If you are a mental health professional who bills insurance for therapy sessions, you have likely seen CPT code 90837 on your claim forms. Maybe you already use it every week. Or perhaps you are new to private practice and want to understand exactly when and how to bill this code.
You are not alone if you find the official language confusing. Many therapists ask the same questions:
- What is the exact description of 90837?
- How is it different from 90834 or 90832?
- Do all insurance companies pay the same rate?
- What happens if my session runs 52 minutes instead of 60?
This guide answers those questions and more. We break down everything you need to know about CPT code 90837 description, documentation requirements, common pitfalls, and best practices for reimbursement.
Let us start with the most important part: the official definition.
What Is the Official CPT Code 90837 Description?
The American Medical Association (AMA) manages the Current Procedural Terminology (CPT) code set. According to the official CPT manual, the description for 90837 is:
Psychotherapy, 60 minutes with patient and/or family member
This means you provide face-to-face psychotherapy services for a total duration of approximately 60 minutes. The code applies to individual therapy, but it can also include family members when clinically appropriate.
The code falls under the broader category of “psychotherapy” services. It does not include additional services like crisis intervention, testing, or medication management unless you report those separately with the correct codes and modifiers.
Key Elements of the Official Description
Let us look closely at three critical parts of the definition.
| Element | What It Means |
|---|---|
| Psychotherapy | A therapeutic process using established psychological techniques to treat mental, emotional, or behavioral disorders. |
| 60 minutes | Total face-to-face time with the patient. The typical range is 53–60 minutes. Some payors allow 52–60 minutes. |
| Patient and/or family member | You can include family members or other collaterals (like caregivers) without changing the code, as long as the primary focus remains the patient’s treatment. |
Important note: The 60 minutes refers to direct clinical contact. It does not include documentation time, administrative tasks, or waiting periods.
How 90837 Compares to Other Psychotherapy Codes
Many therapists ask: “Should I bill 90837 or 90834 for a 50-minute session?” The answer depends on time and medical necessity.
Here is a simple comparison table.
| CPT Code | Time (Typical Range) | Session Length | Common Use Case |
|---|---|---|---|
| 90832 | 30 minutes (16–37 min) | Short session | Check-ins, crisis follow-ups, patients with low acuity |
| 90834 | 45 minutes (38–52 min) | Standard session | Most common outpatient therapy session |
| 90837 | 60 minutes (53–60 min) | Extended session | Complex cases, trauma work, deeper processing |
Why 90834 Remains the Default for Many Providers
Even though 90837 pays more per session, most insurance plans expect 90834 as the standard for weekly outpatient therapy. Why? Because clinical guidelines suggest that 45 minutes is sufficient for many patients.
If you always bill 90837, you may trigger an audit. Payors may ask: “Is 60 minutes medically necessary for every single session?” You need a clear clinical answer.
Medical Necessity: The Real Key to Using 90837
Insurance companies do not pay based on time alone. They pay based on medical necessity. This is the single most important concept to understand.
Medical necessity means the service is:
- Required to treat a diagnosed condition
- Consistent with the patient’s symptoms and functional impairment
- Not just for convenience or patient preference
- Delivered at the appropriate length and frequency
For 90837, you must document why a 60-minute session is necessary. You cannot simply write “patient requested longer session” or “we needed extra time.”
Examples of Legitimate Medical Necessity for 90837
Here are clinical scenarios where 60 minutes makes sense.
- Complex trauma processing – The patient needs extended time to stabilize after a traumatic memory recall.
- Severe mood disorders – The patient requires more time to develop safety plans and coping strategies.
- Cognitive impairment – A brain injury or developmental disability slows the pace of therapy.
- Crisis de-escalation – The session includes significant time managing active suicidal ideation or self-harm urges.
- Family involvement – You spend 15–20 minutes with a family member explaining safety protocols without reducing individual therapy time.
Documentation Requirements for CPT Code 90837
Poor documentation is the number one reason for denied claims or clawbacks. Do not let this happen to you.
