CPT 90837 represents an individual psychotherapy session lasting 53 or more. minutes. 1 In practice this is essentially a “60-minute” therapy session (the CPT descriptor is “Psychotherapy, 60 minutes with patient”). Use 90837 when the primary focus of the visit is face-to-face psychotherapy (no separate medical evaluation). If a psychiatric evaluation or medication management is the main focus, bill the appropriate E/M or pharmacologic code instead. (By contrast, 90834 is used for psychotherapy of 38–52 minutes. As CMS notes, always choose the code matching the actual therapy time (“53 or more minutes” for 90837). Report 90837 only once per encounter when it applies; sessions under 16 minutes are too short to bill a psychotherapy code at all. 2 Practically, 90837 is most often used when clinicians spend about an hour on in-depth therapy with a patient.
A wide range of licensed mental health providers can bill 90837. Under Medicare, eligible providers include psychiatrists (MD/DO), clinical psychologists, independently licensed psychologists, clinical social workers, marriage and family therapists (MFTs), mental health counselors (MHCs), psychiatric nurse practitioners, clinical nurse specialists, physician assistants, and, in certain cases, nurse-midwives and certified anesthetists (for testing). 3 State-licensed licensed professional counselors and other therapists generally bill through supervising physicians or under “incident-to” rules if allowed. In any case, the service must be within the provider’s scope of practice. Site of service: Psychotherapy codes like 90837 are payable in any outpatient setting (office, clinic, hospital outpatient, etc.) 3 This includes in-person and approved telehealth settings. Medicare explicitly notes no site-of-service restrictions for psychotherapy. 4 In small or private practice, providers must be properly credentialed with each payer; in larger organizations the facility bill and provider bill may both apply. But in all cases 90837 requires one-on-one, face-to-face time with the patient.
CPT 90837 is a time-based code. A session must total at least 53 minutes of face-to-face psychotherapy to qualify. (Most providers aim for about 50–60 minutes actual time.) You must document the exact time spent (either start/stop times or total minutes) in the record. Chart notes should clearly indicate when the therapy began and ended, and the total time, since CPT guidance and Medicare require this for time-based codes. The note should also justify the 60-minute duration through clinical detail. Include the patient’s chief issues, goals, interventions used (e.g. CBT, psychodynamic techniques), and patient progress or response. Document the medical necessity and rationale for a longer session. (If 90837 is billed but the patient is only present for part of that time, ensure you note the face-to-face portion versus any administrative or paperwork time.) In short, records must support both the selected ICD diagnosis and the extended duration of therapy. 2 Remember that psychotherapy notes are especially protected (HIPAA “psychotherapy notes”) – sensitive content can be maintained separately, but the insurance claim must still have enough documentation of treatment content.
Psychotherapy vs. E/M: Without E/M: If the encounter is purely psychotherapy (e.g. no medication management beyond incidental), bill 90837 by itself. With E/M: If you provide a significant medical evaluation or management service plus psychotherapy (for example, medication adjustment or medical decision-making is a co-focus), then bill a standard E/M code (new or established patient) plus the psychotherapy add-on code 90838. (CPT 90838 is an “add-on” for ≥53 min psychotherapy provided with a separate E/M service.) When billing E/M and 90838 on the same day, the documentation must show two distinct, substantial services. Medicare emphasizes that to report both E/M and psychotherapy, the services must be “significant and separately identifiable.” 4 Do not unbundle or double-bill: if psychotherapy is incidental to an E/M (i.e., brief counseling during a med visit), the correct code is the E/M itself (or pharmacologic code 90863) rather than adding 90838.
