Accurate CPT coding is essential for proper reimbursement and compliance in your therapy practice. Understanding which codes to use, when to use them, and how to document properly can mean the difference between clean claims and denied payments.

Key Takeaways

• Correct coding ensures proper reimbursement – Using the right CPT code based on session length and type directly impacts how much you're paid for your clinical work

• Codes vary by session length, type, and modality – Individual therapy, family sessions, group work, and crisis interventions each have specific codes with distinct time requirements

• Knowing add-on codes and modifiers prevents billing errors – Understanding when to use add-on codes with evaluation and management services helps you capture the full scope of services provided

Individual Psychotherapy Codes

Individual psychotherapy codes represent the most commonly used billing codes in mental health practice. These codes are time-based, meaning you select the appropriate code based on the total duration of your therapeutic work with the client.

90832 – Psychotherapy, 30 Minutes

This code covers psychotherapy sessions lasting 16-37 minutes. While less common than longer sessions, 30-minute sessions serve specific clinical purposes in your practice.

Use cases for 90832:

• Brief follow-up sessions for clients in maintenance phase of treatment

• Sessions with clients who have limited attention span or stamina

• Structured brief therapy protocols

• Check-in sessions between longer therapeutic appointments

Documentation tips: Your clinical notes should clearly indicate the start and end time of the session, demonstrate that therapeutic work occurred, and show clinical necessity for the shorter duration. Your documentation needs to justify why a shorter session was clinically appropriate rather than simply convenient.

90834 – Psychotherapy, 45 Minutes

This represents the standard individual therapy session, covering 38-52 minutes of psychotherapy. Most therapists use this code for the majority of their individual sessions.

90834 is your primary code for regular outpatient psychotherapy. This session length allows sufficient time for check-in, therapeutic intervention, processing, and planning between sessions.

Documentation requirements: Record total session time, presenting concerns addressed, interventions used, client response to treatment, and progress toward treatment goals. Your notes should demonstrate active psychotherapy occurred throughout the session.

90837 – Psychotherapy, 60 Minutes

This code applies to sessions lasting 53 minutes or longer. Extended sessions provide additional time for complex clinical work that can't be adequately addressed in standard 45-minute sessions.

When to use 90837:

• Complex trauma processing requiring extended time for stabilization

• Family-of-origin work needing deeper exploration

• EMDR or other trauma treatments requiring longer sessions

• Initial sessions requiring extensive history-gathering alongside therapeutic work

Documentation requirements: Your clinical notes must justify the extended time by demonstrating the clinical necessity and complexity of the work performed. Document what specific therapeutic work required the additional time and how the extended session benefited the client's treatment.

Psychotherapy Add-On Codes

Add-on codes allow you to bill for psychotherapy provided during the same session as evaluation and management (E/M) services. These codes recognize that sometimes clients need both medical assessment and psychotherapy in a single visit.

90833, 90836, 90838 – Psychotherapy Add-On Codes

These codes cannot be billed alone—they must be used in conjunction with an E/M code from the same provider during the same session:

• 90833: Add-on for 30 minutes of psychotherapy (16-37 minutes)

• 90836: Add-on for 45 minutes of psychotherapy (38-52 minutes)

• 90838: Add-on for 60 minutes of psychotherapy (53+ minutes)

When to use add-on codes:

Prescribers who provide both medication management and psychotherapy in the same session use these codes most frequently. For example, a psychiatrist who conducts a medication review (billed as an E/M service) and then provides psychotherapy would bill the appropriate E/M code plus the corresponding add-on code.

Most non-prescribing therapists won't use these codes since they don't typically provide E/M services.

Family and Group Therapy Codes

Family and group modalities require different codes that reflect the distinct nature of multi-person therapy work.

90846 – Family Psychotherapy Without Patient Present

This code covers sessions where you meet with family members without the identified client present. Common uses include:

• Collateral sessions with parents of a child client

• Family education about a client's diagnosis or treatment

• Working with family members on their role in the client's recovery

• Addressing family dynamics affecting treatment

The session must focus on the identified client's treatment, not on the family members' own mental health issues.

90847 – Family Psychotherapy With Patient Present

This code applies when the identified client participates in the family session. This represents traditional family therapy where the client and one or more family members engage in therapeutic work together.

90849 – Multiple-Family Group Psychotherapy

This specialized code covers group sessions involving multiple families together. This format is less common in private practice but appears frequently in intensive outpatient programs and residential treatment settings.

Crisis Psychotherapy Codes

Crisis intervention sometimes requires extended sessions that go beyond typical therapy timeframes. Specific codes capture this intensive work.

90839 – Psychotherapy for Crisis, First 60 Minutes

This code applies to the first 60 minutes of crisis psychotherapy provided to a client in acute distress. The situation must constitute an actual crisis—an urgent situation requiring immediate attention to prevent harm.

Criteria for crisis codes:

• Client is experiencing acute psychological crisis with potential for harm

• Immediate intervention is necessary to stabilize the situation

• Standard outpatient therapy appointments are insufficient to address the urgency

• Session requires mobilization of resources beyond typical therapy

90840 – Psychotherapy for Crisis, Each Additional 30 Minutes

Use this add-on code for each additional 30 minutes beyond the first hour of crisis intervention. You can bill 90840 multiple times if crisis work extends beyond 90 minutes, but documentation must clearly justify the extended time.

