What is CPT Code 90837 used for?

CPT 90837 is used to bill individual psychotherapy sessions where the documented face-to-face therapy time with the patient is 53 minutes or more. It is the highest-tier individual psychotherapy code, used for extended sessions reflecting clinical complexity, trauma processing, high-acuity presentations, or initial comprehensive evaluations.

How do I document 60 minutes for 90837?

Document a specific start time and stop time for the psychotherapy portion of the session. Include the total therapy time in the note. Add a clinical rationale explaining why the session required extended time. Document the therapeutic intervention with named technique, patient response with observable markers, risk assessment, and progress toward treatment goals.

Can time alone justify 90837?

No. Time is a necessary condition documented therapy time must reach 53 minutes or more but it is not sufficient on its own. The clinical note must also demonstrate medical necessity for the extended session. A 60-minute session with minimal clinical complexity documented will be downcoded to 90834 in a payer review.

Why do payers deny 90837 claims?

The most common denial triggers are: no documented start and stop time for therapy, no clinical rationale for extended session length, generic intervention documentation without technique specificity, notes that look identical across multiple sessions, billing 90837 routinely without clinical variation, and missing telehealth-specific documentation elements for remote sessions.

Is 90837 billable via telehealth?

Yes. 90837 via telehealth is broadly covered. The correct place-of-service code is 02 (telehealth, non-patient's home) or 10 (patient's home). Modifier 95 is required by many payers. Documentation must include the platform used, patient location, provider location, and confirmation of patient consent for telehealth services.

How does Medicare reimburse 90837?

Medicare covers 90837 at 80% of the Medicare Physician Fee Schedule rate after the patient's deductible, for qualifying mental health diagnoses with documented medical necessity. Medicare Advantage plans may apply different clinical criteria. Geographic location and provider type affect the fee schedule amount.

CPT 90837 in 2026: Billing, Time Requirements, Documentation & Reimbursement

Med Cloud MD
Feb 24
6 min read

Updated: 4d

Person holds clipboard writing notes; background shows blurred person sitting. Blue overlay with text: CPT Code 90837, 60-Minute Psychotherapy Guide.

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Why one minute separates a clean 90837 claim from a downcoded one — and how to document the difference.

Quick Answer: CPT 90837 reports individual psychotherapy of 53 minutes or more of documented face-to-face therapeutic time — not a scheduled 60-minute appointment slot. It's used by licensed behavioral health providers within their state scope of practice and payer credentialing, and it requires documentation that supports both the time and the medical necessity of an extended session.

Key Takeaways

• 90837 requires 53+ minutes of actual face-to-face therapy time — scheduling, paperwork, and note-writing don't count toward that threshold.

• A 52-minute session is 90834, not 90837 — there's no rounding at the boundary.

• 90837 cannot be billed alongside 90832, 90834, or crisis code 90839 for the same patient on the same date.

• Telehealth sessions need the correct modifier (95 for live video, 93 for audio-only) and place-of-service code — requirements vary by payer.

• Since January 1, 2024, Medicare has allowed marriage and family therapists and mental health counselors to bill psychotherapy codes directly, subject to enrollment.

• A longer session doesn't automatically justify 90837 — the documented time and the medical necessity both have to support it.

CPT 90837 at a Glance

Our comparison guide to 90832, 90834, and 90837 covers the full time-code family in more depth; this guide focuses specifically on 90837 mechanics, documentation, and denial prevention.

How the 53-Minute Threshold Actually Works

The CPT descriptor for 90837 reads “Psychotherapy, 60 minutes with patient,” which is why it's commonly called the 60-minute code — but the actual billable threshold is 53 minutes or more of face-to-face therapeutic time. A 60-minute appointment slot that includes 10 minutes of paperwork and 48 minutes of therapy doesn't meet the threshold; it bills as 90834, not 90837. Only the documented therapeutic contact time counts, not the scheduled block.

Common Mistake: Billing 90837 because the appointment was scheduled for an hour, without confirming that actual face-to-face psychotherapy time reached 53 minutes. A 48–52 minute session is upcoding at 90837 — it belongs at 90834.

90837 vs. 90834 vs. the E/M Add-On Codes

Code	Relationship to E/M	Key Consideration
90834	Standalone, without E/M	38–52 minutes; can't be billed with 90837 or an E/M/psychiatric evaluation same day.
90837	Standalone, without E/M	53+ minutes; can't be billed with 90832, 90834, or crisis code 90839 same day.
90833 / 90836 / 90838	Add-on to a qualifying E/M service	30 / 45 / 60 minutes of psychotherapy furnished alongside a separately documented E/M visit.

What the 90837 Note Must Document

• Start and stop times (or total documented minutes) supporting the 53-minute threshold.

• Diagnosis and medical necessity for the extended session.

• Therapeutic modality and interventions used during the session.

• Patient response and progress toward treatment goals.

• Risk assessment when clinically applicable.

• Provider identification, credentials, and signature.

• Telehealth modality, consent, and location details when applicable.

Exact documentation elements can vary by payer — verify specific requirements before assuming one template fits every claim.

Medical Necessity for 90837

Medical necessity for an extended session should come from the actual clinical picture symptom severity, functional impairment, treatment goals, and why a longer session was clinically appropriate that day documented as it happened, not reconstructed afterward to justify a code already selected.

