TL;DR, CPT code 90837 is for a 53+ minute psychotherapy session. It’s one of the most commonly used codes for a typical psychotherapy session. It pays a little better than CPT code 90834 which is for briefer sessions.
CPT code 90837 is another one of the most common CPT codes used by mental health professionals along with 90834 and 90791. Its typical use is for a normal psychotherapy session with a client. Insurers will reimburse this code only once per day, and some only as frequently as twice per week.
CPT Code 90837 is defined as:
Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 60 minutes with the patient and/or family member (time range 53 minutes or more)
Let’s break this down a little bit. Since psychotherapy uses communication to help the patient develop insight and change behavior, it’s not considered medically necessary by insurers when it’s conducted with patients who are so cognitively impaired that communication isn’t possible. Examples of this include psychotherapy with someone who has severe dementia or other psychiatric conditions. Notice that the description is 60 minutes but that it also clarifies that 53+ minutes with a patient or family member is the minimum time necessary to bill CPT code 90837. The clock-time is considered to be actual face-to-face time conducting therapy with a patient or family member not including scheduling, collecting payment, patients running late, etc. (Don’t ask CPT30 his thoughts on this. It triggers him.)
If your session with a patient is complicated by interpreters, maladaptive communication, or the presence of other third-parties, you might be able to use the add-on 90785 for interactive complexity.
Other add-on codes that are important are 99354 and 99355. Don’t get too excited because these codes just mean that you are using even more time than is covered by 90837. For the first 30-74 minutes over a 60-minute session, you add on a 99354 CPT code. For every 30 minutes your session goes over that, you add on a 99355 CPT code.
Here’s a few examples:
There are addons for working outside business hours. One is 99050. It’s used when you do a session outside of your normal business hours. For example, if you meet with a client on a Saturday, you can use 99050 unless that is your normal schedule. If your normal schedule is to work on Saturdays, you would use addon 99051 since it’s still outside of “normal” office hours.
A common modifier used with CPT code 90837 is modifier 95. This is the modifier for teletherapy. Before using this modifier or scheduling teletherapy with a patient, make sure their plan covers this modifier. Many plans do, especially since COVID-19, but some plans require you to conduct teletherapy with their special system. There might also be other limitations so check each plan.
The typical document that accompanies a therapy session that you will bill using CPT code 90837 is a case note. The case note relates to the diagnosis, treatment plan, and how the therapy session related to the biopsychosocial considerations impacting the client. Case notes might include reasons for using any add-ons and also why the 53+ minute session is medically necessary.
CPT code 90837 doesn’t have to be billed by a licensed medical doctor. It’s mainly used by licensed mental health professionals. Typically, Licensed Clinical Social Workers, Licensed Professional Clinical Counselors, Licensed Marriage and Family Therapists, and Clinical Psychologists will bill CPT code 90837.
It depends. Some insurance plans do and some insurance plans don’t (many insurance plans don’t). I probably sound like a broken robot, but it’s always best to call the client’s payer and make certain that an 90837 session is covered without pre-authorization.