What Is CPT Code 90836?
CPT 90836 is a psychotherapy add-on code for 38 to 52 minutes of therapy delivered during the same visit as an evaluation and management (E/M) service. It is always reported in addition to an E/M code such as 99213 or 99214 and cannot be billed on its own. The add-on captures a substantial block of psychotherapy performed alongside the medical management portion of the visit, and it requires modifier 25 on the E/M service to show the medical evaluation was a separate and identifiable service from the therapy.
- It is always an add-on. 90836 cannot appear alone on a claim. Without an accompanying E/M service in the same visit, there is no 90836.
- Modifier 25 goes on the E/M, not on 90836. The modifier signals that the E/M was a separate, identifiable service from the psychotherapy.
- Time determines which add-on to use. 90833 covers 16 to 37 minutes, 90836 covers 38 to 52 minutes, and 90838 covers 53 minutes or more.
What CPT Code 90836 Covers
CPT 90836 reports the psychotherapy component of a combined medication management and therapy visit. The code covers 38 to 52 minutes of psychotherapy delivered in the same encounter as an E/M service, where the provider performs both the medical evaluation and the therapeutic intervention. The therapy time it captures is separate from the time spent on the medical evaluation, and both must be documented independently in the visit note.
The clinical scenario is common in psychiatric practice. A psychiatrist sees a patient for a 15-minute medication check (the E/M service) and then provides 45 minutes of individual psychotherapy (the 90836 add-on). Both services are delivered in the same encounter by the same provider, but they serve different clinical purposes and are documented as distinct services. The E/M captures the medical decision-making around the patient’s medication regimen. The 90836 captures the psychotherapeutic work, which might include cognitive behavioral techniques, psychodynamic therapy, supportive therapy, or any recognized modality.
This is different from standalone psychotherapy. A provider who delivers 45 minutes of therapy without an E/M service would report CPT 90834 instead of 90836. The distinction is whether the visit includes a separately billable medical evaluation. Non-prescribing therapists such as licensed clinical social workers or licensed professional counselors would use 90834 because they do not bill E/M services. Prescribers who perform both the medical management and the therapy in the same visit use the add-on codes (90833, 90836, or 90838) paired with the appropriate E/M level.
How Does 90836 Compare to 90833 and 90838?
The three psychotherapy add-on codes are distinguished solely by the documented therapy time delivered alongside the E/M service. The clinical content and documentation requirements are the same across all three. The only variable is how many minutes of psychotherapy the provider delivered and documented.
| Add-On Code | Therapy Time Range | Typical Scenario | 2026 Medicare Rate (Approx.) |
| 90833 | 16 to 37 minutes | Brief therapy during a medication visit | $55 to $65 |
| 90836 | 38 to 52 minutes | Substantial therapy session with medication management | $95 to $110 |
| 90838 | 53 minutes or more | Extended therapy plus medication management | $120 to $140 |
One question we hear constantly from psychiatry practice managers is whether to default to 90833 on every medication visit to avoid scrutiny. The problem with that approach is it leaves money on the table when the provider actually delivered 45 or more minutes of therapy. If the documentation supports 90836, billing 90833 instead is undercoding, not caution. The correct code is the one that matches the documented time, and accurate time documentation is what protects the claim.
Pick the add-on by the documented psychotherapy time. A visit with 45 minutes of therapy alongside the medical work is a clean 90836. If the therapy ran 55 minutes, it becomes 90838. If it was only 20 minutes, it is 90833. The E/M level is chosen separately based on its own medical decision-making criteria and has nothing to do with the therapy time.
Can 99214 and 90836 Be Billed Together?
Yes. CPT 99214 is an E/M code for an established patient visit with moderate medical decision-making, and 90836 is the psychotherapy add-on billed alongside it. To bill them on the same claim for the same date of service, apply modifier 25 to the 99214. The modifier tells the payer that the E/M service was a separate and identifiable service from the psychotherapy add-on, which is the standard Medicare and commercial payer requirement for reporting an E/M and a procedure or add-on on the same day.
Modifier 25 goes on the E/M code, not on 90836. This is one of the most common billing errors we see across the billing companies we vet for psychiatric practices. Placing modifier 25 on the add-on code instead of the E/M results in a denial every time, and the fix is a corrected claim that wastes days in the resubmission cycle. The correct claim line structure is 99214-25 on one line and 90836 on a separate line, both with the same date of service and the same rendering provider.
The combination works with any E/M level, not just 99214. A psychiatrist billing a 99213 with 90836, or a 99215 with 90836, follows the same rule: modifier 25 on the E/M, add-on on its own line. The E/M level is determined by the medical complexity of the visit, and the add-on is determined by the therapy time. They are selected independently.
Eligible providers for this combination are prescribers who deliver both medical management and psychotherapy in the same visit: psychiatrists, psychiatric nurse practitioners, and physician assistants working under a psychiatrist’s supervision. A non-prescribing clinician who does not bill E/M services would report standalone psychotherapy codes such as 90834 instead.
When a medication visit includes a full therapy session, 90836 is real revenue that documentation gaps quietly erase. Get matched with billing companies that specialize in psychiatry and know how to capture the add-on correctly every time.
