CPT 90837: A Complete Guide to 60-Minute Psychotherapy Billing

CPT 90837 is defined as:

Individual psychotherapy, insight-oriented, behaviour-modifying and/or supportive, 60 minutes

This code describes a long-duration psychotherapy session provided to a single patient. Unlike psychotherapy add-on codes (such as 90836 or 90838), CPT 90837 is a standalone psychotherapy code and does not require an evaluation and management (E/M) service to be billed.

Key features of CPT 90837 include:

• Represents 53 minutes or more of psychotherapy
• Billed for individual (one-on-one) sessions
• Does not require medication management or E/M services
• Intended for extended, medically necessary psychotherapy
• Requires detailed, time-based documentation

CPT 90837 is commonly used when:

• Shorter psychotherapy sessions are clinically insufficient
• The patient presents with moderate to severe symptoms
• Complex emotional, behavioral, or trauma-related issues are addressed
• Therapeutic work requires sustained engagement

CPT 90837 should only be reported when the time threshold is met, and the extended session length is clinically justified and clearly documented.

The clinical purpose of CPT 90837 is to support the delivery of extended individual psychotherapy when shorter sessions are not sufficient to meet a patient’s therapeutic needs. This code is used when deeper, more intensive therapeutic work is required to address complex or persistent mental health conditions.

CPT 90837 supports treatment by allowing clinicians to:

• Provide in-depth psychotherapy within a single session
• Address complex emotional, behavioral, or cognitive issues
• Support trauma processing and emotional regulation
• Improve coping skills and treatment engagement
• Manage conditions requiring sustained therapeutic focus

Common clinical situations where CPT 90837 is appropriate include:

• Trauma-related disorders requiring extended processing
• Severe or persistent mood and anxiety disorders
• Personality disorders or long-standing interpersonal difficulties
• High emotional distress or psychosocial complexity
• Treatment-resistant symptoms needing intensive intervention

CPT 90837 reflects the need for comprehensive, patient-centered psychotherapy when extended time is clinically necessary to support meaningful progress.

CPT 90837 may be billed by licensed mental health professionals who are authorized under state law and payer policy to provide individual psychotherapy services. Providers must be properly credentialed and enrolled with the payer to report this code.

Providers commonly eligible to bill CPT 90837 include:

• Psychiatrists
• Psychologists
• Psychiatric nurse practitioners
• Psychiatric physician assistants
• Licensed clinical social workers
• Licensed professional counselors
• Marriage and family therapists

Key provider requirements include:

• Holding an active license within the provider’s scope of practice
• Being credentialed with the payer for psychotherapy services
• Personally delivering the psychotherapy session
• Complying with supervision rules when applicable

Important considerations:

• Provider eligibility may vary by state and payer
• Scope of practice laws must always be followed
• Incident-to billing does not apply to psychotherapy codes

Confirming provider eligibility before billing CPT 90837 helps prevent claim denials, compliance issues, and reimbursement delays.

CPT 90837 is a time-based psychotherapy code. Accurate time tracking is critical for compliant billing.

Psychotherapy time range for CPT 90837:

53 minutes or more of psychotherapy

There is no upper time limit defined by CPT, but sessions should remain clinically reasonable and supported by documentation.

Time counted toward CPT 90837 includes:

• Face-to-face psychotherapy with the patient
• Therapeutic dialogue and emotional processing
• Cognitive-behavioral interventions
• Insight-oriented psychotherapy
• Behavioral modification strategies
• Trauma-focused therapy
• Supportive psychotherapy with a therapeutic goal

Time that does not count includes:

• Documentation time
• Scheduling or administrative tasks
• Time spent solely on care coordination
• Medication management when billed separately
• Non-therapeutic conversation

Psychotherapy time must be clearly documented, either as total time or with start and stop times.

Understanding how CPT 90837 differs from other psychotherapy codes is essential for proper code selection.

CPT 90834 represents 45 minutes of psychotherapy (38–52 minutes).

CPT 90837 represents 60 minutes of psychotherapy (53 minutes or more).

CPT 90832 represents 30 minutes of psychotherapy (16–37 minutes).

It should only be used when the psychotherapy session meets the minimum time threshold and when the extended duration is clinically justified.

Documentation is the most critical factor in supporting CPT 90837 and defending against audits. Because this code represents extended psychotherapy, payers expect robust, detailed documentation.

Required documentation elements include:

• Diagnosis or diagnoses being treated
• Total psychotherapy time or start and stop times
• Type of psychotherapy provided
• Therapeutic focus and goals
• Interventions and techniques used
• Patient response and engagement
• Progress toward treatment goals
• Clinical rationale for extended session length

Best documentation practices:

• Individualize notes for each session
• Avoid repetitive or templated language
• Clearly link therapy interventions to the diagnosis
• Document why extended time was clinically necessary
• Update treatment plans as clinically indicated

Incomplete or vague documentation is one of the most common reasons CPT 90837 claims are denied or flagged for audit.

Medical necessity is a key requirement for billing CPT 90837. The psychotherapy provided must be reasonable and necessary for the diagnosis and treatment of a mental health condition.

