CPT Code 90837: 2026 Billing Guide for 60-Minute Psychotherapy

What Is CPT Code 90837?

CPT 90837 is the procedure code for a 60-minute individual psychotherapy session, billed when actual psychotherapy time reaches 53 minutes or more on the date of service. The American Medical Association defines it as a standalone time-based code, not an add-on, covering the longest of the three individual psychotherapy tiers. Correct use depends on documented time, modifier selection for telehealth, and payer-specific same-day rules.

• How long is a 90837 session? A 90837 session is 60 minutes of psychotherapy, billable when the documented psychotherapy time is 53 minutes or more. Sessions under 53 minutes fall to 90834 or 90832.
• Does 90837 require a modifier? No modifier is needed for in-person sessions. Telehealth sessions delivered by live, two-way audio and video require modifier 95. A same-day E/M service carries modifier 25 on the E/M, not on 90837.
• Can you bill 90791 and 90837 on the same day? Generally no. Most payers do not reimburse both a diagnostic evaluation and a psychotherapy session for the same patient by the same provider on the same date, though narrow exceptions exist with specific payers.

What CPT Code 90837 Covers

90837 is the time-based code for a 60-minute individual psychotherapy session. The American Medical Association assigns it a threshold of 53 minutes or more of actual psychotherapy time. It is a standalone code, not an add-on, so it is billed on its own rather than alongside an evaluation and management service. Only the time spent delivering psychotherapy counts toward the threshold. Scheduling, no-show buffers, and notes written after the patient leaves do not count. For a full overview of how these codes fit together, see our psychiatry CPT coding and billing guide.

The three standalone individual psychotherapy codes line up by session length:

Each of these codes has its own documentation and billing nuances. For a closer look at the 30-minute code, see our CPT 90832 overview. For the 45-minute code, see our 90834 billing guide.

Why Does the 53-Minute Threshold Trigger So Many Denials?

The line between 90834 and 90837 is a single number: 53 minutes. At 52 minutes of psychotherapy time the session is a 90834; at 53 minutes it becomes a 90837. That narrow margin is exactly why the code draws scrutiny from payers and auditors.

Because 90837 reimburses more than 90834 and is used at high volume, it sits near the top of payer audit lists. When a provider bills 90837 on nearly every claim, it flags utilization review. The most common pattern we see across the billing companies we vet is a practice that bills 90837 by default regardless of session length, and the correction always starts with the same fix: document actual time on every session.

The defense is not to downcode out of caution, because chronic downcoding leaves earned revenue on the table. The defense is documentation that supports the code billed, every time. If the session ran 55 minutes, bill 90837 and document 55 minutes. If it ran 49 minutes, bill 90834 and document 49 minutes. The documented time, honestly recorded, is what picks the code.

What Documentation Does 90837 Require?

A defensible 90837 note records the total psychotherapy time or the start and stop time, the therapeutic modality used, the medical necessity tied to the patient’s diagnosis, and the progress toward the treatment plan. Time is the element payers check first, because it is the element that determines the code.

If a session lands near the 53-minute threshold, record exact minutes rather than rounding. The borderline sessions are precisely the ones a payer will question, and an exact time in the note is the cleanest defense. One question we hear constantly from practice managers is whether start-and-stop times or total minutes are better. The answer depends on payer preference, but either method works when the number is accurate and consistent.

Five elements belong in every 90837 progress note:

1. Total psychotherapy time in exact minutes, or start and stop times.
2. The therapeutic intervention used during the session (CBT, DBT, psychodynamic, etc.).
3. Medical necessity linked to the patient’s active diagnosis and treatment plan.
4. Progress or lack of progress toward treatment goals, with clinical specificity.
5. Any safety risk assessment, medication discussion, or care coordination that occurred during the session.

How Do You Bill 90837 for Telehealth?

