CPT 90834 vs 90837: how to choose the right psychotherapy code

For most therapy sessions, the choice between 90834 and 90837 comes down to one thing: how many minutes of psychotherapy you actually spent with the client. Get it right and the claim pays at the correct rate. Get it wrong, or fail to document the time, and you risk denials, downcoding or money taken back in an audit.

The time thresholds

Psychotherapy codes are based on face-to-face time with the patient and/or family member. Each code covers a range, not an exact number of minutes:

Code	Session length	Minutes that qualify
90832	30 minutes	16 to 37 minutes
90834	45 minutes	38 to 52 minutes
90837	60 minutes	53 minutes or more

So a 50-minute session is a 90834, not a 90837, even though it’s close to an hour. And a session of 15 minutes or less can’t be billed with these codes at all.

Why 90837 gets more scrutiny

90837 pays more than 90834, and some payers have flagged therapists who bill it for most of their sessions. That doesn’t mean you shouldn’t bill it. If the session ran 53 minutes or more, 90837 is the correct code. It does mean your documentation needs to hold up if a payer asks.

What your notes should show

• Start and stop times, or total psychotherapy time
• The interventions used and the client’s response
• How the session connects to the treatment plan and goals
• Why the length of session was clinically appropriate, especially if you bill 90837 often

Add-on codes for psychiatry visits

When a psychiatrist or psychiatric nurse practitioner provides psychotherapy in the same visit as medication management, the psychotherapy is billed with an add-on code next to the E/M code, not with 90834 or 90837. The add-ons follow similar time bands: 90833 (30 minutes), 90836 (45 minutes) and 90838 (60 minutes). The psychotherapy time must be separate from the time spent on the E/M service.

Telehealth sessions

The same time rules apply to telehealth. What changes is the place of service and sometimes a modifier: many payers want place of service 10 for a session where the patient is at home, or 02 when they’re elsewhere, and some still require modifier 95. These rules differ by payer and change often, so check each payer’s current telehealth policy rather than using one format for everyone.

Common mistakes that cause denials

• Billing by the scheduled slot instead of actual time. A 60-minute appointment that ran 48 minutes is a 90834.
• Missing time in the note, which leaves the code unsupported in an audit.
• Wrong telehealth place of service or modifier for that particular payer.
• Billing to the medical plan when behavioral health is carved out to a company such as Optum, Carelon or Magellan, which leads to a CO-109 denial.

Related: Mental health billing · Denial code lookup