Accurate billing keeps your practice legal and paid. CPT 90833 is one of those codes clinicians use when medication management and therapy happen in the same visit. Used correctly, it gets you paid for both kinds of work. Used incorrectly, it leads to denials and audits. This guide explains when to use 90833, how to document it, which providers typically bill it, and how to avoid common mistakes.
What is CPT 90833?
CPT 90833 is an add-on psychotherapy code for 16–37 minutes of psychotherapy provided with an evaluation and management (E/M) service by the same provider on the same day. It is not a standalone code. You must bill it together with an appropriate E/M code for that same visit.
When to use 90833 — the clinical rule
Use 90833 when both of these are true for the same patient, same day, same clinician:
- You perform an E/M service (for example medication management).
- You also provide face-to-face psychotherapy that totals between 16 and 37 minutes and is clinically distinct from the E/M work.
Example 1: A psychiatrist adjusts meds and then spends 25 minutes using CBT techniques to address panic symptoms. Bill an E/M code (based on MDM), and add 90833 for the psychotherapy portion.
Example 2: A psychiatric NP completes medical decision making about mood stabilizers, then provides 20 minutes of supportive psychotherapy in the same visit. Bill the E/M + 90833.
Who commonly bills 90833
90833 is primarily for clinicians who can bill an E/M service and also provide psychotherapy during that visit. That usually means:
- Psychiatrists (MD/DO)
- Psychiatric nurse practitioners and other nurse practitioners who bill E/M services
- Some physicians in integrated care settings
Licensed therapists who do not bill E/M codes (for example LCSWs, LMFTs, LPCs) generally use standalone psychotherapy codes such as 90832, 90834, or 90837 instead. Always confirm each payer’s rules for provider types. Cadence Collaborative+1
Key billing and documentation rules you must follow
Follow these exact items to make a clean, audit-ready claim:
- Select the E/M code by medical decision making (MDM), not by time. When psychotherapy is billed with an E/M, the E/M level must be based on MDM per CPT guidance. Document the medical decision making clearly.
- Record psychotherapy time separately. Track start/stop times or total face-to-face psychotherapy minutes that are separate from the E/M portion. For 90833, document 16–37 minutes of dedicated psychotherapy time.
- Make the two services separately identifiable. Your note must show two distinct services: the medical evaluation/management and the psychotherapy work, with details showing both were medically necessary.
- Do not report psychotherapy under 16 minutes. If the therapy portion is less than 16 minutes, there is no appropriate add-on code.
- Prolonged services rules. You may not report prolonged service codes for psychotherapy when you billed an add-on psychotherapy code with an E/M on the same day. Long psychotherapy beyond those thresholds has specific rules.
Modifier 25 — when and why
Modifier 25 shows the E/M service was a separate, significant service on the same day as another procedure or service. AMA guidance explains modifier 25 is appropriate when the E/M is truly distinct and is supported in the record. Some payers explicitly ask for modifier 25 on the E/M when you bill a psychotherapy add-on; others do not. Best practice: document the MDM and, when payer guidance requires it, append modifier 25 to the E/M code. If you are unsure, check the payer policy.
Claim order and simple billing flow
- Choose the correct E/M code (based on MDM).
- If payer requires, append modifier 25 to the E/M to indicate a separate identifiable service.
- Add CPT 90833 as the psychotherapy add-on code.
- List the psychotherapy time in the chart note and on any worksheets you keep for billing review.
Telehealth and 90833
Many payers allow psychotherapy and E/M services by live audio-video telehealth, and the psychotherapy add-on codes are commonly accepted for telehealth when face-to-face interaction is via video. Coverage can vary by payer and by the telehealth technology used. Confirm before billing.
Common mistakes and quick fixes
- Mistake: Billing 90833 alone. Fix: Never bill the add-on by itself. Always pair with an appropriate E/M.
- Mistake: Choosing an E/M level by time when psychotherapy was provided. Fix: Use MDM when add-on psychotherapy codes are billed.
- Mistake: Not documenting psychotherapy start/stop or content. Fix: Add a separate psychotherapy section in the note with time, modality, goals, and patient response.
- Mistake: Expecting prolonged service codes to apply with add-on psychotherapy. Fix: Do not apply prolonged service codes when you bill 90833/90836/90838 with an E/M; check specific payer rules for exceptions.
Audit-ready note sample (short)
Use plain, exact language so a coder or auditor can see the two services clearly.
Visit date: 09/15/2025
Total visit time: 40 minutes.
E/M (MDM) — 15 minutes
- Reason for visit: follow up for major depressive disorder; patient reports increased insomnia and partial response to sertraline.
- Assessment: moderate depression with worsening sleep, medication side effects suspected.
- Plan: increased sertraline 50 mg to 100 mg; discussed side effect monitoring; safety plan reviewed.
Psychotherapy — 25 minutes (CPT 90833)
- Time: 25 minutes face-to-face psychotherapy, separate from medication management.
- Modality: brief cognitive behavioral techniques to address sleep hygiene and anxiety.
- Goal: reduce nightly rumination and improve sleep onset.
- Patient response: practiced relaxation technique, reported immediate reduction in anxiety; plan to continue CBT homework.
- Provider signature.
Quick checklist before you submit a claim
- E/M code chosen based on MDM, documented.
- Psychotherapy time documented separately (start/stop or total minutes).
- E/M and psychotherapy are separately described in the note.
- Modifier 25 added if payer requires and documentation supports it.
- Check payer rules for telehealth or provider type restrictions.
Final notes
90833 is a useful add-on when medication management and psychotherapy occur in the same visit. The keys are simple: pick the right E/M code using MDM, document psychotherapy minutes and technique separately, and follow payer modifier rules. If you build a one-page template that separates the E/M and psychotherapy sections and captures time and MDM clearly, you will reduce denials and make life easier for your billers and auditors. For payer-specific rules, always check the latest policy documents or contact the payer’s provider help line.