Common 90837 Claim Errors

Modifiers and Telehealth Billing

Telehealth 90837 claims commonly use modifier 95 for live video or modifier 93 for audio-only sessions, paired with the payer's required place-of-service code — but exact modifier and POS combinations vary by payer and aren't universal across Medicare, Medicaid, and commercial plans. Verify the current requirement before submitting rather than assuming last year's combination still applies.

Medicare Billing for CPT 90837

CMS guidance identifies 53 minutes or more as the applicable Medicare threshold for 90837. Since January 1, 2024, Medicare has allowed marriage and family therapists and mental health counselors to bill psychotherapy codes directly, in addition to psychologists, clinical social workers, and psychiatrists subject to state licensure and Medicare enrollment. Medicare telehealth policy for behavioral health has its own POS and modifier requirements, separate from commercial payer rules; confirm current CMS guidance before billing telehealth sessions.

Commercial Insurance Considerations

Commercial payer policies for 90837 can differ from Medicare and from each other in authorization requirements, credentialing, telehealth rules, and documentation requests. Don't assume a commercial plan follows Medicare's approach simply because CMS guidance is well documented; verify the specific payer's current policy.

What Determines Your Actual 90837 Payment

Variable	Why It Matters
Payer contract / fee schedule	Sets the allowed amount for the code, which varies by payer.
Provider enrollment and network status	Affects whether the claim is even payable at the contracted rate.
Place of service	In-office and telehealth rates can differ.
Patient benefits (deductible/coinsurance)	Determines what portion the payer covers versus the patient owes.

90837 Denial Prevention Workflow

Encounter → Documentation Review → Code Selection → Modifier/POS Review → Eligibility Check → Submission → Adjudication → Payment Posting → Denial Review → Appeal/Correction

Most 90837 denials trace back to the code-selection and modifier-review steps — catching a time or modifier mismatch there is far cheaper than fixing it after a denial.

90837 Billing Audit Checklist

• Documented time supports 53+ minutes of face-to-face therapy.

• No conflicting same-day code (90832, 90834, or 90839) billed.

• Medical necessity for the extended session is documented, not assumed.

• Telehealth modifier and POS match current payer policy.

• Provider is enrolled and credentialed with the specific payer.

7 Questions to Ask Before Billing 90837

1. Did the documented psychotherapy time actually support 53+ minutes?

2. Does the note describe the actual clinical service provided?

3. Does the diagnosis support the treatment being delivered?

4. Are payer-specific requirements satisfied?

5. Are the POS and modifier correct for this payer?

6. If an E/M service was also reported, are both services separately supported?

7. Could an independent reviewer understand why this was medically necessary?

When to Audit Your 90837 Billing

• Repeated denials or downcoding on 90837 claims.

• Frequent payer requests for records on this code.

• Inconsistent coding patterns across providers.

• Sudden, unexplained changes in reimbursement.

• Telehealth-specific claim issues or rejections.

How MedCloudMD Can Help

MedCloudMD's behavioral health billing specialists work on the areas covered in this guide — 90837 documentation review, coding accuracy, modifier/telehealth compliance, denial management, and AR follow-up — with certified coders and human review built into the workflow.

Need help reviewing your 90837 billing workflow? Our team can review your current documentation and denial patterns with you.

Explore our Behavioral Health Billing Services, or talk to our billing team about your current 90837 claims.

Frequently Asked Questions

What is CPT 90837?

It's the code for individual psychotherapy sessions of 53 minutes or more of documented face-to-face therapeutic time — often called the “60-minute” code because of its CPT descriptor, though the actual billable threshold is 53 minutes.

How many minutes are required for 90837?

53 minutes or more of documented, face-to-face psychotherapy time — scheduling, paperwork, and note-writing don't count toward that threshold.

What is the difference between 90834 and 90837?

90834 covers 38–52 minutes; 90837 covers 53 minutes or more. The boundary is exact — 52 minutes is 90834, 53 minutes is 90837, with no rounding.

Can 90837 be billed with an E/M service?

Not as a standalone code alongside an E/M visit. When psychotherapy is furnished with a qualifying E/M service, the add-on codes 90833, 90836, or 90838 are used instead, based on the psychotherapy time.

Can CPT 90837 be billed via telehealth?

Yes, when the payer's telehealth policy allows it, using the correct modifier (95 for live video, 93 for audio-only) and place-of-service code — requirements vary by payer.

What documentation is required for 90837?

Documented start/stop times or total minutes, diagnosis and medical necessity, therapeutic modality, patient response, progress toward goals, and provider signature — exact elements can vary by payer.

Does Medicare cover CPT 90837?

Yes, when furnished by an eligible, enrolled provider and supported by documentation meeting the 53-minute threshold and medical necessity — verify current CMS guidance for specifics.

What are common reasons 90837 claims are denied?

Documented time that doesn't reach 53 minutes, billing it alongside a conflicting same-day code, missing telehealth modifiers, and documentation that doesn't support medical necessity for an extended session.

Does every 60-minute appointment qualify for 90837?

No. A 60-minute scheduled slot doesn't guarantee 53 minutes of actual face-to-face therapy time — the code depends on documented therapeutic time, not the appointment length.

Disclaimer: This content is provided for educational and informational purposes only and should not be considered legal, coding, reimbursement, or medical advice. Billing regulations, CPT® coding, CMS policies, and payer requirements may change over time and can vary by payer and location. Healthcare providers should verify current coding guidelines and reimbursement policies with the appropriate payer, CMS, AMA CPT® resources, or qualified coding professionals before submitting claims. MedCloudMD provides professional medical billing and revenue cycle management services to support healthcare organizations but does not guarantee reimbursement outcomes.