Duration Limits: CPT guidelines (and Medicare) warn that psychotherapy codes should reflect the actual time. Use the code that most closely matches the face-to-face time. (For example, 90834 for 38–52 min; 90837 for ≥53 min.) Don’t under-report by using a shorter code when the session is 60+ min, and do not bill 90837 for sessions less than 53 minutes. The CMS contractor guidance explicitly states “do not report psychotherapy of less than 16 minutes” and instructs choosing the code by time range. 2
Frequency of Billing: Each 90837 code represents one distinct therapy session. You may bill multiple therapy sessions on the same day only if they are truly separate encounters (for example, if you saw the patient twice on one day, or saw a family and then the patient individually with a significant break). Many payers, however, typically allow at most one unit of 90837 per day per patient. Check each payer policy – for instance, some Medicare Advantage plans require authorization for multiple 60-minute sessions on the same day, whereas Medicare FFS generally expects one psychotherapy session per day unless exceptional circumstances.
ICD-10 and Medical Necessity: Ensure the diagnosis code(s) support medical necessity for psychotherapy. Medicare’s guidance lists hundreds of psychiatric/neuro codes that support coverage of 90837. 2 A clear mental health diagnosis (e.g. major depression, anxiety disorder) must be documented. The progress note should make it clear why a 60-minute session is necessary (e.g. complex issues, intensive therapy goals) since longer sessions are assumed more resource-intensive.
Commercial Payer Rules: Most commercial insurers follow CPT definitions, but details can vary. Check for payer-specific edits: some payers require 90837 to be distinct from pharmacologic management codes, and may limit billing without pre-authorization. For example, UnitedHealthcare often requires prior authorization for 90837 (but not for 90834). Aetna’s provider guides list 90837 under covered telehealth therapy (see below). Always verify coverage and any carve-outs (age limits, plan exclusions, network requirements, etc.) with each carrier.
CPT 90837 is approved for telehealth by Medicare and most payers. For Medicare, 90837 is on the list of permanently covered telehealth services. 1 When billing 90837 as a telemedicine service, use Modifier 95 (or “GT” in some systems) to indicate a synchronous telehealth encounter. 5 Place of Service (POS) should reflect where the patient is located. CMS recommends using POS 02 for telehealth (non-home) or POS 10 if the patient is in their home. 5 Some final rules now allow billing with the POS that would have been used in-person, but always pair with the telehealth modifier. Audio-only visits: Medicare continues to allow audio-only psychotherapy (modifier 93) under certain conditions (e.g. patient has no video access) through at least 2024. 3 However, payers differ on audio-only coverage, so check their policies (many commercial plans expanded telehealth to include audio for behavioral health during COVID and may continue it).
Private insurers generally mirror Medicare’s telehealth approach. For example, Aetna’s telehealth code list explicitly includes 90837 as covered for televideo/audio sessions. 7 In practice, bill the same CPT code (90837) for a video session, add modifier 95 (per payer rules), and use the correct POS. Some states have telehealth parity laws requiring insurers to pay the same for virtual therapy as in-person. In summary, telehealth 90837 is widely reimbursed, but always verify if your payer requires any specific modifier or POS (e.g. some require POS 10 vs 02) or has additional telehealth rules.
90834 (Psychotherapy, 38–52 min) vs 90837 (53+ min): Use 90834 for sessions under 53 minutes. If you often run 45-minute sessions, 90834 is appropriate. Bump to 90837 only when the therapy is 53 minutes or longer. Medicare and CPT guidelines explicitly segment the codes by minute ranges. 2
90847 (Family psychotherapy with patient) and 90846 (family w/o patient): These are family therapy codes (each 50 minutes). They are not interchangeable with 90837. If the visit involves family members and the identified patient together (e.g. child with parents), use 90847. If family members meet without the patient, use 90846. 3 In both cases these are still 50-minute codes, not 60. By comparison, 90837 is strictly individual therapy.
90853 (Group therapy): This is used for therapy with multiple patients (45–60 min). It’s a separate code (group psychotherapy ~45-60 min). 9 Don’t use 90837 for group sessions.
