- Key Takeaways
- CPT code 90837 reports individual psychotherapy of 53 minutes or longer, the highest-value routine therapy code and the one payers scrutinize most for time documentation.
- A single minute decides the code: 52 minutes bills as 90834, while 53 minutes or more supports 90837, so documented start and stop times protect the claim.
- Since January 1, 2024, Medicare has paid marriage and family therapists and mental health counselors, expanding who can independently bill psychotherapy codes like this one.
- Time gaps are the leading reason payers downcode, so notes should record actual face-to-face time plus medical necessity, the therapy modality, patient response, and the plan.
- Non-prescribers report 90837 as a standalone code, while prescribers who also bill an E/M use the psychotherapy add-on codes instead, never both together.
90837 is the code every therapist wants to bill and the one that keeps practice owners up at night. It is the highest-value routine individual psychotherapy code, which is exactly why payers watch it more closely than any other. And the pool of clinicians who can bill it just grew: effective January 1, 2024, Medicare began paying marriage and family therapists and mental health counselors for the first time, under the Consolidated Appropriations Act, 2023. More providers billing a closely watched, higher-paying code means the rules around it matter more than ever.
Current as of 2026. Always verify code status and payment with your specific payer, since policies change.
The 53-minute line
90837 is individual psychotherapy of 53 minutes or longer. The commonly used phrase “60-minute session” is shorthand; the actual billing threshold is 53 minutes, set by the AMA time rules. A 55-minute session qualifies. A 52-minute session does not, and must be billed as 90834.
That single minute is the whole game. The three individual psychotherapy codes are separated only by time:
- 90832: 16 to 37 minutes
- 90834: 38 to 52 minutes
- 90837: 53 minutes or more
What counts is face-to-face clinical time: the actual work of treating the patient, processing, teaching coping skills, intervening. What does not count is scheduling the next visit, discussing insurance, lobby time, or writing the note after the patient leaves. If five minutes of a session goes to benefits questions, that time comes off the clock.
Documentation requirements for 90837
Time-documentation gaps are the single most common reason payers downcode 90837 to 90834, and the difference is real money on every visit. The fix is a note that proves the session. Every 90837 note should include:
- Actual face-to-face time, as a start and stop time or a clearly stated total of 53 minutes or more
- Medical necessity for the session, tied to current symptoms or functional impairment
- The therapeutic modality used (CBT, DBT, psychodynamic, and so on)
- The patient’s response to the interventions
- The plan for the next session
A note that reads only “60-minute session, supportive therapy” will not hold up. One that documents “53 minutes face-to-face, CBT targeting panic symptoms, patient practiced exposure hierarchy, reduced avoidance reported, continue weekly” will.
Because 90837 draws heightened payer attention, the documentation bar is effectively higher than for shorter codes. For the fuller picture of how payers audit this code and the recent legal pushback against disparate scrutiny, our analysis of Illinois PA 104-0446 covers the emerging protections, and our psychiatry billing and coding guide details the audit triggers.
- Neolytix • Medical Billing
Medical Billing
Who can bill 90837, and what they are paid
This is where 2026 looks different from a few years ago. Clinical social workers and psychologists have long billed 90837. Since January 1, 2024, marriage and family therapists and mental health counselors are also eligible Medicare providers and can bill it independently. Psychiatrists and psychiatric nurse practitioners can bill it as well, though when they also manage medication in the same visit, the coding changes (see the next section).
Payment often varies by credential. Under Medicare, newly eligible therapist types are generally paid at a percentage of the psychologist rate rather than the full amount, and several commercial behavioral health plans apply similar credential-based tiers, while others pay a single contracted rate regardless of license. One rule applies to everyone: each provider must be enrolled and credentialed with the payer before submitting a claim, since billing before enrollment is grounds for recoupment. Our guide to therapist credentialing covers that enrollment step, which matters especially for the newly eligible provider types.
Where 90837 fits among the therapy codes
A few relationships are worth knowing, and the full code family is covered in our psychotherapy billing guide:
- 90834 versus 90837: the same service, separated only by the 52 versus 53 minute line. Chronic downcoding out of caution leaves earned revenue behind; chronic upcoding invites recoupment. The note decides it.
- Standalone versus add-on: non-prescribers use the standalone code, 90837. When a prescriber provides both medication management and therapy in one visit, they bill an E/M code plus a psychotherapy add-on (90833, 90836, or 90838), not 90837. Standalone and add-on codes are never billed together for the same encounter.
- Crisis and complexity: crisis psychotherapy (90839) cannot be combined with 90837 on the same date for the same patient. The interactive complexity add-on (90785) may be added when specific communication barriers are documented.