Your notes should answer three questions for the payor:
- What did you do? (specific therapeutic interventions)
- How long did it take? (start and stop times)
- Why was that length necessary? (clinical justification)
A Simple Documentation Template for 90837
Use this structure in your progress notes.
**Start time:** 2:00 PM **End time:** 3:00 PM **Total face-to-face time:** 60 minutes **Clinical justification for 60 minutes:** [Patient name] continues to experience severe anxiety with panic attacks occurring 3–4 times weekly. Today’s session required extended time to complete a trauma narrative intervention and teach two new grounding techniques. The patient needed repeated redirection due to dissociative symptoms, which slowed the pace of therapy. **Interventions provided:** - Cognitive restructuring (25 min) - Grounding skills training (15 min) - Safety planning related to self-harm urges (10 min) - Review of between-session exposures (10 min) **Patient response:** Patient tolerated the extended session well and demonstrated ability to use one new grounding skill independently before session end.
What Not to Write
Avoid these vague or risky statements:
- “Patient wanted to talk longer”
- “We had a lot to cover”
- “Therapist prefers 60-minute sessions”
- No time justification at all
Payor Policies: Who Pays for 90837 and Who Does Not?
This section saves you money and stress. Not every insurance company treats 90837 the same way.
Medicare
Medicare covers psychotherapy under Part B. Their official policy for 90837 includes:
- Reimbursement for 60 minutes (53–60 minutes face-to-face)
- Requires an active treatment plan
- Must be medically necessary
- No prior authorization for most outpatient settings, but always verify
Medicare does not reimburse 90837 for maintenance therapy (services to prevent decline without functional improvement).
Commercial Insurance Plans
Policies vary widely. Here is a general guide.
| Payor Type | Typical Stance on 90837 | Notes |
|---|---|---|
| Aetna | Covered with medical necessity | May audit frequent use |
| Anthem (Blue Cross) | Often requires prior authorization after a set number of sessions | Check local plan |
| Cigna | Covered | Expects clear time documentation |
| UnitedHealthcare | Covered but subject to clinical review | High use may trigger a records request |
| Optum | Covered | Similar to UnitedHealthcare |
| Kaiser Permanente | Varies by region | Many plans prefer 90834 |
| Medicaid (state dependent) | Often covered but lower reimbursement rate | Some states limit to 90834 |
Always verify individual patient benefits before billing 90837. Do not assume coverage.
Payors That Often Restrict 90837
Some payors explicitly limit 90837. They may:
- Require prior authorization for sessions over 45 minutes
- Cap the number of 60-minute sessions per year (e.g., 12 sessions)
- Deny 90837 for certain diagnoses (e.g., adjustment disorders, mild anxiety)
- Downgrade 90837 to 90834 automatically
Real example: One major Blue Cross plan in Texas pays 90837 only for patients with a GAF score below 50 or a serious mental illness diagnosis like bipolar I or schizophrenia.
Billing Rules and Time Boundaries
The AMA provides guidelines for time-based codes. Here is what you need to know.
The “Rule of Eights” for Psychotherapy Codes
Many billers follow a simple rule: the midpoint rule.
- For 90837 (60 min), the midpoint is 60 minutes.
- The typical allowable range is 53–60 minutes.
- Some payors accept 52–60 minutes.
If your session is less than 53 minutes, you should generally bill 90834 (45 minutes) instead.
If your session is more than 60 minutes (e.g., 75 minutes), you cannot bill two units of 90837. Instead, you use:
- 90837 for the first 60 minutes
- +99354 (prolonged service, 60–74 minutes) or +99355 (75+ minutes) – but note these codes are often denied in outpatient mental health
In practice, most outpatient therapists keep sessions within 53–60 minutes to avoid prolonged service code issues.
Can You Bill 90837 for Telehealth?
