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Billing for behavioral health services can be tricky, especially when it comes to time-based psychotherapy codes. CPT 90837 represents extended individual therapy sessions lasting 53 minutes or more. These sessions are critical for patients requiring more in-depth therapeutic work; however, they are also prone to denials if not correctly documented.
This guide will help you understand the proper use of CPT 90837, provide realistic clinical scenarios, clarify documentation requirements, explain modifier usage, and outline reimbursement trends. By following these best practices, you can avoid unnecessary claim rejections and optimize your revenue cycle.
What is CPT Code 90837?
CPT 90837 is defined as:
“Psychotherapy, 60 minutes with patient and/or family member.”
This code should be used when a therapy session extends beyond the 53-minute threshold. It is primarily for individual therapy, but may include brief involvement of a family member when clinically appropriate.
These sessions usually involve deeper therapeutic interventions, such as trauma-focused therapy, cognitive-behavioral techniques, or complex emotional processing. It’s essential to note that this code is specifically for psychotherapy—it does not encompass medical evaluations, medication management, or physical examinations.
When Should You Bill CPT 90837?
Here are enhanced real-world scenarios where this code is correctly applied:
Trauma Recovery and Complex PTSD
A veteran struggling with post-traumatic stress disorder participates in a 60-minute session where the therapist uses trauma narrative exposure techniques and emotional regulation strategies. Due to the session’s depth and Complexity, CPT 90837 is the appropriate code.
Advanced Cognitive Behavioral Therapy for Anxiety Disorders
A patient with severe generalized anxiety undergoes intensive cognitive restructuring and behavioral experiments. The clinician dedicates over 55 minutes to identifying core fears and creating actionable coping strategies.
Chronic Depression Requiring Extended Processing
A client with long-standing major depressive disorder needs extended time for deep emotional work. The therapist uses interpersonal therapy to explore grief and unresolved issues, requiring a full hour of focused treatment.
Family Involvement in Adolescent Therapy
A teenager with social anxiety engages in a 50-minute individual session, followed by a brief 10-minute segment with parents for psychoeducation and support planning. The total session length exceeds 53 minutes, qualifying for 90837.
Telehealth for Rural Patients with Limited Access
A patient in a remote area connects with the therapist via secure video for a 60-minute teletherapy session addressing panic disorder. Telehealth-specific modifiers ensure proper billing.
These scenarios demonstrate that CPT 90837 should be reserved for longer, more complex sessions, rather than routine check-ins or brief follow-ups.
Important Documentation Guidelines
To bill 90837 correctly, your documentation must:
- Justify medical necessity (why a more extended session was needed)
- Include start and stop times or the total number of minutes
- Describe the specific therapeutic interventions used
- Note patient progress or lack of progress toward treatment goals
- Include any family involvement if applicable
Failing to document time or medical necessity is one of the biggest reasons for denials. Always ensure your notes explain why an extended session was required.
Modifier Usage for CPT 90837
- Modifier 95 – Indicates that the session was provided via telehealth
- Modifier GT – An alternative telehealth modifier required by some payers
- Modifier 59 – Used to indicate a distinct service provided on the same day as another
- Interactive Complexity (90785) – Add if there were communication barriers, high emotional intensity, or involvement of multiple participants
- Add-On Code 90838 – Used when psychotherapy is combined with an E/M service
Reimbursement Tips For CPT 9037
- Time Threshold: The session must be at least 53 minutes to qualify for 90837.
- Shorter Sessions: If therapy is 38–52 minutes, use CPT 90834. If 30 minutes, use CPT 90832.
- Extended Sessions: If therapy exceeds 90 minutes, you may need to add-on prolonged service codes, such as 99354.
- Telehealth: Most payers now reimburse teletherapy at the same rate as in-person sessions, but always confirm payer-specific requirements for modifiers and place-of-service codes.
Expected Payment Rates
- Medicare 2025 average reimbursement: around $150–$160 per session
- Private insurance: often reimburses 10–20% more for 45-minute sessions
- Financial Impact: High-volume providers using accurate 90837 billing strategies have reported revenue increases of up to 70% compared to using shorter-session codes
Why MindCare is the Right Choice for Behavioral Health Billing
Billing for extended psychotherapy sessions requires a specialized understanding of time-based codes, modifiers, and payer rules. Mistakes can lead to denials, audits, or reduced payments.
At MindCare, we go beyond basic billing:
- 85% fewer denials through meticulous claim scrubbing
- 40% faster reimbursements with payer-specific optimization
- Up to 70% revenue growth for practices that adopt our tailored strategies
- Complete compliance assurance, reducing audit risks
We handle the complexities of behavioral health billing so you can focus entirely on what matters most: delivering quality mental health care to your patients.
Let Mind Care Billing Help
We help mental health providers use the correct CPT codes, avoid denials, and get paid faster. If you're unsure which code to use, or tired of dealing with rejections, our team can take billing off your plate entirely.
Schedule a Free Consultation with Mind Care Billing today — and leave the coding confusion behind.