Indicators of medical necessity include:

• Moderate to severe psychiatric symptoms
• Functional impairment affecting daily life
• Complex trauma or emotional dysregulation
• Safety concerns requiring extended therapeutic support
• Treatment-resistant symptoms
• Significant psychosocial stressors impacting mental health

Common medical conditions include:

• Major depressive disorder
• Post-traumatic stress disorder
• Bipolar disorder
• Anxiety disorders
• Personality disorders
• Obsessive-compulsive disorder
• Substance use disorders
• Complex grief and adjustment disorders

Important medical necessity considerations:

• Diagnosis alone does not justify CPT 90837
• Extended time must be clinically relevant and documented
• Routine or supportive conversation does not meet criteria
• Use of CPT 90837 should vary based on patient need

Clear documentation linking extended psychotherapy time to clinical necessity is essential for compliant billing and audit defense.

Reimbursement for CPT 90837 varies by payer, geographic region, provider type, and contractual terms. Because this code represents extended psychotherapy, it generally reimburses at a higher rate than shorter psychotherapy codes but is also subject to increased payer scrutiny.

Key reimbursement factors include:

• Payer-specific coverage policies for extended psychotherapy
• Provider credentialing and contract terms
• Place of service, including in-person versus telehealth
• Frequency limits or utilization review requirements
• Accuracy and completeness of documentation

Common reimbursement challenges:

• Claim denials due to insufficient time documentation
• Requests for additional medical records
• Frequency edits limiting repeated use of CPT 90837
• Downcoding to shorter psychotherapy codes
• Delayed payment related to audit review

Best practices to support reimbursement:

• Verify payer-specific CPT 90837 policies before billing
• Ensure documentation clearly supports time and medical necessity
• Monitor denial patterns and payer feedback
• Avoid routine or automatic use of extended sessions
• Conduct periodic billing and documentation audits

Understanding payer requirements and maintaining strong documentation practices are essential to ensuring consistent and appropriate reimbursement for CPT 90837 services.

Ethical and compliant use of CPT 90837 requires that extended psychotherapy sessions are clinically appropriate, accurately documented, and honestly billed. Providers must ensure that billing reflects the services actually delivered and meets payer and regulatory requirements.

Key ethical and compliance principles include:

• Billing CPT 90837 only when extended time is medically necessary
• Accurately documenting psychotherapy duration and content
• Avoiding upcoding or routine use of extended sessions
• Ensuring psychotherapy is therapeutic, not purely supportive
• Maintaining professional boundaries and ethical standards

Legal and regulatory considerations:

• Compliance with state scope-of-practice laws
• Adherence to payer-specific billing policies
• Proper documentation to support audit review
• Awareness of payer utilization and frequency limits=

Compliance best practices:

• Provide ongoing training on psychotherapy coding
• Conduct internal audits and peer reviews
• Update documentation templates as regulations change
• Address errors promptly and transparently

Strong ethical and compliance practices protect patients, providers, and practices from financial and regulatory risk.

CPT 90837 may be billed for telehealth psychotherapy when permitted by payer policy and applicable federal and state regulations. Telehealth sessions must meet the same clinical, time, and documentation standards as in-person psychotherapy.

Telehealth requirements for CPT 90837 include:

• Real-time audio and visual communication
• Psychotherapy time meeting the minimum threshold of 53 minutes
• Clinical appropriateness for telehealth delivery
• Services provided by an eligible, credentialed provider
• Patient consent documented when required

Telehealth documentation best practices:

• Indicate that the session was conducted via telehealth
• Document the technology or modality used
• Clearly record total psychotherapy time
• Describe therapeutic interventions provided
• Note any limitations related to remote care

Important considerations:

• Audio-only services may not qualify, depending on payer rules
• Privacy and confidentiality standards must be maintained
• Payer-specific telehealth policies may vary
• Place of service and modifiers must align with payer requirements

Failure to follow telehealth-specific billing and documentation guidelines may result in claim denials or delayed reimbursement.

As telehealth continues to expand, exploring the benefits of virtual medical billing assistants can support cleaner claims and faster reimbursement.

CPT 90837 is considered a high-risk code for audits. Common errors include:

• Billing CPT 90837 without meeting time thresholds
• Inadequate documentation of psychotherapy time
• Repetitive or templated notes lacking clinical detail
• Routine use of CPT 90837 without justification
• Lack of medical necessity documentation
• Billing extended sessions for supportive counseling only

Auditors often look for patterns such as consistent maximum-time billing or identical documentation across multiple visits.

To reduce audit risk when billing CPT 90837:

• Document psychotherapy time clearly and consistently
• Individualize notes for each session
• Describe specific therapeutic interventions
• Explain why extended time was clinically necessary
• Avoid default use of CPT 90837
• Conduct periodic internal chart audits

As practices scale, understanding our 4-in-1 virtual medical assistant can help improve productivity while supporting day-to-day practice operations.

CPT 90837 is an essential code for delivering extended, in-depth psychotherapy to patients with complex or severe mental health needs. Ensure accurate, compliant, and optimized billing for CPT 90837 with expert support from Summit RCM. Our specialized virtual medical assistant services help behavioral health practices reduce denials, minimize audit risk, and improve reimbursement through precise coding and thorough documentation review.

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