90837 vs 90834: Billing Therapy Time Without Audits

CPT 90834 is psychotherapy of 38 to 52 minutes. CPT 90837 is psychotherapy of 53 minutes or more. The code comes from the psychotherapy time documented in the note, not from the length of the appointment slot. A 50-minute session is a 90834, even when the calendar says it was an hour.

Medicare billing guidance spells this out. First Coast Service Options, the Medicare contractor for Florida, Puerto Rico and the U.S. Virgin Islands, says in its billing article A57520 that psychotherapy codes are time-based, that start and stop times or total time "must be documented" for 90832, 90834 and 90837, and that you "choose the code closest to the actual time." Missing time was also the most common problem in the HHS Inspector General's 2023 audit of Medicare psychotherapy claims, so the time in the note is where to start.

The time bands

Each psychotherapy code has a nominal time: 30 minutes for 90832, 45 for 90834 and 60 for 90837. The billing article gives the ranges that map to each one:

The bands follow from the "closest to the actual time" rule. 37.5 minutes is halfway between 30 and 45, so 38 minutes is closer to 45 and takes 90834. 52.5 is halfway between 45 and 60, so 53 minutes takes 90837. The same bands appear in the HHS Office of Inspector General's 2023 national audit of Medicare psychotherapy, which cites them from the AMA's CPT code set. The article is also direct about short sessions: "Do not report psychotherapy of less than 16 minutes duration."

What counts as psychotherapy time

The article sets three rules for the minutes:

• Face-to-face time with the patient. The patient must be present for all or some of the service.
• Start and stop times, or total time. Either is acceptable. "10:02 to 10:57" works. So does "55 minutes of psychotherapy". "Session held" does not.
• E/M time is not psychotherapy time. When a psychiatrist or other prescriber does an E/M visit and psychotherapy in the same encounter, the psychotherapy time is counted on its own, and the two services have to be separately identifiable in the note.

A booked hour is not an hour of psychotherapy. Time the patient spends on intake forms, checking in, or waiting isn't face-to-face psychotherapy. Time the clinician spends writing the note after the patient leaves isn't either.

Worked session examples

A few of these deserve a closer look.

The 50-minute hour

Many practices schedule a "therapy hour" of about 50 minutes. Coded by its minutes, that is a 90834. If a clinician's sessions do run 53 minutes or more, 90837 is correct, but each note has to show that session's own time. A note template that prints the same "60 minutes" on every visit proves nothing about any one of them.

Under-billing is an error too

The OIG audit found a provider that billed 90834 for a session whose note recorded 55 minutes of psychotherapy. The right code was 90837, so the provider had been paid at the lower code's rate. Code from the minutes, in both directions.

One session, one code, one unit

The same audit found a provider whose billing system had turned the minutes into units: one session was billed as 30 units of 90832. A psychotherapy session is reported once, with the code whose band the time falls in. Check how your practice management system builds the claim line.

Sessions of 90 minutes or more

The article lets a physician or other qualified health care professional add a prolonged service code to 90837 when the psychotherapy, not performed with an E/M service, is 90 minutes or longer with direct patient contact. Prolonged services can't be reported with the E/M add-ons 90833, 90836 or 90838. Confirm with each payer which prolonged service code it accepts.

The add-on codes

90833, 90836 and 90838: psychotherapy with an E/M visit

These are the add-on versions of 90832, 90834 and 90837, used when a prescriber does an E/M visit and psychotherapy in the same encounter. They use the same time bands, counted on the psychotherapy time alone. The OIG audit found claims where the note gave only the total time of the encounter, with no split between the E/M and the psychotherapy, and treated the psychotherapy as unsupported. Record the psychotherapy minutes separately.

90785: interactive complexity

90785 is an add-on for sessions where specific communication factors make the service harder to deliver. The article lists it with 90791 and 90792, with 90832, 90834 and 90837, with psychotherapy performed alongside an E/M service, and with group psychotherapy (90853). It should not be billed when the patient can't communicate by any means. When it's billed with a time-based code, the note must show the time spent on the interactive complexity.