Other codes: 90832 (16–37 min), 90833/36/38 (psychotherapy add-ons with E/M) all parallel the individual therapy codes. 90839/40 are for crisis intervention. Essentially, 90837 stands alone for one-on-one, extended therapy.
E/M Visits: As above, you may bill an E/M visit plus psychotherapy only if the requirements for both are met separately. In that case, use the appropriate E/M code with add-on 90838 (not 90837). If you only want to report psychotherapy (no independent E/M), use 90837 by itself. Remember that a distinct diagnosis is not required when billing E/M and psychotherapy together on the same day, 4 but your documentation must clearly separate the two services (e.g., separate subheadings, medical decision-making vs psychotherapy content).
Prolonged Services: Because 90837 is a time-based service, if a single psychotherapy session is very long, you may bill prolonged service codes. For example, Medicare allows adding a prolonged services code (e.g. CPT 99354/99355 for outpatient) when an individual psychotherapy session without E/M extends 90 minutes or longer. 2 (If you have both E/M and psychotherapy, prolonged codes generally do not apply.) Always check payer rules on prolonged services – Medicare’s guidance is clear, but private insurers may vary.
Interactive Complexity (90785): This is an add-on code for psychotherapy. Use 90785 alongside 90837 when communication factors complicate the session (e.g. involving an interpreter, child with guardian, or other barriers). CMS specifically allows 90785 with psychotherapy codes (including 90837) when such complexity is present. 2 It requires additional documentation (e.g. number of participants, difficulties managed). Note that 90785 must be billed in addition to the base code 90837 (you cannot report 90837 by itself to capture complexity).
EAP and Group: If the patient is in an Employee Assistance Program or other special program, use any required modifiers (e.g. Aetna’s “HJ” for EAP) per insurer rules – the underlying CPT remains 90837. Also, 90837 can be billed with 90792/90791 on separate days (initial evaluations), but not on the same day with 90839/40 (crisis) or 90791/92. 4
CPT 90837 is valued for its allowance of extended therapeutic time. For clinicians, it reimburses at a higher rate than shorter-session codes, compensating for the longer encounter. It enables therapists to provide thorough interventions in complex cases. For patients, a 60-minute session can allow deeper exploration of issues and reduce the need for multiple shorter visits. Using 90837 appropriately means scheduling real hour-long sessions and documenting their content, which can improve care without encountering coding denials (since 90837 already anticipates the extra time). In short, 90837 supports intensive therapy work: it is an efficient way to meet clinical needs and ensure fair payment for longer sessions.
Sources:
Telehealth.HHS.gov - Billing for telebehavioral health (Feb 2025) https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-behavioral-health/billing-for-telebehavioral-health
CMS - Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520) (Jan 2025) https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=57520&ver=33
CMS - MLN1986542 - Medicare & Mental Health Coverage (Jul 2024) https://www.cms.gov/files/document/mln1986542-medicare-mental-health-coverage.pdf
CMS - Billing and Coding: Psychiatry and Psychology Services (A57480) (Nov 2024) https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480
CMS - MM12982 - Medicare Physician Fee Schedule Final Rule Summary: CY 2023 (Nov 2022) https://www.cms.gov/files/document/mm12982-medicare-physician-fee-schedule-final-rule-summary-cy-2023.pdf
Telehealth.HHS.gov - Billing and coding Medicare Fee-for-Service claims (Feb 2025) https://telehealth.hhs.gov/providers/billing-and-reimbursement/billing-and-coding-medicare-fee-for-service-claims
Aetna - Approved Behavioral Health Telemedicine Services (May 2020) https://www.aetna.com/document-library/health-care-professionals/bh-televideo-service-codes-covid-19.pdf
Telehealth.HHS.gov - Billing for telehealth (Feb 2025) https://telehealth.hhs.gov/providers/billing-and-reimbursement
Telehealth.HHS.gov - Telehealth for older adults (Jan 2025) https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-older-adults/billing-telehealth
