Introduction
CPT code 90837 is one of the most widely used psychotherapy billing codes in mental health services. It represents individual psychotherapy sessions lasting 60 minutes and is essential for accurate reimbursement in therapy practices. While patients see it as “an hour with a therapist,” medical billers know it comes with strict documentation, time requirements, and frequent audits.
This article will break down what CPT 90837 is, when to use it, billing challenges, comparisons with other codes, insurance concerns, and best practices. If you’re a mental health provider, biller, or even a patient trying to understand your insurance claims, this guide is for you.
What is CPT Code 90837?
CPT 90837 is defined as:
- Individual psychotherapy, 60 minutes
- Used for outpatient therapy sessions in a clinical setting, office, or telehealth.
- Can include:
- Patient discussion of thoughts, emotions, and behaviors
- Cognitive-behavioral therapy (CBT)
- Psychodynamic or supportive therapy
- Trauma-focused therapy
This code is often confused with CPT 90834 (45 minutes) or CPT 90832 (30 minutes). The difference is session length and depth of treatment.
Why is CPT 90837 Important?
- For providers: It captures extended psychotherapy time, which reflects both the work done and the value of longer sessions.
- For billers: It affects claim approval, insurance reimbursement, and compliance with medical necessity guidelines.
- For patients: It explains why insurance sometimes questions or denies “long therapy sessions.”
Documentation Requirements for 90837
Insurance companies are stricter with 90837 than shorter codes because of potential overuse. To avoid denials, documentation should include:
- Start and end times of the session
- Evidence of medical necessity (why longer time was needed)
- Detailed notes on treatment interventions
- Patient progress and response
- Any risk factors (suicidality, trauma, severe symptoms)
Pro Tip: Many billers use templates for 90837 documentation to ensure compliance.
CPT 90837 vs. CPT 90834: Key Differences
| Code | Time Range | Typical Use Case | Reimbursement |
|---|---|---|---|
| 90832 | 16–37 minutes | Short check-ins or focused therapy | Lowest |
| 90834 | 38–52 minutes | Standard therapy session | Moderate |
| 90837 | 53+ minutes (usually 60) | Extended therapy session, complex cases | Highest |
Insurance companies often prefer 90834 because it costs less. That’s why 90837 is frequently flagged or audited.
Insurance Reimbursement for CPT 90837
Many insurance carriers require prior authorization or justification for 90837. Denials usually occur due to:
- Lack of medical necessity documentation
- Overuse without clinical explanation
- No clear start and stop times recorded
Average reimbursement:
- Private insurance: $120–$160 per session
- Medicare/Medicaid: Around $100–$120 (varies by state)
Patients may face higher copays because of the longer time billed.
Common Billing Errors with 90837
- Defaulting to 90837 for all sessions without justification
- Missing time documentation
- Not differentiating between 90834 and 90837
- Using 90837 for phone check-ins (not covered)
- Failing to update diagnosis codes to reflect severity
Best Practices for Using CPT 90837
- Use 90837 only when clinically necessary
- Clearly document why longer time was needed
- Track session start and stop times
- Educate patients on insurance coverage for longer sessions
- Consider telehealth modifiers (e.g., 95, GT) when applicable
Alternatives and When Not to Use 90837
Sometimes shorter codes or add-on codes are more appropriate:
- 90834: Standard 45-minute sessions
- 90832: Brief follow-ups
- 90833: Add-on for psychotherapy with medical management (psychiatrists)
Providers should avoid automatically choosing 90837 when the session was shorter than 53 minutes.
Reviews of CPT 90837 in Practice
- Therapists say it allows for meaningful depth with patients dealing with trauma or complex conditions.
- Billers see it as one of the most problematic codes because of denials.
- Patients often find it confusing, especially when they’re charged more for “an hour session.”