CPT Code 90833: The 2026 Billing Guide for Psychotherapy Add-On With E/M

What Is CPT Code 90833?

CPT code 90833 is the add-on procedure code for approximately 30 minutes of individual psychotherapy, defined by 16 to 37 minutes of face-to-face therapy time, provided during the same visit as an evaluation and management service. It is the code psychiatrists and psychiatric nurse practitioners use when they deliver both medication management and psychotherapy in a single encounter.

• It is always an add-on, never standalone: 90833 must be billed alongside a primary E/M code such as 99213 or 99214. Submitting 90833 without a paired E/M code results in an automatic denial.
• Time range is 16 to 37 minutes: The psychotherapy portion must last at least 16 minutes to qualify. If therapy time reaches 38 minutes, the correct add-on becomes 90836. Document exact start and stop times for the therapy component separately from the E/M time.
• Modifier 25 goes on the E/M code: When billing an E/M service on the same date as 90833, append modifier 25 to the E/M to signal that the medical evaluation was significant and separately identifiable from the psychotherapy.

What CPT 90833 Covers

CPT 90833 reports individual psychotherapy delivered alongside a medical evaluation and management service in the same encounter. The AMA descriptor reads “Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure).” That parenthetical is the critical detail: 90833 is a list-separately code, meaning it cannot appear on a claim without a primary E/M service attached.

The therapy covered under 90833 includes insight-oriented, behavior-modifying, and supportive psychotherapy interventions, the same modalities covered by standalone codes like 90832, 90834, and 90837. The difference is the clinical context. With 90833, the provider is also managing the patient’s medications, reviewing lab results, adjusting dosages, or conducting a psychiatric evaluation during the same visit. That medical work gets coded under the E/M, and the therapy work gets coded under the add-on.

One question we hear constantly from practice managers is whether a provider can bill 90833 alongside a standalone psychotherapy code in the same visit. The answer is no. 90833 cannot be billed with 90832, 90834, or 90837 on the same date of service. It also cannot be appended to a psychiatric diagnostic evaluation (90791 or 90792). The add-on codes exist specifically for the combined visit, and mixing them with standalone therapy codes is one of the fastest routes to a denial.

What Is the Time Range for CPT 90833?

CPT 90833 covers 16 to 37 minutes of face-to-face psychotherapy time, documented separately from the time spent on the evaluation and management component of the visit. If the psychotherapy portion runs 15 minutes or less, no add-on code is billable. If it reaches 38 minutes, the correct add-on shifts to 90836.

The time distinction matters because it is the single most audited element of add-on psychotherapy claims. The psychotherapy minutes must be counted independently from the E/M minutes. A provider who spends 20 minutes on medication management and 25 minutes on cognitive behavioral therapy in the same visit bills the E/M for the medical portion and 90833 for the therapy portion. The total encounter might run 45 to 50 minutes, but only the therapy minutes determine which add-on code to report.

Across the billing companies we vet, the time documentation error we see most often is a note that records the total visit length without separating the therapy component from the medical component. That note does not support 90833 or any add-on code, because the payer has no way to confirm that the therapy portion met the 16-minute minimum. Start and stop times for the psychotherapy component, recorded in the clinical note, are the standard that survives an audit.

Can CPT Code 99214 and 90833 Be Billed Together?

Yes. Billing 99214 alongside 90833 is the most common combined-visit billing structure in psychiatry. The E/M code 99214 captures the moderate-complexity medication management, and 90833 captures the psychotherapy delivered in the same appointment. Together, the two codes reflect the full scope of the encounter.

The billing mechanics work like this: the E/M code goes on the primary claim line, with modifier 25 appended to indicate the medical evaluation was significant and separately identifiable from the psychotherapy. 90833 goes on a second line as the add-on, with no modifier needed on the add-on itself. The documentation must support both services independently: a medical note covering the E/M decision-making and a therapy note covering the psychotherapy intervention, duration, and response.

In our experience matching providers with billing partners, the combined 99214 plus 90833 visit is where psychiatry practices either capture or lose the most revenue. The 2026 Medicare national average for this pairing is approximately $217 combined, roughly $135 for 99214 and $82 for 90833, compared to roughly $173 for a standalone 90837 (60-minute therapy) or $114 for a standalone 90834 (45-minute therapy). That difference adds up across a full patient panel. The table below shows how the common psychiatry billing structures compare.

For a deeper look at billing standalone therapy sessions versus combined visits, see our CPT code 90834 billing guide.

Who Can Bill CPT 90833?

