Providing effective mental health care often requires longer sessions when patients present with trauma, crises, or multiple co-occurring conditions. CPT code 90837 was created for psychotherapy sessions lasting 60 minutes or more, allowing clinicians to bill appropriately for the extended time. However, without precise documentation, claims may face 90837 denials, reduced reimbursement, or payer scrutiny.
Unlike the standard 90834 (45–50 minutes), billing 90837 requires detailed justification of medical necessity. Proper documentation not only prevents denials but also protects your practice in audits. Partnering with a professional medical billing company or using expert telehealth billing services can help streamline compliance and reimbursement.
This guide explains how to bill CPT 90837 correctly, avoid denials, and secure timely payments.
Step 1: Match Session Time with Medical Necessity
To bill 90837, you must document at least 53 minutes of face-to-face time. Notes should clearly explain why the session required extra time—for example:
- Trauma-focused treatment
- Crisis stabilization
- Complex cases with multiple mental health concerns
By linking clinical need with session duration, you create a strong foundation for billing.
Step 2: Document Clearly and Completely
Comprehensive documentation is the key to preventing 90837 denials. Every note should include:
- Start & stop times (e.g., 10:05–11:12) or total minutes
- Clinical justification for extended time (e.g., crisis, severe anxiety, trauma therapy)
- Interventions applied (CBT, DBT, exposure therapy, safety planning, etc.)
- Patient progress and measurable outcomes
- Risk/safety statements if relevant
- Next session plan (focus areas or therapeutic goals)
Clear documentation strengthens your claim and ensures audit readiness.
Step 3: Follow Telehealth Billing Rules
With the rise of virtual care, telehealth billing services are essential for compliant 90837 claims. Always:
- Add Modifier 95 for telehealth services
- Use the correct place of service (POS) codes:
- POS 10 = patient’s home
- POS 02 = other telehealth locations
- POS 10 = patient’s home
- Confirm payer-specific rules, since Medicare covers 90837 telehealth through Sept 30, 2025, but commercial payers may vary
Step 4: Use Add-On Codes When Needed
Longer or complex sessions may require additional CPT codes:
- 99354 – Prolonged service (if over 90 minutes, depending on payer)
- 90838 – Psychotherapy with E/M services (instead of 90837 alone)
- 90785 – Interactive complexity (e.g., interpreters, children, or third-party involvement)
Using the right add-ons ensures complete reimbursement.
Step 5: Avoid Common Denial Triggers
Most 90837 denials occur due to:
- Missing or incomplete session time
- Identical times recorded across multiple notes
- Weak or vague medical necessity documentation
- Billing sessions under 53 minutes
- Telehealth coding errors (wrong modifier or POS)
- Frequent 90837 use without clinical justification
Step 6: Build a Streamlined Workflow
A strong workflow minimizes mistakes:
- EHR templates prompting for time, interventions, and patient progress
- Billing team training on CPT codes, modifiers, and telehealth rules
- Quarterly claim audits to ensure compliance
- Automated reminders for timely and complete documentation
Step 7: Be Ready for Reviews or Denials
Even with accurate billing, some payers may request clarification. In such cases:
- Submit detailed session notes with exact times and clinical need
- Provide a utilization narrative explaining frequent 90837 use
- Attach professional statements and relevant documentation for appeals
Step 8: Use a Final Pre-Submission Checklist
Before submitting your claim, double-check:
- Exact session time recorded
- Clear medical necessity documented
- Correct CPT, modifier, and POS codes
- Add-ons applied when needed
- Payer-specific rules followed
Example of Audit-Proof Documentation
- Date: 2025-06-12
- Start/End: 09:05–10:12 (67 minutes face-to-face)
- Diagnosis: F41.1 Generalized Anxiety Disorder
- Reason for extended time: Severe escalation of panic symptoms requiring stabilization and safety planning
- Interventions: Cognitive restructuring, exposure planning, guided breathing, 3-step safety plan
- Patient progress: Reported decreased anxiety (SUD 0/10), practiced coping skills in-session
- Safety: No imminent risk; safety plan reviewed
- Plan: Weekly 60-minute sessions ×4, daily breathing practice homework
- Billing: 90837, Modifier 95, POS 10 (telehealth)
Conclusion
Accurately billing CPT code 90837 requires more than tracking session time—it demands clear documentation of medical necessity, appropriate coding, and adherence to payer rules. By working with a professional medical billing company or outsourcing telehealth billing services, providers can minimize errors, prevent 90837 denials, and secure faster reimbursements.
FAQs
Q1. Can 90837 be billed for group therapy?
No, 90837 applies only to individual psychotherapy sessions.
Q2. Is parental involvement allowed in 90837 sessions?
Yes, if it is part of treatment and documented properly.
Q3. Can you bill 90837 with another psychotherapy code on the same day?
No, overlapping psychotherapy codes for the same patient on the same day are not allowed.
Read detailed blog:CPT Code 90837: How to Bill 60-Minute Psychotherapy Sessions Without Denials
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