In person, 90837 generally needs no modifier. When the 60-minute session is delivered over live, two-way audio and video, it is billed with modifier 95 to signal synchronous telehealth, and the place of service should reflect where the patient was located. Telehealth place of service and coverage rules continue to shift, so confirm the current-year policy with each payer before submitting.

Audio-only sessions are coded differently, so do not append modifier 95 to a phone-only visit. If a separately identifiable evaluation and management service is performed the same day, modifier 25 goes on the E/M service, not on 90837. In our experience matching providers with billing partners, telehealth modifier errors are now one of the top three denial drivers in psychiatry, and they are entirely preventable with a clean submission workflow.

For a deeper look at telehealth billing rules specific to psychiatry, see our guide on psychiatry telehealth billing and Medicare rules.

Add-On and Same-Day Billing Scenarios

90837 is a standalone code, so it is not combined with the psychotherapy add-on codes. The add-ons 90833, 90836, and 90838 attach to an E/M visit when a prescriber provides therapy during a medication visit; they are a different billing path from a standalone 90837 session.

Same-day questions come up often. Billing 90837 on the same day as a diagnostic evaluation such as 90791 is generally not reimbursed for the same patient by the same provider, though some payers allow it in narrow, well-documented circumstances. Billing 90837 with a same-day E/M is possible when both are distinct and separately documented, with modifier 25 on the E/M. In every same-day scenario, confirm the payer’s policy first.

For group psychotherapy, a different code applies entirely. See our CPT 90853 group psychotherapy overview for that billing path.

How Much Does 90837 Reimburse?

90837 reimburses more than the shorter psychotherapy codes, reflecting the session length. Medicare publishes a national fee for the code each year in the Physician Fee Schedule and then adjusts it by locality, so the amount changes annually and varies by region. Commercial payers such as Aetna set their own contracted rates, frequently benchmarked to a percentage of the Medicare fee, which means there is no single national figure that applies everywhere.

Rather than rely on a fixed number, check the current fee schedule for each of your top payers, since the spread between them is often wide. Providers often come to us after months of accepting reimbursement without checking it against their contracted rates, only to discover that a specific payer has been underpaying a high-volume code like 90837 for quarters. If 90837 is a high-volume code in your practice, even a small per-session underpayment compounds quickly. Our guide to improving your revenue cycle walks through where behavioral health practices recover the most.

Why Does 90837 Get Denied, and How Do You Prevent It?

The most frequent 90837 denials trace back to a handful of recurring issues. These are the patterns we see across the billing companies in our network, ranked by how often they cause lost revenue:

1. Psychotherapy time not documented or not supporting the 53-minute threshold.
2. Missing or weak medical necessity connecting the session to the patient’s diagnosis.
3. Frequency limits exceeded for the patient under their plan.
4. Telehealth modifier or place of service errors on video sessions.
5. Same-day conflicts with other services billed by the same provider.

Prevention is procedural. Confirm the documented time supports 90837 before submission, tie every session to the treatment plan, track payer frequency limits, match modifiers to the delivery method, and check same-day rules before combining services. A billing partner with psychiatry experience runs these checks before the claim goes out, which is what keeps the denial rate down before it becomes a collections problem.

If you are weighing whether to outsource that workflow, our guide on how to outsource psychiatry medical billing covers what to look for in a billing partner and when the handoff makes financial sense.

90837 Under Medicaid and Behavioral Health Plans

Medicaid programs reimburse 90837 at their own state-set rates, which are typically lower than Medicare and commercial payers. Each state Medicaid program may also impose its own prior authorization requirements, frequency limits, and documentation standards that differ from commercial rules. Providers billing 90837 to Medicaid should verify the state-specific fee schedule and any plan-level restrictions before submitting.

The biggest issue we see providers run into with Medicaid psychotherapy billing is assuming that commercial documentation standards will satisfy Medicaid review. They often do not. For a broader look at Medicaid-specific billing in behavioral health, see our Medicaid guide for behavioral health practices.

Frequently Asked Questions