The 90837 CPT code reports individual psychotherapy of 53 minutes or more with the patient. CPT assigns 38 to 52 minutes to 90834 and 16 to 37 minutes to 90832. Most 90837 downcodes and denials come back to one gap: psychotherapy time that isn’t documented, or that doesn’t actually reach 53 minutes.
The 60-minute session is a staple for many therapists, which is exactly why it draws review. The fixes are unglamorous: a time statement in every note, a clear split between E/M and therapy time, and knowing which payer rules apply before the session is scheduled.
The three time thresholds
AAPC’s Knowledge Center (26 May 2023) lays out how CPT’s psychotherapy codes map to minutes:
| Minutes of psychotherapy | Code without E/M | Add-on code with E/M |
|---|---|---|
| Under 16 | Not reportable | Not reportable |
| 16 to 37 | 90832 | 90833 |
| 38 to 52 | 90834 | 90836 |
| 53 or more | 90837 | 90838 |
Two consequences follow. First, the clock is the patient’s time in psychotherapy, not the appointment slot. A “60-minute” slot that starts late and ends at minute 50 is a 90834. Second, the boundaries are hard. A note that says 52 minutes supports 90834, not 90837, however intensive the session was.
Why 90837 claims get downcoded or denied
No time in the note. This is the big one. When the HHS Office of Inspector General audited Medicare psychotherapy claims from March 2020 through February 2021 (report A-09-21-03021, 2 May 2023), 128 of 216 sampled enrollee days did not meet Medicare requirements, and undocumented psychotherapy time was one of the errors it named. OIG estimated $580 million in improper payments out of the roughly $1 billion Medicare paid for psychotherapy in that year. It recommended that CMS implement system edits for psychotherapy services and conduct medical reviews. A time-based code with no time can’t be defended on review.
Time documented, but not credibly. AAPC’s 2023 summary of the OIG findings says providers should document start and stop times or total time. Either can work. What doesn’t hold up is a template that stamps “60 minutes” on every note for every patient, or a total that doesn’t match the scheduling record. When the pattern looks automated, a reviewer can treat the time as unsupported.
Time that belongs to another service. When an E/M is billed at the same visit, AAPC’s 2023 summary of the OIG findings is explicit: time spent on the E/M cannot be counted toward the psychotherapy time, or the reverse. Crisis work is its own code family, covered below.
Payer rules on 60-minute sessions. Commercial and Medicaid plans write their own behavioral health policies, and some ask for authorization or clinical justification before paying extended sessions. Those rules live in each payer’s reimbursement policy and contract. Pull the policy for your top payers rather than assuming Medicare’s approach applies.
Code pairs that don’t go together. CMS’s Psychotherapy for Crisis page (last modified 25 February 2026) says not to bill the crisis codes, 90839 and 90840, with 90832, 90833, 90834, 90836, 90837 or 90838. A session that turns into a crisis is reported as crisis psychotherapy, not as 90837 with extra minutes.
Add-ons for prescribers: 90833, 90836, 90838
Practitioners who can bill E/M services, such as psychiatrists and psychiatric nurse practitioners, report psychotherapy performed at the same visit as an E/M with an add-on code: 90833, 90836 or 90838. AAPC’s Codify lay descriptions describe each as psychotherapy performed in addition to an evaluation and management service in the same session, using the same 16, 38 and 53-minute thresholds.
The rule that trips audits, per AAPC (1 March 2022): when a psychotherapy add-on is billed, choose the E/M level on medical decision making, not time, and document psychotherapy time that is exclusive to the psychotherapy. In practice, the note needs:
- An E/M section that supports the level on problems, data and risk.
- A separate psychotherapy section with its own minutes and the therapeutic interventions used.
- A total that doesn’t count the medication-management conversation twice.
A prescriber visit billed as a 99214 with 90838 needs 53 or more minutes of psychotherapy beyond the E/M work. If the note can’t show that, the add-on drops to 90836 or 90833.
Telehealth: modifiers, place of service and the Medicare rule
Psychotherapy codes are on Medicare’s telehealth list (CMS MLN1986542, March 2026). For Medicare:
- Place of service. CMS’s Telehealth & Remote Monitoring booklet (MLN901705, December 2025) tells professional billers to use POS 10 when the patient is at home and POS 02 when the patient is somewhere else. CMS’s Telehealth FAQ (updated 26 February 2026) adds that telehealth to a patient at home has been paid at the non-facility rate since 1 January 2024.
- Modifiers. For professional claims, the same MLN booklet identifies telehealth by POS 02 or POS 10; it lists modifier 95 only for institutional claims for outpatient therapy by hospital-employed physical, occupational and speech therapists. Audio-only is different: under the CY2025 PFS final rule (Federal Register 2024-25382, 89 FR 97760), Medicare requires modifier 93 on telehealth services furnished audio-only (FQ for RHCs and FQHCs). Many commercial and Medicaid plans also require modifier 95 (real-time audio-video) or modifier 93 (audio-only), as AAPC’s Codify defines them. Check each payer’s telehealth policy.
- Location and timing. The Consolidated Appropriations Act, 2021 permanently removed geographic and place-of-service restrictions for behavioral health telehealth, and audio-only is permitted (CMS Telehealth FAQ, Q11). Medicare’s in-person visit requirement for mental health telehealth takes effect after 31 December 2027, so it applies from 1 January 2028; patients already receiving mental health telehealth at home before then need an in-person visit every 12 months rather than one before the first telehealth visit (FAQ, Q5). General Medicare telehealth flexibilities run through 31 December 2027 (FAQ, Q1).
For the wider code set, see our guide to telehealth billing codes.
Documentation that survives an audit
Drawn from the OIG findings and AAPC’s audit guidance (1 March 2022; 26 May 2023):
- Psychotherapy time, either start and stop or total minutes, written by the clinician for this session.
- Separate E/M and psychotherapy time when an add-on is billed. E/M level on MDM.
- A treatment plan. AAPC notes that no single treatment-plan requirement applies in every jurisdiction, but MACs generally expect one covering the type, amount, frequency and duration of services, the diagnosis and goals, updated periodically.
- What was done: the therapeutic interventions and the patient’s response, not a copied paragraph.
- Modality and location: in person or telehealth, with POS and modifiers that match.
- A signature on every note. OIG counted missing signatures among the guidance errors.
A quick internal test: pull ten 90837 notes per clinician each quarter. If any fail items 1 or 6, fix the template before the next payer does it for you. For more on where behavioral health claims break down, see behavioral health billing challenges and fixes, and our resources library for coding quick-references.
If your 90837 claims keep coming back as 90834, or not at all, our mental health billing services team has been working these claims for practices since 1992.
