90837 CPT Code: Description, When & How to Use, Common Mistakes
Guide
As a psychotherapist, understanding and correctly using CPT codes is crucial for your practice's financial health and ethical standing. This guide focuses on therapy CPT code 90837, a key billing code for mental health billing. For a comprehensive guide to all CPT codes with cheat sheet and examples, refer here.
1. What is CPT Code 90837?
CPT Code 90837 is used for billing individual psychotherapy sessions lasting 53 minutes or more. This code is part of the Current Procedural Terminology (CPT) system, which is maintained by the American Medical Association (AMA) as mental health billing guidelines.
The 90837 code can be used for any general psychotherapy session, and also covers a variety of therapeutic interventions, including but not limited to:
Cognitive Behavioral Therapy (CBT)
Interpersonal Therapy (IPT)
Dialectical Behavior Therapy (DBT)
Mindfulness-based therapies
Psychodynamic therapy
Eye Movement Desensitization and Reprocessing (EMDR)
Solution-Focused Brief Therapy (SFBT)
90837 is not restricted to a single type of therapy but can be used for any individual psychotherapy session meeting the time criteria. The focus is on the duration and nature of the service rather than the specific therapeutic approach used.
2. Time Requirements for 90837
To bill using CPT code 90837, your session must last at least 53 minutes. Here are key points to remember:
The 53-minute minimum is for face-to-face psychotherapy time only.
Time spent on documentation, scheduling, or other non-therapy activities doesn't count towards the 53 minutes.
The upper limit for 90837 is typically considered to be around 89 minutes. For sessions lasting 90 minutes or more, consider using add-on codes or consulting with a billing specialist.
Accurate time tracking is crucial. Consider using a timer during sessions to ensure precision.
It's worth noting the differences between 90837 and related codes:
90834 is used for 45-minute sessions (38-52 minutes)
90832 is used for 30-minute sessions (16-37 minutes)
Choosing the correct code based on session duration is essential for ethical billing practices and avoiding potential audits.
3. When to Use 90837
Use therapy CPT code 90837 for in-depth, individual psychotherapy sessions. Appropriate scenarios include:
Discussing a client's history or background in detail
Managing a crisis or emergency
Administering psychological testing
Reviewing treatment plans or progress thoroughly
Conducting intensive trauma-focused therapy sessions
Addressing complex or multiple mental health issues in a single session
Remember, 90837 is for individual therapy. Use different codes for group or family therapy sessions.
5. Maximizing Reimbursement with 90837
Mental health billing doesn't have to be painful. To maximize reimbursement:
Verify insurance plan coverage before beginning treatment
Ensure your documentation supports the use of 90837 (or use an AI note tool like Supanote.ai that can do that for you)
Stay updated on insurance policies regarding 90837
Consider the impact on your overall practice revenue
Build relationships with insurance providers
Regularly review and update your fee schedules
Remember, while 90837 often has higher reimbursement rates, it's crucial to use it appropriately and ethically. Overuse of this code can trigger audits and potentially harm your professional reputation. This article mentions average reimbursement rates by CPT codes and location.
Negotiating with Insurance Companies
When negotiating contracts with insurance companies, consider the following:
Demonstrate the value of longer sessions for certain conditions or treatments.
Provide data on improved outcomes or reduced overall treatment duration when using longer sessions.
Be prepared to justify your use of 90837 with clear documentation and treatment plans.
4. Common Mistakes to Avoid
Avoid these common pitfalls when using CPT code 90837:
Billing for sessions shorter than 53 minutes
Insufficient documentation of medical necessity
Overuse of the code, which may trigger audits
Neglecting to update treatment plans regularly
Using 90837 for all sessions regardless of actual duration
Failing to obtain proper consent for longer sessions
Not discussing potential higher copayments with clients
5. Limitations of 90837
Be aware of these limitations:
Some insurance plans may limit the number of 90837 sessions
Medicare typically allows up to 36 sessions annually
You can generally bill no more than four units daily and 22 units within seven days
Some insurers may require pre-authorization for extended sessions
Clients may have higher copayments for 90837 compared to shorter session codes
Always verify specific limitations with each insurance plan/ provider. It's also crucial to discuss any potential limitations or additional costs with your clients before using this code.
6. Documentation Essentials for 90837
Proper documentation is critical when billing therapy CPT code 90837.