Yes, for most payors. Since the public health emergency (PHE) for COVID-19, telehealth parity rules expanded. However:
- Check if your state requires a telehealth modifier (e.g., 95 or GT)
- Some payors require place of service (POS) 02 for telehealth
- Medicare accepts 90837 via telehealth in many cases but verify current policies
Common Mistakes When Using CPT Code 90837
Avoid these errors to protect your revenue and compliance.
Mistake #1: Billing 90837 for Every Session
This is the fastest way to get audited. Insurance companies expect variation. If you see 30 patients this week and bill 90837 for 28 of them, that raises a red flag.
Mistake #2: Ignoring Time Documentation
You finish a 58-minute session. You note “60 minutes” in your billing system. But your note says “session length: 50 minutes.” That inconsistency will cause a denial or recoupment.
Always document actual start and stop times.
Mistake #3: Using 90837 for Low-Acuity Patients
A patient with mild grief after a pet loss may not need 60 minutes. Billing 90837 for low medical necessity is fraud, even if the patient is willing to stay longer.
Mistake #4: Not Checking Individual Payor Policies
A managed care plan may cover 90837, but an ERISA self-funded plan through the same insurance company may not. You must verify each policy.
Step-by-Step: How to Decide If 90837 Is Right for a Session
Follow this decision tree before you bill.
- What is the session’s total face-to-face time?
- Less than 53 minutes → Do not use 90837.
- 53 minutes or more → Consider 90837.
- Is the extended time medically necessary?
- Yes, due to clinical factors (trauma, severity, cognition, crisis) → Proceed.
- No, the patient just “likes long sessions” → Use 90834.
- Does the patient’s insurance plan cover 90837?
- Verify benefits. Do not assume.
- Do you have prior authorization if required?
- Some plans require it after the first 8 sessions.
- Is your documentation complete?
- Start/stop times + justification + interventions + response.
If you answer “no” to any of the above, reconsider using 90837.
Reimbursement Rates for 90837 (2024–2025 Estimates)
Rates vary by location, payor, and contract. Below are approximate ranges to help you set expectations.
| Payor Type | Average Reimbursement (60 min) |
|---|---|
| Medicare (2024 national average) | 90–110 |
| Medicaid | 60–85 |
| Blue Cross Blue Shield (commercial) | 100–150 |
| Aetna | 110–145 |
| Cigna | 95–135 |
| UnitedHealthcare | 105–140 |
| Out-of-network (patient responsible) | 150–250+ |
These are facility/professional fee amounts before any patient copay or deductible. Your actual payment may differ by +/- 30%.
What About Using 90837 with Other Codes?
Sometimes you provide additional services during the same visit. Here is what you should know.
90837 and 90833 (Psychotherapy with E/M)
You cannot bill 90837 and 90833 together. The 90833 code is for 30–44 minutes of therapy added to an evaluation and management (E/M) service. For a 60-minute session, use only 90837.
90837 and 90785 (Interactive Complexity)
You may add 90785 (interactive complexity) to 90837 when the patient has communication or behavioral difficulties that require extra provider effort. Examples include:
- Patient with severe autism who needs gestural communication
- Patient who is aggressive or disruptive during session
- Use of a translator for a patient with selective mutism
This add-on code increases reimbursement slightly.
90837 and Crisis Codes (90839, 90840)
Crisis codes are for urgent situations requiring 30+ minutes of intervention. Generally, you do not bill 90837 on the same day as a crisis code unless the crisis ends and a distinct psychotherapy session begins. Most payors bundle them.
Documentation Examples for 90837: Before and After
Let us look at real documentation differences.
Weak Note (Likely Denied)
“Met with patient for 60 minutes. Discussed anxiety symptoms. Patient reports some improvement. Will continue to meet weekly.”
Why this fails: No time justification. No specific interventions. No medical necessity.
Strong Note (Appropriate for 90837)
Session time: 9:00 AM – 10:00 AM (60 minutes face-to-face)
Clinical justification for extended session: Patient diagnosed with PTSD (F43.10) with recurrent nightmares and hypervigilance. Today’s session included EMDR phase 4 processing of a traumatic memory. The patient experienced significant emotional dysregulation requiring 15 minutes of stabilization and grounding exercises before processing could resume. A 45-minute session would have been insufficient to complete the processing unit and establish a safe state before discharge.