Documentation Requirements for 90836
A defensible 90836 claim requires two distinct services documented in one encounter note. The E/M portion must document the medical evaluation, the clinical decision-making around medication management, and the medical necessity for the visit. The psychotherapy portion must document the therapy time, the therapeutic modality or techniques used, the clinical focus of the session, and the patient’s response. Each service needs its own time and substance in the record.
The most important documentation element is the separation of time. The note must clearly show how many minutes were spent on the medical evaluation and how many minutes were spent on psychotherapy. If the provider documents a 60-minute visit but does not break out the therapy time from the medical time, the payer has no basis for paying the add-on separately. The add-on gets denied, and the provider receives payment only for the E/M.
In our experience matching providers with billing partners, the psychiatry practices that consistently collect on 90836 are the ones that use a structured note template with separate sections for the E/M and the psychotherapy. The template prompts the provider to enter the start and stop time for the therapy component, the therapeutic modality, and a brief narrative of the session content. Without that structure, providers tend to write a combined narrative that does not clearly separate the two services, and the claim fails on review. For practices looking at how psychiatric consultation and reporting codes fit into the broader billing picture, the documentation discipline required for 90836 applies across the entire add-on family.
Why 90836 Gets Denied
The denial reasons for 90836 are predictable and preventable. Understanding them before they happen is the difference between clean claims and resubmission cycles that delay payment by weeks.
- Billing 90836 without an E/M service. This is the most basic error. 90836 is an add-on code and requires an E/M service on the same claim for the same date of service. Submitting 90836 alone results in an automatic denial.
- Missing modifier 25 on the E/M. Without modifier 25, the payer sees two services on the same day and assumes the add-on is included in the E/M payment. The E/M pays, the add-on denies. The fix is a corrected claim with modifier 25 on the E/M line.
- Therapy time not documented separately from medical time. If the note does not distinguish how much time was spent on psychotherapy versus medical evaluation, the payer cannot confirm the add-on was a separate service. The claim is denied for insufficient documentation.
- Provider type does not support the code. 90836 is for prescribers who bill both E/M and psychotherapy. If a non-prescribing therapist bills 90836, it will deny because that provider type does not report E/M services. The correct code for a non-prescribing therapist delivering 45 minutes of standalone psychotherapy is 90834.
- Time falls outside the 38 to 52 minute range. If the documented therapy time is 35 minutes, the correct code is 90833, not 90836. If it is 55 minutes, the correct code is 90838. Payers audit time documentation against the code, and a mismatch triggers a denial or a downcode.
Providers often come to us after losing months of 90836 revenue to one of these patterns. The fix is always the same: a structured documentation template, correct modifier placement, and a billing team that audits claims before submission rather than after denial.
Frequently Asked Questions
CPT 90836 is a psychotherapy add-on for 38 to 52 minutes of therapy delivered in the same visit as an E/M service. It is reported in addition to the E/M code and cannot be billed on its own. The code is used by prescribers who deliver both medication management and psychotherapy in the same encounter.
Yes. 90836 is an add-on code, always billed together with an E/M service and never alone. The E/M captures the medical visit and 90836 captures the psychotherapy provided alongside it. Without a qualifying E/M on the same claim, 90836 will be denied.
Yes. 99214 is an E/M code and 90836 is the psychotherapy add-on billed with it. Apply modifier 25 to the 99214 and document the medical visit and the psychotherapy time as separate services. The same rule applies to any E/M level paired with 90836.
Modifier 25 goes on the E/M service, not on 90836. It signals that the E/M was a separate, identifiable service from the psychotherapy add-on. Placing modifier 25 on the add-on code instead of the E/M is a common error that results in a denial.
Prescribers who deliver both medical management and psychotherapy in the same visit bill 90836. This typically includes psychiatrists, psychiatric nurse practitioners, and physician assistants. A non-prescribing therapist would use standalone psychotherapy code 90834 for a 45-minute session instead.
CPT 90834 is a standalone psychotherapy code for 38 to 52 minutes of therapy without an E/M service. CPT 90836 is the add-on version of the same therapy time, billed only when an E/M service is also provided in the same visit. The therapy time range is identical, but the billing context is different.
Medicare reimbursement for 90836 varies by geographic locality, but the national average is approximately $95 to $110 as of the 2026 Physician Fee Schedule. The E/M service is paid separately at its own rate. Combined, a 99214-25 plus 90836 typically reimburses between $200 and $260 depending on the locality adjustment.
Next Steps
If your practice bills combined medication management and psychotherapy visits, verify that your documentation templates separate E/M time from therapy time and that modifier 25 is applied correctly on every claim. Review your recent 90836 denial rate to identify whether a documentation or modifier issue is costing you revenue.
For practices that need a billing partner with psychiatry-specific experience in add-on code documentation and payer rules, Psychiatry Billers connects you with vetted billing companies that specialize in behavioral health billing across all payer types.
If your practice is losing revenue on the 45-minute psychotherapy add-on because of documentation gaps or modifier errors, a billing partner who specializes in psychiatry can close that gap. Get matched with vetted billing companies that know 90836 inside and out.