Common billing errors to avoid
- Billing 90837 without documented time. The leading cause of downcodes to 90834. Record actual start and stop times, not just “60-minute session.”
- Counting non-clinical minutes. Scheduling, benefits talk, lobby time, and note writing do not count toward the 53-minute threshold.
- Upcoding a shorter session. Billing 90837 for a 48 to 52 minute session is upcoding and invites recoupment. It belongs at 90834.
- Billing standalone and add-on codes together. Never report 90837 with a psychotherapy add-on (90833, 90836, 90838) for the same encounter.
- Combining 90837 with crisis code 90839. The two cannot be billed for the same patient on the same date.
- Missing the telehealth modifier. A video session needs modifier 95 and the correct place of service, or it can deny.
- Billing before enrollment. Newly eligible provider types must be enrolled with the payer first, or the claim is subject to recoupment.
Telehealth in 2026
90837 remains one of the most telehealth-delivered codes in medicine. For a synchronous video session, append modifier 95 and use the appropriate telehealth place of service. Medicare continues to cover behavioral health telehealth under extended flexibilities in 2026, though originating-site and audio-only rules are still evolving, and commercial audio-only policies vary. Confirm each payer’s current telehealth requirements before submitting.
Reimbursement context
90837 is paid under the Medicare Physician Fee Schedule, and it reimburses more than 90834, which is both its appeal and the reason for the scrutiny. The exact amount depends on the provider’s credential, the place of service, and locality adjustments. Treat any single figure as illustrative and confirm the current rate for the specific provider type and setting through the CMS Physician Fee Schedule Look-Up Tool, which updates annually.
The bottom line
90837 rewards clinicians for the longer sessions many patients need, but only when the claim can prove it. Document the real face-to-face time, establish medical necessity, match the code to the provider type and enrollment, and keep standalone and add-on coding straight. Do that and the higher-value code holds up under scrutiny. For practices that would rather not police behavioral health time rules and payer-by-payer policies themselves, Neolytix has supported healthcare organizations across the United States for over 14 years, with behavioral health documentation and coding review built into its medical billing services so 90837 claims are defensible before they go out.
- Neolytix • Contact Us
Schedule a Consultation
Neolytix partners with healthcare organizations across revenue cycle, credentialing, and administrative operations ,14+ years of expertise and AI-enabled automation to reduce inefficiencies and drive sustainable growth.
This guide reflects Neolytix’s expertise in healthcare revenue cycle management and is intended for educational purposes only. It does not constitute legal or compliance advice. CPT codes and reimbursement rates are periodically updated by the AMA and CMS.
Sources
- American Medical Association. CPT psychotherapy codes and time rules (90832, 90834, 90837). https://www.ama-assn.org/practice-management/cpt
- Centers for Medicare & Medicaid Services. Marriage and Family Therapists & Mental Health Counselors (2024 Medicare eligibility). https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers/marriage-family-therapists-mental-health-counselors
- Centers for Medicare & Medicaid Services. Physician Fee Schedule Look-Up Tool (reimbursement by provider type and locality). https://www.cms.gov/medicare/physician-fee-schedule/search
- AAPC. CPT code 90837 reference. https://www.aapc.com/codes/cpt-codes/90837
Frequently Asked Questions
How many minutes is required for CPT 90837?
90837 requires 53 minutes or more of face-to-face psychotherapy time on the date of service. You do not have to reach exactly 60 minutes, so a 55-minute session qualifies. Only active clinical time counts, not scheduling, note writing, or lobby time. A session of 52 minutes or fewer bills as 90834.
What is the difference between 90834 and 90837?
Both are individual psychotherapy codes separated only by time. 90834 covers 38 to 52 minutes, and 90837 covers 53 minutes or more. Because 90837 pays more, payers watch it closely, so the note must document the actual time. Billing 90837 for a shorter session is upcoding and invites recoupment.
Can an LCSW or LMFT bill 90837?
Yes. Licensed clinical social workers and psychologists have long billed 90837. As of January 1, 2024, marriage and family therapists and mental health counselors also became eligible Medicare providers and can bill it, though often at a percentage of the psychologist rate. Each provider must be enrolled with the payer before billing.
Does 90837 need a modifier for telehealth?
Yes. For a video psychotherapy session, append modifier 95 to 90837 and use the correct telehealth place of service. Medicare continues to cover behavioral health telehealth under extended flexibilities in 2026, though originating-site and audio-only rules are evolving. Confirm each payer’s current telehealth policy before submitting the claim.
Why does 90837 get audited or downcoded?
90837 is the highest-value routine therapy code, so payers monitor providers who bill it heavily and downcode sessions that lack clear time documentation. The most common triggers are missing start and stop times, no stated medical necessity, and a high 90837-to-90834 ratio. Solid documentation is the defense against both.
