CPT 90837 is a specific billing code that has become increasingly important for mental health professionals providing in-depth individual psychotherapy.

This code represents a significant, lengthy therapy session that goes beyond standard brief interventions, offering comprehensive mental health support to patients who require more extensive treatment.

What Is CPT 90837?

CPT 90837 is a billing code specifically designed for individual psychotherapy sessions lasting 60 minutes or more. Unlike shorter session codes, this designation indicates a more comprehensive and intensive therapeutic intervention that allows mental health professionals to provide in-depth, focused treatment.

Clinical situations that typically warrant a 90837 code include complex mental health conditions, intensive trauma work, comprehensive diagnostic assessments, and treatment of deeply rooted psychological issues. These sessions require significant time and expertise, addressing multiple layers of a patient's psychological concerns in a single, extended therapy session.

Who Can Bill CPT 90837?

Several licensed mental health professionals are authorized to bill using CPT 90837, including:

• Licensed Psychologists

• Psychiatrists

• Licensed Clinical Social Workers

• Licensed Professional Counselors

• Marriage and Family Therapists

• Psychiatric Nurse Practitioners

These professionals can bill the code in various settings, such as:

• Private practice offices

• Community mental health clinics

• Telehealth platforms

• Hospital outpatient departments

• Integrated healthcare facilities

Codes 90837 vs. 90834

The primary difference between CPT 90837 and CPT 90834 lies in the session duration and complexity of treatment. CPT 90837 is a 60-minute (or longer) individual psychotherapy session, while CPT 90834 covers 45-minute sessions.

Providers typically choose 90837 when:

• The patient requires more extensive therapeutic intervention

• Complex psychological issues need comprehensive exploration

• Multiple treatment goals are addressed in a single session

• More in-depth diagnostic work is necessary

Conversely, 90834 might be used for:

• Shorter, more focused therapy sessions

• Maintenance or follow-up treatments

• Less complex mental health concerns

• Patients with time or financial constraints

Cost of CPT 90837

The cost of a CPT 90837 session can vary significantly depending on multiple factors. Without insurance, patients might expect to pay between $100 to $250 per session, with some specialized providers charging up to $300 or more.

Factors influencing the cost include:

• Provider's credentials and experience

• Geographic location

• Practice setting

• Specialization in specific mental health areas

• Local market rates for mental health services

With insurance, out-of-pocket costs can range from $20 to $50 per session, depending on the patient's specific insurance plan, deductible, and co-pay requirements.

Insurance Coverage for CPT 90837

Most major insurance providers cover CPT 90837, including:

• Private health insurance plans

• Medicare

• Medicaid

• Employee assistance programs

• Some state-sponsored health plans

Clients should take several steps to verify their coverage:

• Contact their insurance provider directly

• Review their current insurance policy documents

• Confirm in-network provider status

• Understand their specific mental health benefits

• Ask about any pre-authorization requirements

Common Denials or Issues with CPT 90837

Insurance claims for CPT 90837 might be denied due to:

• Insufficient documentation

• Lack of medical necessity justification

• Coding errors

• Out-of-network provider usage

• Exceeded session limits

To prevent denials, providers must:

• Maintain detailed, comprehensive session notes

• Clearly demonstrate medical necessity

• Use precise and accurate diagnostic codes

• Provide thorough treatment plans

• Ensure all documentation meets insurance guidelines

Mistakes to Avoid With CPT 90837

These are common mistakes to avoid: 

Time Tracking Errors

Critical mistakes in billing CPT 90837 often stem from inaccurate time documentation:

• Rounding session duration imprecisely

• Estimating instead of precisely tracking time

• Failing to document exact minutes of direct therapeutic intervention

• Inconsistent time reporting across session notes

Documentation Deficiencies

Insufficient clinical documentation can significantly impact claim approval:

• Lack of detailed explanation for session length

• Failing to articulate medical necessity

• Incomplete description of therapeutic interventions

• Vague or generic progress notes

• Missing specific diagnostic justifications

Coding and Billing Violations

Providers must be aware of potential billing compliance issues:

• Upcoding (billing for longer sessions than conducted)

• Downcoding (billing for shorter sessions than performed)

• Mismatched diagnostic and procedural codes

• Repeated use of crisis codes for standard sessions

• Inconsistent billing practices

Maximizing Reimbursement with Proper 90837 Billing

Successful reimbursement for CPT 90837 requires a strategic approach that goes beyond simple documentation. 

Understanding Reimbursement Fundamentals

Mental health providers must develop a comprehensive understanding of the complex billing landscape to ensure maximum financial return for their services.

• Develop precise, detailed documentation

• Understand insurance provider-specific requirements

• Create clear, justifiable treatment plans

• Maintain consistent billing practices

• Stay current with coding and billing regulations

Documentation Best Practices

Effective documentation is the cornerstone of successful reimbursement. Providers should focus on creating comprehensive, clear, and medically necessary documentation that explicitly justifies the extended therapy session.

• Detailed session notes

• Specific treatment interventions used

• Patient's clinical presentation

• Progress towards treatment goals

• Rationale for 60-minute session

• Measurable therapeutic outcomes

Negotiating with Insurance Providers

Successful billing goes beyond accurate documentation. Providers can take proactive steps to improve their reimbursement rates and relationships with insurance companies.

• Build strong professional relationships with insurance representatives

• Provide clear, consistent documentation

• Demonstrate the value of comprehensive therapy sessions

• Understand your market rate and value

• Be prepared to appeal denied claims

• Maintain professional credentials and continuing education

Utilizing Technology and Resources

Modern billing success relies heavily on technological solutions and ongoing education.

• Invest in advanced Electronic Health Record (EHR) systems

• Use billing software with built-in compliance checks

• Attend regular professional billing workshops

• Join professional associations with billing resources

• Subscribe to medical billing publications

• Participate in peer consultation groups

Billing Tips for Providers

Effective documentation for CPT 90837 requires:

• Precise session duration tracking

• Detailed description of therapeutic interventions

• Clear explanation of treatment goals

• Specific diagnostic rationale

• Patient progress notes

• Justification for session length

Establishing medical necessity involves:

• Demonstrating complex psychological needs

• Linking treatment to specific diagnostic criteria

• Showing how the extended session benefits the patient

• Providing clear, measurable treatment objectives

Frequently Asked Questions

Can you use CPT 90837 for teletherapy? 

Yes, teletherapy sessions are fully billable under CPT 90837, provided they meet the same clinical and documentation standards as in-person sessions.

Is 90837 covered by Medicare? 

Medicare typically covers CPT 90837 when provided by qualified mental health professionals and deemed medically necessary.

What is the difference between 90837 and 90839? 

CPT 90837 is for standard individual psychotherapy sessions, while 90839 is used for psychotherapy crisis sessions involving immediate risk assessment and intervention.

Bottom Line

CPT 90837 is an important tool in providing comprehensive mental health care. By understanding its nuances, both patients and providers can navigate the complexities of mental health billing and ensure access to necessary, in-depth therapeutic support.

Patients are encouraged to work closely with their mental health providers and insurance companies to understand their specific coverage and treatment options.

Disclaimer: This guide is for general informational purposes only and does not constitute medical, legal, or financial advice. Healthcare providers should consult appropriate professionals to ensure compliance with applicable billing and insurance regulations. Patients are encouraged to verify their insurance coverage and treatment options independently.