CPT 90833 is designed for prescribing mental health providers who deliver both medical evaluation and psychotherapy in the same visit. In practice, that means psychiatrists and psychiatric mental health nurse practitioners (PMHNPs). Other prescribing providers such as physician assistants working in psychiatry may also bill 90833 if their scope of practice and payer enrollment allow it.

Licensed therapists who do not prescribe, including licensed clinical social workers, licensed professional counselors, and psychologists who are not prescribers, cannot bill 90833. Because 90833 requires a paired E/M code, and E/M services require medical evaluation and management authority, non-prescribing clinicians bill standalone psychotherapy codes instead: 90832 for about 30 minutes, 90834 for about 45 minutes, or 90837 for about 60 minutes.

The most common issue we see providers run into is a non-prescribing clinician billing 90833 because the session happened to include some elements that felt like medical management. Unless the rendering provider has prescribing authority and is enrolled with the payer as a prescriber, the E/M plus add-on structure does not apply, and the claim will deny.

How to Bill CPT 90833 Correctly

Clean 90833 billing follows a consistent process that prevents the most common denial triggers before the claim goes out. These six steps are the backbone of accurate add-on psychotherapy billing:

1. Confirm the visit includes both E/M and psychotherapy. The provider must perform a distinct medical evaluation or management service (medication review, dosage adjustment, lab interpretation) alongside a distinct psychotherapy intervention in the same encounter.
2. Document the therapy time separately. Record exact start and stop times for the psychotherapy portion of the visit, independent of the E/M time. The therapy component must reach at least 16 minutes to support 90833.
3. Select the correct E/M code for the medical portion. Code the E/M based on the level of medical decision-making or total physician time, using 99213 for low-to-moderate complexity or 99214 for moderate complexity. The E/M must stand on its own.
4. Append modifier 25 to the E/M code. Modifier 25 signals that the evaluation and management service was significant and separately identifiable from the psychotherapy. Without it, payers bundle the E/M into the add-on and deny one of the two lines.
5. Report 90833 on a separate claim line. The add-on code appears on its own line without a modifier. Do not append modifier 25 to 90833 itself.
6. Write two distinct notes. The medical note covers the E/M: chief complaint, review of systems or history, clinical assessment, and plan. The therapy note covers the psychotherapy: modality used, issues addressed, patient response, and time. Both must be present to support the claim.

Common CPT 90833 Denials and Fixes

Every psychiatry practice that bills 90833 regularly encounters the same denial patterns. Providers often come to us after months of watching these claims reject for reasons that trace back to documentation and coding rather than the clinical work itself.

• Missing primary E/M code. 90833 was submitted without a paired E/M code on the same claim. Fix: always pair 90833 with the appropriate E/M code on the same date of service.
• Missing modifier 25 on the E/M. The payer bundled the E/M into the add-on because modifier 25 was not appended. Fix: append modifier 25 to every E/M billed on the same date as 90833.
• Therapy time not documented separately. The note records only total visit time without splitting out the psychotherapy minutes. Fix: document exact start and stop times for the therapy component in the clinical note.
• Therapy time under 16 minutes. The documented psychotherapy time does not meet the minimum threshold. Fix: if the therapy runs under 16 minutes, no add-on code is billable for that visit.
• Billed alongside a standalone therapy code. 90833 was reported on the same date as 90832, 90834, or 90837. Fix: use either the standalone code or the add-on code, never both on the same date.
• Billed with a diagnostic evaluation. 90833 was appended to 90791 or 90792 instead of an E/M code. Fix: add-on psychotherapy codes pair only with E/M codes, not diagnostic evaluations.

Documentation Requirements for CPT 90833

A 90833 claim requires two distinct documentation elements in the medical record: one supporting the E/M service and one supporting the psychotherapy. Payers audit add-on psychotherapy claims by checking whether each service is documented independently and whether the therapy time meets the minimum threshold.

Across the billing companies we vet, the strongest documentation practice for combined visits follows this structure:

• E/M note: Chief complaint, interval history, medication review, mental status exam findings, assessment and plan including any prescription changes. This note must support the E/M level billed on its own merits.
• Psychotherapy note: Modality used (CBT, supportive, psychodynamic, or other), specific issues addressed, therapeutic interventions delivered, patient response, and exact start and stop times for the therapy portion. “Psychotherapy provided” without detail does not meet the standard.
• Separate time entries: The record must show that the psychotherapy time (16 to 37 minutes for 90833) was tracked independently from the E/M time. If a payer audits the claim, the time entries are the first thing reviewed.

For a broader reference on how psychiatry billing codes fit together, including standalone psychotherapy, diagnostic evaluations, and group codes, the psychiatry CPT codes guide covers the full code family.

Frequently Asked Questions