Mental health services are a critical component of modern healthcare, and accurate billing ensures providers are compensated fairly for their time and expertise. Among the most frequently used codes in psychotherapy is CPT Code 90837, which applies to sessions lasting 60 minutes or longer.
This comprehensive guide explores every aspect of cpt code 90837, including its definition, requirements, reimbursement rates, and medical necessity documentation. Whether you’re a mental health professional, biller, or healthcare administrator, this article provides in-depth insights to optimize billing accuracy and compliance.
CPT Code 90837
What Is CPT Code 90837?
CPT Code 90837 stands for:
“Psychotherapy, 60 minutes with patient and/or family member.”
It is used by licensed mental health professionals (psychologists, psychiatrists, licensed clinical social workers, etc.) to bill for extended therapy sessions. Unlike 90834 (45 minutes), 90837 covers sessions that run 53 minutes or longer, with the standard duration being 60 minutes.
Key Features of 90837
-
Applies to individual, family, or group psychotherapy
-
Requires face-to-face interaction (in-person or via telehealth)
-
Must meet medical necessity criteria
-
Reimbursement varies by payer (Medicare, Medicaid, private insurance)
CPT Code Description 90837
The American Medical Association (AMA) defines 90837 as:
“A therapeutic intervention conducted for 60 minutes or more, focusing on evaluating and treating mental health disorders through verbal and behavioral techniques.”
Common Therapeutic Approaches Covered Under 90837
✔ Cognitive Behavioral Therapy (CBT)
✔ Dialectical Behavior Therapy (DBT)
✔ Psychodynamic Therapy
✔ Trauma-Focused Therapy
✔ Solution-Focused Brief Therapy (SFBT)
Comparison: 90837 vs. Other Psychotherapy Codes
| CPT Code | Session Duration | Description |
|---|---|---|
| 90832 | 16-37 minutes | Individual psychotherapy (brief) |
| 90834 | 38-52 minutes | Individual psychotherapy (standard) |
| 90837 | 53+ minutes | Individual psychotherapy (extended) |
| 90846 | 50 minutes | Family therapy (without patient) |
90837 CPT Code Requirements
To bill 90837, providers must meet specific criteria:
1. Time Requirement
-
Minimum 53 minutes of therapy (though most insurers expect 60 minutes).
-
Time includes assessment, treatment planning, and intervention.
2. Documentation Requirements
-
Progress notes detailing therapeutic interventions
-
Diagnosis (ICD-10 code) justifying medical necessity
-
Start and end times of the session
3. Qualified Providers
-
Psychiatrists (MD/DO)
-
Psychologists (PhD/PsyD)
-
Licensed Clinical Social Workers (LCSW)
-
Licensed Professional Counselors (LPC)
-
Psychiatric Nurse Practitioners (PMHNP)
CPT 90837 Reimbursement Rate
Reimbursement for 90837 varies by payer, location, and provider credentials.
2024 Average Reimbursement Rates
| Payer | Average Rate (USD) |
|---|---|
| Medicare | $150 – $190 |
| Medicaid | $90 – $140 |
| Private Insurance | $120 – $250 |
Note: Rates fluctuate based on geographic adjustments and contract negotiations.
90837 Medical Necessity Statement
Insurance companies require proof of medical necessity to approve 90837. Key elements include:
-
Diagnosis (e.g., Major Depressive Disorder, PTSD)
-
Treatment Plan (goals, frequency, expected outcomes)
-
Clinical Justification (why 60+ minutes are needed)
Example Medical Necessity Statement:
*”Patient presents with severe PTSD and requires extended sessions due to complex trauma history. Standard 45-minute sessions are insufficient for processing traumatic memories and implementing grounding techniques.”*
CPT Code 90837 Telehealth Modifier
Since the COVID-19 pandemic, telehealth has become a permanent option for psychotherapy. When billing 90837 via telehealth, use:
-
Modifier 95 (Synchronous Telehealth)
-
Place of Service (POS) Code 02 (Telehealth)
Example: 90837-95 (Telehealth psychotherapy, 60+ minutes)
Medical Necessity for 90837
Insurers often scrutinize 90837 claims more than 90834 due to higher reimbursement. To avoid denials:
✅ Document session length clearly
✅ Link treatment to diagnosis
✅ Avoid routine use (only when clinically justified)
90837 Reimbursement Rate Medicaid
Medicaid reimbursement for 90837 is typically lower than Medicare or private insurance.
| State | Medicaid Rate (Approx.) |
|---|---|
| California | $110 – $130 |
| Texas | $90 – $110 |
| New York | $120 – $150 |
Providers should verify rates with their state Medicaid program.
Conclusion
CPT Code 90837 is essential for mental health professionals providing extended therapy. Proper documentation, adherence to time requirements, and medical necessity justification are crucial for reimbursement. Telehealth has expanded access, but modifiers like 95 must be used correctly. Understanding payer-specific rates (Medicare, Medicaid, private insurers) ensures financial sustainability for practices.
FAQs
1. Can I bill 90837 for a 50-minute session?
No, 90837 requires at least 53 minutes, but insurers typically expect 60 minutes.
2. Does Medicare cover 90837 via telehealth?
Yes, with modifier 95 and POS 02.
3. What if an insurer denies 90837?
Appeal with detailed notes proving medical necessity and session duration.
4. Can nurse practitioners bill 90837?
Yes, if licensed and within their scope of practice.
