CPT 90837 is the standard code for individual psychotherapy lasting 53 or more minutes of direct face-to-face contact. This is the most frequently billed therapy code. Sessions under 53 minutes should use 90834 (38-52 min) or 90832 (16-37 min). Time-based billing requires exact documentation of session start and stop times.
Bill CPT 90837 only when the session length is 53+ minutes of direct patient contact. The 8-minute rule does not apply to psychotherapy codes; use actual documented time. Common billing errors include rounding session times, missing start/stop documentation, and billing 90837 for sessions under 53 minutes. Do not bundle multiple sessions into a single code on the same day. Each session is a separate billable unit. Time spent on administrative tasks or case consultation (not involving the patient) does not count toward session length.
Most commercial payers require prior authorization for ongoing psychotherapy, often with session limits (e.g., 20-30 sessions per year). Medicare covers psychotherapy without session limits when medically necessary. Session limits vary by payer and state Medicaid program. After reaching session limits, obtain additional authorization before billing further sessions or request medical necessity review. Document clinical progress and ongoing treatment necessity to support authorization requests.
Use modifier 25 if an E/M service (99213-99215) is billed on the same day as psychotherapy. Modifier 95 indicates telehealth delivery. Modifier 93 indicates audio-only service where allowed by payer. Do not bill psychotherapy codes on the same date with psychiatric evaluation codes (90791, 90792) without modifier 25 for the E/M component. Separate procedure billing (59) is not needed for therapy codes.
Document exact start and stop times (e.g., "2:00 PM - 2:55 PM"). Note the therapeutic modality (individual therapy, CBT, DBT, etc.), clinical interventions used, patient presentation and mental status, progress toward treatment goals, and any safety concerns. Patient response and engagement level should be included. Incomplete time documentation is the leading cause of CO-16 denials for therapy codes.
CPT 90837 requires 53 minutes or longer of face-to-face individual psychotherapy. Sessions under 53 minutes should bill 90834 (38-52 minutes) or 90832 (16-37 minutes). Do not round times to meet code requirements.
Document exact start and stop times, session modality, clinical observations, patient response to treatment, and any clinical interventions. Time must match the code billed. Missing time documentation results in CO-16 denials.
CO-16 (Claim lacks required documentation) denials occur when time documentation doesn't match the code billed, start/stop times are missing, or the session length doesn't support the CPT level claimed.
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