Your session notes should include:
Start and end times of the actual therapy session
Issues, topics, and goals addressed
Specific interventions, tests, or assessments used (use a standard SOAP or other template)
The client's response to the session
Plans for follow-up or next steps
Justification for the extended session length
Any risk assessments conducted
Updates to the treatment plan
The best way to do this is use one of several AI note tools (incl. Supanote.ai) - they write your notes and ensure they are compliant, and take care of the above for you so you don't have to worry about being audited ever.
Additionally, do ensure your documentation clearly demonstrates the medical necessity for the extended session time. This might include:
Complexity of the client's presentation
Severity of symptoms
Need for intensive intervention
Progress towards treatment goals
Remember, your notes should tell the story of why this particular session required more time and how it contributes to the client's overall treatment plan.
7. Common CPT Codes in Psychotherapy
While this guide focuses on 90837, it's important to understand other commonly used CPT codes in psychotherapy. This knowledge will help you choose the most appropriate code for each session and situation.
90832 - Psychotherapy, 30 minutes
Use for sessions 16-37 minutes long
Typically used for brief, focused interventions
Case Study: Sarah, a college student, comes in for help managing test anxiety. You spend 30 minutes teaching her quick relaxation techniques and creating a study schedule. This focused, 30 minute individual therapy intervention is appropriate for the 90832 code.
90834 - Psychotherapy, 45 minutes
Use for sessions 38-52 minutes long
The most commonly used psychotherapy code (see here for a detailed primer on using 90834)
Case Study: John, dealing with mild depression, attends weekly 45-minute sessions. You use CBT techniques to help him challenge negative thoughts and develop coping strategies. These standard-length 45 minute individual therapy sessions are typically billed under 90834.
90837 - Psychotherapy, 60 minutes
Use for sessions 53 minutes or longer
Appropriate for more complex cases or intensive interventions
Case Study: Maria, who has complex PTSD, requires longer sessions to process trauma using EMDR. Your sessions are typically run 60-75 minutes, making 90837 the appropriate code.
90791 - Psychiatric diagnostic evaluation
Use for initial assessments without medical services
Typically used by non-medical mental health providers
Case Study: You conduct an initial 90-minute session with new client Alex, gathering history, assessing symptoms, and formulating a preliminary diagnosis and treatment plan. This comprehensive evaluation session would be billed under 90791.
90792 - Psychiatric diagnostic evaluation with medical services
Similar to 90791, but includes medical services
Typically used by psychiatrists or other medical professionals
Case Study: Dr. Lee, a psychiatrist, conducts an initial evaluation of a patient with suspected bipolar disorder. The 75-minute session includes a detailed history, mental status exam, and discussion of potential medication options. This would be billed under 90792.
90853 - Group psychotherapy
Use for group therapy sessions, regardless of length
One unit per patient, per group session
Case Study: You run a weekly anxiety management group with 8 participants. Each 90-minute session is billed as one unit of 90853 per participant.
90846 - Family psychotherapy without patient present
Use for sessions with family members when the identified patient is not present
Case Study: You meet with the parents of a teenage client to discuss family dynamics and parenting strategies. This 50-minute session without the teen present would be billed as 90846.
90847 - Family psychotherapy with patient present
Use for family therapy sessions where the identified patient is present
Case Study: You conduct a 60-minute family therapy session with a child and their parents, addressing communication issues. This would be billed under 90847.
8. Choosing the Right Code: A Comparative Case Study
Let's consider a therapist, Dr. Taylor, working with a client, Emily, throughout different stages of treatment:
Initial Session: Dr. Taylor conducts a 75-minute initial assessment with Emily, who presents with symptoms of anxiety and depression. Dr. Taylor gathers Emily's history, assesses her current symptoms, and develops a preliminary treatment plan.
Appropriate Code: 90791 (Psychiatric diagnostic evaluation)
Regular Sessions: For the next few weeks, Dr. Taylor sees Emily for 45 minute individual therapy sessions, using CBT techniques to address her anxiety and depression.
Appropriate Code: 90834 (Psychotherapy, 45 minutes)
Crisis Session: Emily experiences a panic attack and calls for an emergency session. Dr. Taylor sees her for a 60 minute individual therapy session, providing immediate support and adjusting her treatment plan.
Appropriate Code: 90837 (Psychotherapy, 60 minutes)
Family Session: Dr. Taylor invites Emily's partner to join a session to discuss how they can support Emily's treatment. This session lasts 50 minutes.