The related coverage policy, LCD L33252, asks for the record to name the communication factor present. It lists four: managing maladaptive communication among participants; caregiver emotions or behaviors that interfere with the treatment plan; a sentinel event with a mandated report to a third party; or the use of play equipment, devices, an interpreter or a translator. The note must also describe the adaptations used in the session.

Why 90837 gets reviewed

90837 pays more than 90834, so it's the code where a wrong time costs the most, and Medicare has found the time is often missing. In its 2023 audit of the first year of the COVID-19 public health emergency, the OIG found that of 216 sampled patient days, 128 didn't meet Medicare requirements. It estimated $580 million in improper payments out of the $1 billion Medicare paid for psychotherapy in that period. The most common finding was missing time: on 60 sampled days, providers hadn't documented the psychotherapy time. In 54 of them the note had neither start and stop times nor a total, and in 6 it gave only the total time of a combined E/M and psychotherapy encounter. The next most common, on 43 days, was a treatment plan that was missing or incomplete. The OIG recommended that CMS add system edits for psychotherapy claims and strengthen provider education.

That audit followed earlier OIG audits of four psychotherapy providers, which found improper payment rates of 88 to 99 percent. Commercial plans and Medicaid programs set their own documentation rules, so check each payer's policy as well. If you see a run of 90837 claims downcoded to 90834, or a records request for a batch of 90837 sessions, read the notes before you answer: the time either supports the code or it doesn't.

A documentation checklist that holds up in a review

From the billing article and the LCD:

• Time: start and stop times, or total psychotherapy minutes, for every session.
• With an E/M visit: psychotherapy minutes recorded separately from the E/M, and both services clearly separate in the note.
• Every page: legible, with the patient's full name and the date of service, and the legible signature of the clinician who provided the care.
• The session itself: a summary of the session with the therapeutic interventions used, the patient's participation and response, and progress toward goals. The LCD says statements such as "supportive psychotherapy given" "are not adequate."
• Treatment plan: measurable, objective goals, the interventions, session frequency and the estimated duration of treatment, updated "generally at least every three months."
• 90785: the communication factor present and the adaptations used, plus the time spent on them.
• Diagnosis: a code the record supports.

Before the claim goes out, check that the code matches the minutes in the note. It's a short check, and it's the one the audits keep failing.

For the evaluation that comes before therapy starts, our post on CPT 90791 vs 90792 covers which evaluation code to use and what can't be billed with it on the same day.

Where Beeline fits

Beeline is a US company with a dedicated billing team. For behavioral health practices it codes psychotherapy from the time and content in the clinician's notes, checks each claim against payer edits before it goes out, and works the denials that come back. Our behavioral health billing page has a tool to "Find the psychotherapy code" for a session. If you'd like a second look at your therapy claims, start with a free consultation.

Frequently Asked Questions

What is the time requirement for 90837?

53 minutes or more of face-to-face psychotherapy with the patient. Medicare contractor billing guidance tells you to choose the code closest to the actual time, so 53 minutes and up is closer to 90837's 60 minutes than to 90834's 45. The note must show start and stop times or the total time.

What is the difference between 90832 and 90834?

90832 is psychotherapy of 16 to 37 minutes, with a nominal time of 30 minutes. 90834 is 38 to 52 minutes, with a nominal time of 45. Under 16 minutes, neither is billed.

Can I bill 90837 for a 50-minute session?

No. 50 minutes falls in the 38 to 52 minute band, which is 90834. 90837 needs at least 53 minutes of psychotherapy documented in the note.

Do I need start and stop times for psychotherapy?

Medicare's billing guidance accepts either start and stop times or the total time, but one of them must be in the note for 90832, 90834 and 90837. In the OIG's 2023 audit, missing time was the most common problem it found. Commercial payers may set their own rules, so check each payer's policy.

Can 90837 be billed with an E/M visit?

Not as 90837. When a prescriber does an E/M visit and psychotherapy in the same encounter, the psychotherapy is billed with an add-on code: 90833, 90836 or 90838, chosen by the psychotherapy time alone. The E/M time doesn't count toward it.