Time thresholds: The first hour (90839) requires a minimum of 60 minutes of face-to-face crisis work. Each additional 30-minute unit (90840) requires at least 30 minutes.

Time-Based Billing Rules and Documentation Requirements

Understanding how to calculate billable time and what documentation standards apply prevents billing errors and audit problems.

Total Time vs Face-to-Face

For psychotherapy codes, billable time includes direct face-to-face contact with the client (or family members for family codes). Time spent on activities outside the session—writing notes, consulting with other providers, making referrals—is not included in the billable time for psychotherapy codes.

How to Document Sessions

Strong documentation protects you during audits and ensures appropriate reimbursement:

• Record start and end times clearly: "Session conducted from 10:00 AM to 10:47 AM (47 minutes)" removes any ambiguity about session length

• Document therapeutic work performed: Describe the interventions used, topics addressed, and therapeutic techniques applied

• Show medical necessity: Connect the session content to the client's diagnosis and treatment plan

• Note client response: Document how the client responded to interventions and any progress or setbacks observed

Common Coding Mistakes and Audit Tips

Even experienced clinicians make billing errors that can trigger audits or result in payment denials. Understanding common mistakes helps you avoid them.

Using Wrong Code for Session Length

This represents the most frequent error in psychotherapy billing. A 40-minute session should be billed as 90834 (38-52 minutes), not 90832 (16-37 minutes). Similarly, a 55-minute session requires 90837 (53+ minutes), not 90834.

Some therapists consistently underbill by using 90834 for all sessions regardless of actual length. While this might seem conservative, it represents inaccurate coding. Other therapists round up inappropriately, billing 90837 for 50-minute sessions. Both practices create problems during audits.

Omitting Modifiers

Modifiers provide additional information about the service and can significantly impact reimbursement:

• Modifier 95: Indicates synchronous telemedicine service rendered via real-time interactive audio and video telecommunications

• Modifier GT: Alternative telemedicine modifier used by some payers instead of 95

Failing to append the appropriate telemedicine modifier can result in claim denial, as many insurers require documentation that services were provided remotely.

Billing Family Therapy Codes for Individual Sessions

Some clinicians incorrectly use 90847 (family therapy with patient present) when a parent simply attends part of a child's individual session. Unless the parent actively participates in therapeutic work and family dynamics are being addressed, individual therapy codes remain appropriate even with a parent present.

Inadequate Crisis Code Documentation

Crisis codes (90839, 90840) trigger scrutiny because they reimburse at higher rates. Using these codes for situations that don't meet crisis criteria—such as a client being upset but not in acute distress—constitutes improper billing. Your documentation must demonstrate the crisis met clinical criteria for immediate intervention.

Quick Reference CPT Code Table

Frequently Asked Questions

Can these codes be used for telehealth?

Yes, psychotherapy CPT codes can be used for telehealth services with appropriate modifiers. Most payers require modifier 95 or GT to indicate the service was provided via synchronous audio-video telecommunications.

The clinical requirements remain the same, you must provide the same quality and duration of service as you would in person. Verify your specific payer's telehealth policies, as requirements vary.

How do I choose between 90834 and 90837?

Base your decision on actual session length and clinical need. If your session lasted 38-52 minutes, use 90834. If it lasted 53 minutes or longer, use 90837. Don't choose codes based on desired reimbursement, choose based on services actually provided. Clinical necessity should determine session length in the first place.

What happens if I bill the wrong code?

If you discover a coding error, you should file a corrected claim with the insurance company. Most payers have specific procedures for claim corrections. Systematic patterns of incorrect coding can trigger audits, potentially requiring you to repay overpayments with interest.

Do I need to document anything besides time for psychotherapy codes?

Yes, comprehensive documentation includes much more than session duration. You need to document the presenting problem, interventions provided, client's response to treatment, progress toward goals, current mental status, risk assessment when relevant, and the plan moving forward.

Can I bill for time spent writing notes after the session?

No, psychotherapy codes only cover direct client contact time. Documentation time, consultation with other providers, and case management activities are considered part of the practice cost of providing psychotherapy.

Professional Disclaimer: This article is for informational purposes only and is not a substitute for professional billing advice, coding guidance, or legal counsel. Therapists should consult current CPT coding guidelines, payer-specific requirements, and billing specialists to ensure their coding practices meet all applicable regulations and contractual obligations.

Sources

American Medical Association. (2024). CPT® 2024 Professional Edition. American Medical Association.

American Psychological Association. (n.d.). Understanding CPT codes and billing. https://www.apaservices.org/practice/reimbursement/health-codes

Centers for Medicare & Medicaid Services. (2023). Medicare Learning Network: Telehealth Services. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/telehealthsrvcsfctsht.pdf

Centers for Medicare & Medicaid Services. (n.d.). Evaluation and Management Services Guide. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf

American Psychiatric Association. (n.d.). CPT Coding for Psychiatrists. https://www.psychiatry.org/psychiatrists/practice/practice-management/coding-reimbursement-payment

National Association of Social Workers. (n.d.). Private Practice Billing and Coding. https://www.socialworkers.org/practice/naswstandards/billing-coding

SimplePractice. (2023). Insurance and Billing Guide for Therapists. https://www.simplepractice.com/blog/insurance-billing-guide-therapists/