90837 – Psychotherapy, 60 Minutes with Patient
CPT code 90837 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90837
?
90837 is a CPT code designated for individual psychotherapy services, specifically when the session lasts approximately 60 minutes. This entry provides an overview of the code's clinical significance, documentation requirements, and payer considerations. It is crucial for providers to ensure that clinical notes reflect evidence-based practices, including a detailed record of treatment objectives, interventions applied, and measurable progress indicators. In cases where the billing is time-based, it is essential to accurately document the start and stop times to substantiate the billed duration, thus ensuring compliance with payer expectations.
Documentation Tips
When billing for time-based psychotherapy under CPT 90837, it is vital to document both the start and stop times of the session. Additionally, thorough documentation should include the therapeutic modality utilized (e.g., Cognitive Behavioral Therapy, Dialectical Behavior Therapy), the assessment tools employed, the clinical focus of the session, patient responses, and a clear plan for follow-up care. For sessions involving scored instruments, ensure that copies of completed assessments are retained. In the case of telehealth sessions, documentation should also reflect patient consent and details about the platform used for delivery. Utilizing standardized documentation structures, such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan), can enhance audit readiness and improve overall documentation quality.
At a Glance
- Service Type: Psychotherapy
- Use Case: Individual Therapy
- Typical Setting: Outpatient clinic or telehealth (subject to payer policy)
- Billing Unit: Per session (varies by payer and specific circumstances)
- Common Pairings: 90791, 96127, other psychotherapy codes
Billing Examples
For instance, a clinician may conduct a 60-minute session utilizing Cognitive Behavioral Therapy (CBT) to help a patient manage anxiety symptoms. During the session, the clinician documents specific interventions, such as cognitive restructuring techniques and breathing exercises, and notes the patient’s progress toward their treatment goals, such as a reduction in anxiety severity from 7 to 5 on a 10-point scale. If the session duration varies, ensure that the appropriate time-based psychotherapy code is billed, reflecting the actual face-to-face time spent with the patient, whether it is less than or greater than 60 minutes.
Compliance Guidelines
- Validate payer coverage and authorization requirements prior to billing to avoid claim denials.
- Clearly document medical necessity and ensure services are directly linked to applicable ICD-10 diagnoses to support the treatment provided.
- Apply the correct modifiers, such as modifier 95 for telehealth services, as required by payer guidelines.
- Avoid upcoding by selecting the code that accurately reflects the documented time and level of service provided.
- Conduct regular audits of documentation practices to identify areas for improvement, minimize denials, and enhance the quality of clinical notes.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F32.0
- F41.1
- F33.1
- F43.10
- F41.9
- F34.1
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
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Q1: What is this code used for?
A: CPT code 90837 is used for individual therapy sessions lasting approximately 60 minutes. Clinicians must ensure that the clinical activities and documentation align with the code definition to support the billed service.
Q2: Can it be billed via telehealth?
A: Yes, many payers cover telehealth services when the sessions are synchronous and appropriate modifiers, along with patient consent, are documented. Always verify the specific payer policy regarding telehealth billing.
Q3: What documentation will payers request?
A: Payers typically request documentation that includes the time spent, the therapeutic techniques or instruments utilized, patient responses, and a clear linkage to a covered ICD-10 diagnosis to ascertain the medical necessity of the service.
Q4: Can this code be billed with other services?
A: Yes, when billing for multiple services, it is essential to document the distinct time spent on each service and provide a rationale for each. Utilize add-on codes or adhere to E/M separation rules as applicable to ensure proper billing.
Q5: What are common denial reasons?
A: Common reasons for claim denials include missing time records, failure to establish medical necessity, incorrect use of modifiers, or billing outside established frequency limits for services.
