Behavioral health providers face unique documentation and billing challenges, especially when reporting time-based psychotherapy services. Selecting the correct CPT code is essential for accurate reimbursement, compliance, and reducing claim denials.
One of the most frequently used psychotherapy codes is CPT code 90837, which is commonly associated with a 60-minute psychotherapy session. However, billing 90837 correctly involves more than simply scheduling an appointment for one hour. Providers and billing teams must understand time requirements, documentation standards, medical necessity, payer policies, and the differences between other psychotherapy codes.
This guide explains what 90837 CPT code means, when it should be used, how the time requirement works, documentation requirements, billing considerations, common mistakes, and strategies to help behavioral health practices reduce denials.
What Is CPT Code 90837?
CPT code 90837 is used to report individual psychotherapy without a medical evaluation and management (E/M) service.
The commonly used CPT description is:
Psychotherapy, 60 minutes with patient
Although the code is commonly referred to as a “60-minute psychotherapy code,” Medicare billing guidance generally instructs providers to select the psychotherapy code closest to the actual documented psychotherapy time. Under CMS guidance, 90837 is generally reported for psychotherapy lasting 53 minutes or more.
The service involves psychotherapy provided directly to the patient by a qualified healthcare professional within the scope of their professional practice and applicable payer requirements.
Psychotherapy may involve therapeutic techniques intended to address mental, emotional, or behavioral conditions and help patients work toward identified treatment goals.
Providers should remember that the selected code must accurately represent the service actually performed and documented.
Understanding the 90837 Time Requirement
One of the most important aspects of billing CPT code 90837 is understanding that psychotherapy coding is time-based.
CMS guidance for the psychotherapy code family generally identifies the following time ranges:
- 90832: 16–37 minutes
- 90834: 38–52 minutes
- 90837: 53 minutes or more
CMS also states that psychotherapy time should be documented using either start and stop times or the total amount of psychotherapy time, depending on the applicable documentation requirements.
For example, if a provider conducts and documents 55 minutes of psychotherapy, 90837 may be the appropriate code based on applicable payer requirements.
However, if the documented psychotherapy time is 45 minutes, the provider should generally evaluate whether 90834, rather than 90837, is the appropriate code.
Simply scheduling a patient for a 60-minute appointment does not automatically support billing 90837. The medical record should support the actual psychotherapy service and the amount of time spent providing it.
Why Accurate Time Documentation Matters
Time documentation is particularly important because 90837 represents a longer psychotherapy service than 90832 or 90834.
Incomplete or inconsistent documentation may create billing risks, including:
- Claim denials
- Requests for medical records
- Downcoding
- Payment delays
- Audit findings
- Recoupment risk
Accurate time documentation helps demonstrate that the selected CPT code reflects the service actually performed.
90837 vs. 90834: What Is the Difference?
Behavioral health practices frequently need to distinguish between CPT codes 90834 and 90837.
| CPT Code | General Service | CMS Time Range |
| 90834 | Psychotherapy without medical E/M | 38–52 minutes |
| 90837 | Psychotherapy without medical E/M | 53 minutes or more |
The primary difference is the documented duration of the psychotherapy service.
For example:
- A documented 45-minute psychotherapy session may support 90834.
- A documented 53-minute psychotherapy session may support 90837.
The service should be coded based on the actual service provided rather than the provider’s preferred reimbursement level.
Because payer policies may differ, providers and billing teams should also verify individual payer requirements and applicable contracts before submitting claims.
What Documentation Is Needed for CPT Code 90837?
Strong documentation is essential when billing psychotherapy services.
The medical record should support the patient’s need for treatment and demonstrate the psychotherapy service provided. CMS guidance for outpatient psychotherapy emphasizes documenting the time spent in psychotherapy, therapeutic interventions, treatment goals, patient participation, and progress toward those goals.
Depending on the patient, payer, and clinical circumstances, documentation may include the following elements.
1. Date of Service
The record should clearly identify when the psychotherapy service was provided.
2. Patient Identification
The medical record should contain appropriate patient identification information and be maintained according to applicable recordkeeping requirements.
3. Psychotherapy Time
For time-based psychotherapy services, documentation should support the amount of psychotherapy time provided.
CMS guidance allows relevant time to be documented through:
- Start and stop times, or
- Total psychotherapy time
The time recorded should accurately reflect the psychotherapy service.
4. Medical Necessity
The record should demonstrate why psychotherapy was clinically appropriate for the patient.
Documentation should support the presence of a mental, emotional, or behavioral condition or symptoms that affect the patient’s functioning and justify the service provided.
Medical necessity requirements may vary by payer, so practices should review payer-specific policies.
5. Therapeutic Interventions
The documentation should identify the therapeutic work performed during the session.
Depending on the patient’s treatment plan, this may involve interventions such as:
- Supportive psychotherapy
- Behavioral interventions
- Cognitive techniques
- Coping strategies
- Emotional processing
- Goal-oriented therapeutic discussions
The note should reflect the actual clinical service rather than relying on repetitive or generic language.
6. Patient Participation and Response
A psychotherapy record should demonstrate the patient’s involvement in the therapeutic process where applicable.
