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Psychotherapy codes are reported and billed according to specific timing and usage rules. Knowing these rules beforehand is essential to ensure correct coding, avoid billing errors, and understand which services can or cannot be claimed.
Key Points:
- Psychotherapy codes are time-based; report the code once the session reaches the midpoint of the defined time.
- Some codes can be billed separately, while others require a medication management service.
- There is no prolonged care code for psychotherapy. Codes 99354 and 99355 were deleted in 2023, and 99417 cannot be used in conjunction with psychotherapy.
- Psychotherapy is billed as one unit per day; multiple units for the same session are generally denied.
- Prolonged E/M codes cannot be reported by providers who do not have E/M services in their scope of practice (CPT® Assistant, July 2022).
Individual Psychotherapy Codes: 90832, +90833, 90834, +90836, 90837, +90838
There are two categories of individual psychotherapy codes.
- The first category includes codes used to report psychotherapy alone: 90832, 90834, and 90837. These codes are most commonly used by social workers, psychologists, and other behavioral health therapists. Psychiatrists, psychiatric nurse practitioners (NPs), and physician assistants (PAs) may also report these codes if medication management is not performed during the same visit. These codes are time-based and do not differentiate between various types of psychotherapy or therapy settings. They follow the CPT® midpoint rule, which requires that the session meet more than half of the minimum time described in the code. For example, if the code specifies 30 minutes, the service must last at least 16 minutes to be reported.
- The second category consists of add-on psychotherapy codes: +90833, +90836, and +90838. The plus sign indicates that these codes are added to an E/M service when psychotherapy is provided along with medication management on the same calendar day. Psychiatrists, psychiatric NPs, and psychiatric PAs bill these codes.
According to CPT®, psychotherapy is defined as:
“Psychotherapy is the treatment of mental illness and behavioral disturbances in which the physician or other qualified health care professional, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.”
Use these individual psychotherapy codes when the focus of the session is on the individual patient, even if a family member or significant other participates in part or all of the session. For interventions that target family relationships, family therapy codes should be used instead.
How to Document and Bill Individual Psychotherapy When It’s the Only Service
For individual psychotherapy provided as the sole service of the day, CPT® guidelines do not require recording start and stop times; only the total session time is needed. However, it is essential to verify your payer’s policies, as some payers may have specific requirements for start and stop times. Always document the actual time spent in the clinical note. When selecting the code for the visit, base it on the actual session duration, not the scheduled appointment time.
Individualized Treatment Plan and Psychotherapy Goals
To provide psychotherapy beyond a few sessions, most Medicare contractors and private payers require an individualized treatment plan. This plan should specify:
- The type of therapy
- The frequency of sessions
- The duration of services
- The anticipated goals
For Medicare, there must be an expectation that the patient will improve or avoid further deterioration or hospitalization for the service to be considered medically necessary. While Medicare fee-for-service does not limit the duration of treatment, managed care plans, including Medicare, Medicaid, and many private payers, may have coverage limits.
Payers require that treatment goals be reviewed periodically with the patient, progress be documented, and goals be updated as needed. Although “periodically” is not defined in CPT®, for long-term therapy, a quarterly update is generally considered reasonable.
Some payers may require pre-authorization for codes 90837 and 90838, which cover psychotherapy sessions of 60 minutes or longer.
Add-On Psychotherapy Codes (Used With Medication Management)
- +90833 – Psychotherapy time: 16–37 minutes
- +90836 – Psychotherapy time: 38–52 minutes
- +90838 – Psychotherapy time: 53 minutes or more
- May require pre-authorization
Stand-Alone Psychotherapy Codes
- 90832 – Psychotherapy time: 16–37 minutes
- 90834 – Psychotherapy time: 38–52 minutes
- 90837 – Psychotherapy time: 53 minutes or more
- May require pre-authorization
Psychotherapy Documentation Guidelines: Recording Time
Scenario
A therapist selects 90832 (Psychotherapy, 16–37 minutes) in the order set. Can the time description in the order be used as documentation of the session length?
Guidance:
No, this is not sufficient. The therapist must document the actual time spent in the psychotherapy session. Simply selecting the code in the order set, whether it indicates “30 minutes” or “16–37 minutes”, does not validate the time spent with the patient. Accurate documentation should reflect the real duration of the session, regardless of the code range.
Family and Group Therapy CPT® Codes
Group Therapy
Group psychotherapy is reported with CPT® code 90853. This is not a time-based code; one unit is reported for each group member. Sessions typically last 45–50 minutes, and some payers limit the group size to 12 participants. Documentation should include a summary of the group’s goals and purposes for the day, which can be the same for all participants, as well as a description of the individual patient’s interaction and participation in the session. Many payers also require the number of group members to be recorded in each patient’s chart.
Family Therapy
CPT® lists two family therapy codes. 90846 covers family psychotherapy without the patient present (50 minutes) and has a status indicator of restricted by Medicare, meaning coverage and payment are determined by individual payers. 90847 covers family psychotherapy with the patient present (50 minutes) and is an active code in the Medicare fee schedule. Documentation should note who attended the session, the interactions that occurred, and the nature of the psychotherapy.
Why Providers Trust MindCare for Psychotherapy Billing Excellence?
Psychotherapy billing requires precision, a deep understanding of mental health guidelines, and an awareness of payer-specific policies. Even minor documentation gaps can delay payments or trigger audits. MindCare offers specialized expertise in behavioral health billing, with a strong focus on psychotherapy services. We ensure that providers avoid costly errors while confidently meeting compliance standards.
At MindCare, we go beyond claim submission. Our dedicated mental health billing team supports psychiatrists, therapists, and behavioral health clinics with accurate, timely reimbursements. We stay ahead of policy updates so you don’t have to, helping your practice run smoothly and profitably. Trust MindCare to handle your billing, allowing you to focus on delivering high-quality patient care.