Appropriate Code: 90847 (Family psychotherapy with patient present)
Brief Check-in: Between regular sessions, Emily has a 20-minute phone consultation with Dr. Taylor to discuss medication side effects.
Appropriate Code: 90832 (Psychotherapy, 30 minutes)
Ongoing Treatment: As Emily's treatment progresses and her symptoms improve, Dr. Taylor transitions back to 45-minute sessions.
Appropriate Code: 90834 (Psychotherapy, 45 minutes)
This case study illustrates how a therapist might use different CPT codes throughout a client's treatment, depending on the nature and duration of each session. Always remember to document the rationale for using each code, especially when varying from your typical session length or type.
9. Impact on Your Practice
Proper use of 90837 can significantly impact your practice:
It can increase revenue when used appropriately
It allows for more in-depth sessions, potentially improving patient outcomes
Correct usage demonstrates professionalism and ethical practice
It can differentiate your practice, attracting clients who prefer or require longer sessions
It may lead to shorter overall treatment durations for some clients
However, be mindful of potential drawbacks:
Higher client copayments may affect attendance or retention
Some clients may find longer sessions overwhelming
It may reduce the total number of clients you can see in a day
10. Best Practices for Implementing 90837
To effectively implement 90837 in your practice:
Establish clear policies for session length and billing
Invest in reliable timekeeping methods
Use a good practice management software (see here for a comparison of top 12 EHRs for solo practice)
Regularly audit your billing practices
Stay updated on changes in billing codes and regulations
Provide thorough training to all staff involved in billing
Develop a system for tracking insurance authorizations and limits
Create templates for documentation that include all necessary elements for 90837
Implement a quality assurance process to review documentation regularly
Communicating with Clients
Clear communication with clients about session length and billing is crucial:
Discuss the potential benefits of longer sessions when appropriate
Explain any differences in copayments or out-of-pocket costs
Obtain informed consent for longer sessions and document it in the client's file
Regularly review the appropriateness of session length as treatment progresses
11. Frequently Asked Questions
Q: What exactly is the 90837 CPT code?
It's a billing code for individual psychotherapy sessions lasting 53 minutes or longer.
Q: What are the time requirements for 90837?
A: The session must last at least 53 minutes of face-to-face psychotherapy time.
Q: How often can I use the 90837 code?
A: You can use it as often as medically necessary, but be aware of insurance limitations.
Q: Are there any limitations to using 90837?
A: Yes, including insurance restrictions and daily/weekly billing limits.
Q: How does 90837 differ from other psychotherapy codes?
A: It's for longer sessions compared to 90834 (45 minutes) or 90832 (30 minutes).
Q: Can I use 90837 for telehealth sessions?
A: Generally, yes, but check with specific insurance providers for their telehealth policies.
Q: What if a session goes slightly over 52 minutes?
A: Use your clinical judgment. If the extra time was necessary and beneficial, 90837 may be appropriate. Document your reasoning clearly.
Q: Do I need special certification to use 90837?
A: No specific certification is required, but you must be licensed to provide psychotherapy in your state.
Q: Can a psychologist bill 99417 with 90837?
A: No, a psychologist cannot bill 99417 with 90837. Here's why:
Code Incompatibility: 90837 is a psychotherapy code for a 60-minute session (53+ minutes), while 99417 is an add-on code for prolonged office visits. These codes are not designed to be used together.
Different Code Sets: 90837 is part of the psychiatry section of CPT codes, while 99417 is from the evaluation and management (E/M) section. Psychologists typically don't use E/M codes.
Intended Use of 99417: The 99417 code is meant to be used with certain E/M codes (like 99205 or 99215) for physicians and qualified healthcare professionals who can bill E/M services. It's not intended for use with psychotherapy codes.
Proper Billing for Extended Sessions: If a psychotherapy session extends significantly beyond 60 minutes, the appropriate action is not to add 99417. Instead, consider the following options: a) If the session lasts up to 89 minutes, continue to bill only 90837. b) For sessions 90 minutes or longer, check with the specific payer. Some may allow billing two units of 90837, while others may require the use of different codes or have specific policies for extended sessions.
12. References and Additional Resources
Centers for Medicare & Medicaid Services: Mental Health Services
American Medical Association: CPT Code Set Information
Remember, while this guide provides a comprehensive overview of CPT code 90837, it's crucial to stay updated on the latest regulations and consult with billing specialists or professional associations for specific questions related to your practice. Continuing education in billing practices can be a valuable investment for any mental health professional in private practice.