriate reimbursement from insurance companies and for complying with mental health billing standards.

CPT Code 90837 billing guidelines

By following the following billing guidelines, licensed clinical social workers and mental health professionals can ensure accurate billing and prevent issues with mental health insurance reimbursements.

Cannot be billed with E/M codes: CPT Code 90837 cannot be billed alongside Evaluation and Management (E/M) codes (e.g., 99213) unless modifier 25 is applied. This is essential to ensure that therapy services are distinguished adequately from others during billing.
Preauthorization requirements: Some insurers may require preauthorization for extended therapy sessions, particularly for patients receiving intensive psychotherapy services over a prolonged period. This is crucial for mental health professionals to ensure mental health insurance providers cover the extended sessions.
Telehealth compliance: Mental health professionals must ensure they comply with HIPAA regulations and use the appropriate place-of-service modifiers when billing for psychotherapy services provided via telehealth.
Medicare medical necessity: Medicare may require additional justification to demonstrate the medical necessity of frequent use of CPT Code 90837, particularly for patients not showing significant progress in their therapy services. Documentation of the need for prolonged therapy sessions is essential for ensuring reimbursement.

Other relevant CPT codes

These other CPT codes are essential for mental health professionals to ensure proper compensation and to avoid denied claims from insurance companies.

CPT code 90834: This code is for individual therapy sessions lasting about 45 minutes. It is one of the most common CPT codes for standard psychotherapy and provides accurate billing for a range of mental health concerns.
CPT code 90832: Used for shorter therapy sessions (30 minutes). This code is appropriate when the time spent with the client is shorter but still requires accurate coding for the services rendered.
CPT code 90847: Applied for family therapy where the patient is present. It is often used when family dynamics are involved in the patient's diagnostic evaluation and therapy sessions.
CPT code 90853: This code is for group psychotherapy. It is used when licensed professional counselors or clinical psychologists work with multiple clients in a group setting.

Frequently asked questions

Yes, CPT Code 90837 can be billed for telehealth services as long as it complies with HIPAA regulations and appropriate place-of-service modifiers are used.

Some insurance companies may require prior authorization for extended therapy sessions like CPT Code 90837, especially if used frequently.

To qualify for CPT Code 90837, the session must last at least 53 minutes.