CPT Codes for Psychotherapy: 90832, 90834, 90837, 90846, 90847

Standard psychotherapy sessions commonly use time-based codes, which are determined by the amount of time spent on therapy. For all time-based codes, the start and stop times indicated in your notes should reflect only the face-to-face time spent on therapy, not any of the administrative work related to the session, such as writing notes, scheduling future sessions, or collecting payment.

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Time-based psychotherapy codes

Understanding which code to use for different session lengths can be tricky due to highly-specific time ranges.

CPT Code: 90832

Description: Individual psychotherapy, 30 minutes

Session length: 16-37 minutes

CPT Code: 90834

Description: Individual psychotherapy, 45 minutes

Session length: 38-52 minutes

CPT Code: 90837

Description: Individual psychotherapy, 60 minutes

Session length: 53 minutes or longer

CPT Code: 90846

Description: Therapy without the client present

Session length: 50-minute session. The minimum duration is 26 minutes

CPT Code: 90847

Description: Conjoined therapy with the client present

Session length: 50-minute session. The minimum duration is 26 minutes

Two watchpoints when using these codes:

Claims can only include one time-based psychotherapy code (90832, 90834, or 90837). Claims including more than one of these time-based codes will automatically be denied.
Additionally, claims with 3 or more CPT codes generally require authorization from the insurance prior to submitting. Please confirm with the client's insurance beforehand.

Code 90837 and risk of audits

Frequent use of 90837 is a common trigger of insurance audits, as this is considered an “extended session." It’s up to the provider's discretion to determine if an extended session is medically necessary. However, providers should be aware that insurance payers expect documentation that supports the use of this code and demonstrates medical necessity, as payers will want to understand why 90837 was billed as opposed to a “standard” psychotherapy session, a 90834.

When billing 90837, providers should include detailed information in their progress notes such as:

The acuity of the client's symptoms and/or impairment on functioning
The specific interventions utilized to address these symptoms. Interventions utilized with this code are typically time-intensive, evidence-based modalities used to treat more acute diagnoses.
Connect the diagnoses with the treatment plan and the client's outlined goal or objective, with any barriers, by spending less time with the client. Show how a 90837 session contributes to achieving the overall treatment objectives or why shorter sessions are insufficient.
Show how the complexity of the client's condition or the specific treatment modality required necessitates the extended time, and how the session contributes significantly to achieving the overall treatment goals.

Examples:

"EMDR for acute symptoms of PTSD" would be an intervention, symptom acuity, and diagnosis for which an extended session would be medically indicated.
"Supportive therapy for mild depression associated with an adjustment disorder" is unlikely to meet the criteria that would indicate the level of medical necessity that would support the billing of an extended session.

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Disclaimer

This article is for informational purposes only, and is not intended as, and should not be relied upon as, legal, financial, medical, or consulting advice. It is ultimately your responsibility as a provider to maintain accurate and correct records for your services, and to ensure compliance with any applicable regulations. If you have questions or concerns, you should seek appropriate legal, financial, medical, and consulting advice.