Interventions: EMDR (bilateral stimulation, 25 min), grounding skills (15 min), safety check (10 min), psychoeducation on trauma responses (10 min).
Patient response: Patient reported decreased distress (SUDS 7 to 4) and demonstrated diaphragmatic breathing independently. No suicidal ideation at session end.
This note justifies the time, describes the work, and shows medical necessity.
Audit Risks and How to Reduce Them
Insurers and Medicare audit psychotherapy claims regularly. Common triggers include:
- Billing 90837 for more than 80% of sessions
- Large increase in 90837 use from one year to the next
- Notes that copy and paste the same justification every week
- No variation in session length
How to Protect Yourself
- Vary your codes – Use 90834 and 90832 when clinically appropriate.
- Write unique notes – Never copy-paste your justification.
- Track your metrics – Know your percentage of 90837 claims.
- Educate your team – If you employ other clinicians, train them.
- Keep a billing log – Note each payor’s specific rules.
Frequently Asked Questions (FAQ)
Q1: Can I bill 90837 for a 52-minute session?
Most payors accept 53–60 minutes. A 52-minute session is technically closer to 90834. Some payors allow a 2-minute grace period, but you take a risk. To be safe, aim for 53+ minutes or bill 90834.
Q2: Does 90837 include time writing notes?
No. Only face-to-face clinical contact.
Q3: Can I use 90837 for couples therapy?
It depends. If the focus is treating a diagnosed mental health condition for one identified patient, and a partner attends as a collateral, yes. If you are doing relationship counseling without a designated patient with a mental disorder, you should not bill 90837.
Q4: What happens if I accidentally bill 90837 but the session was 50 minutes?
If you discover the error before the claim is processed, correct it. If the claim paid incorrectly, you must return the overpayment or adjust the claim. Intentionally billing longer codes is fraud.
Q5: Does 90837 require a specific diagnosis?
No specific diagnosis is required, but the diagnosis must justify the length. For example, Z codes (e.g., Z63.0, relationship distress) rarely support 60 minutes.
Q6: Can I bill 90837 for a group therapy session?
No. Group therapy uses 90853.
Q7: How often can I bill 90837 for one patient?
There is no universal limit, but medical necessity must support each session. For many patients, weekly 60-minute sessions exceed their needs. Some payors cap 90837 to 1–2 times per week.
Q8: Does Medicare cover 90837 for telehealth in 2025?
Medicare telehealth policies change frequently. As of late 2024, many flexibilities remain but some have expired. Always check the latest CMS guidance.
Additional Resources for Therapists and Billers
For more in-depth information, visit the American Psychological Association’s (APA) practice management page on psychotherapy codes. They provide payor-specific updates and free webinars.
👉 APA Practice Organization – CPT Code 90837 Resource
(Note: Verify URL independently. The APA frequently updates their guidance.)
Final Tips for Long-Term Success with 90837
Do not treat 90837 as a “default” code. Treat it as a clinical tool for specific situations.
- Build good documentation habits now
- Check each payor’s policy every six months (they change)
- Join a local billing consultation group
- When in doubt, bill 90834 and document why 60 minutes was not necessary
Your goal is to provide excellent care, get paid fairly, and stay compliant. That balance is possible with clear knowledge and consistent practices.
Conclusion
CPT code 90837 describes a 60-minute psychotherapy session for an individual patient, with or without family members present. Proper use requires session times of at least 53 minutes, strong medical necessity, detailed documentation of start and stop times, and awareness of individual payor policies. By following the guidelines in this article, you can reduce denials, avoid audits, and ensure you receive appropriate reimbursement for extended therapeutic work.
Disclaimer: This article is for educational purposes only. It does not constitute legal or medical advice. Billing and coding rules change frequently. Always consult the current CPT manual, your payor contracts, and a qualified coding specialist before submitting claims.