Documentation may address:
- Patient participation
- Response to interventions
- Progress toward treatment goals
- Changes in symptoms or behavior
- Continued treatment needs
7. Treatment Goals and Progress
Psychotherapy should generally be connected to an established treatment plan.
CMS guidance for outpatient psychotherapy references periodic summaries of treatment goals, progress toward those goals, and updated treatment plans.
Can 90837 Be Billed With an E/M Service?
CPT code 90837 represents psychotherapy without a medical evaluation and management service.
When psychotherapy is performed in conjunction with an E/M service, providers may need to consider the psychotherapy add-on code structure rather than billing 90837 for the psychotherapy portion.
CMS guidance distinguishes standalone psychotherapy codes, including 90832, 90834, and 90837, from psychotherapy add-on codes used with an appropriate E/M service, including 90833, 90836, and 90838.
When E/M and psychotherapy services are reported on the same date, the services must be significant and separately identifiable. Additionally, time spent performing the E/M service should not be counted as psychotherapy time.
For this reason, providers should clearly document the distinct services performed.
Is CPT Code 90837 Used for Telehealth?
Psychotherapy services may be furnished through telehealth when applicable federal and payer requirements are met.
The U.S. Department of Health and Human Services’ telehealth guidance lists 90837 as psychotherapy without medical evaluation, reported for 53 or more minutes, among behavioral health services used for telehealth billing. However, telehealth coding, modifiers, place-of-service reporting, and coverage requirements can vary depending on the payer and program.
Before submitting a telehealth claim for 90837, providers should verify:
- Whether the payer covers the service through telehealth
- Current telehealth billing requirements
- Appropriate place-of-service reporting
- Required modifiers
- Provider eligibility
- Documentation requirements
- Patient location and other applicable requirements
Because telehealth rules can change, practices should avoid relying on outdated billing workflows.
Common 90837 Billing Mistakes
Behavioral health organizations can reduce denials and compliance risks by identifying common billing errors before claims are submitted.
Billing 90837 Without Supporting the Time Requirement
- One of the most common errors is reporting 90837 when the documentation does not support sufficient psychotherapy time.
- An appointment scheduled for one hour does not necessarily establish that 53 or more minutes of psychotherapy were performed.
- The documentation should support the actual service.
Using 90837 for an E/M and Psychotherapy Combination
- Providers should not assume that a standalone psychotherapy code is appropriate when a separately billable E/M service is also performed.
- The appropriate coding approach depends on the services provided and the applicable code requirements.
Counting Non-Psychotherapy Time
- Administrative activities and other services should not automatically be counted toward psychotherapy time.
- Billing teams should ensure that documented psychotherapy time reflects the psychotherapy service itself.
Insufficient Medical Necessity Documentation
- A psychotherapy claim may be vulnerable when the record does not clearly support why treatment was necessary.
- Documentation should connect the patient’s condition, symptoms, treatment goals, and therapeutic interventions.
Copy-and-Paste Documentation
- Repeated documentation with minimal patient-specific information may create compliance concerns.
- Notes should accurately describe the patient’s clinical circumstances and the therapeutic service provided on the date of service.
Ignoring Payer-Specific Policies
- Different commercial payers, Medicare contractors, and other health plans may have different coverage and documentation requirements.
- A successful billing process should include payer-specific verification rather than relying on one universal rule.
How to Reduce Denials for CPT Code 90837
- Preventing denials begins before the claim reaches the payer.
- Behavioral health practices can strengthen their revenue cycle by implementing proactive processes.
Verify Coverage Before the Appointment
- Eligibility and benefits verification can help identify potential limitations before the service is provided.
- Practices should confirm relevant coverage requirements, authorization requirements, and provider network status when applicable.
Review Documentation Before Claim Submission
Documentation review processes can identify missing information before claims are submitted.
Key areas may include:
- Documented psychotherapy time
- Medical necessity
- Diagnosis coding
- Treatment plan support
- Provider credentials
- Required signatures
- Telehealth information, when applicable
Monitor Denial Trends
- Denial management should not focus only on correcting individual claims.
- Practices should analyze recurring denial patterns to identify root causes.
- For example, repeated denials related to time documentation may indicate a provider education or workflow issue.
Maintain Current Coding Knowledge
- Behavioral health billing requirements can change.
- Regular coding education and compliance reviews can help providers and billing teams remain aligned with current requirements.
The Importance of Medical Billing Support for Behavioral Health Practices
Behavioral health providers need to balance clinical responsibilities with increasingly complex billing requirements.
An effective medical billing process can help practices improve:
- Claim accuracy
- Documentation workflows
- Denial prevention
- Payment follow-up
- Revenue visibility
- Compliance monitoring
Professional billing support can also help identify recurring revenue leakage caused by coding errors, missing documentation, payer-specific requirements, or ineffective follow-up processes.
For psychotherapy services such as 90837, proactive billing processes are especially important because accurate time reporting, documentation, and payer policy compliance all contribute to clean claim submission.
Final Thoughts
CPT code 90837 is an important psychotherapy billing code for providers delivering longer individual psychotherapy sessions without a medical E/M service.
Successful 90837 billing depends on more than recognizing it as a 60-minute psychotherapy code. Providers and billing teams must ensure that the documented psychotherapy time supports the selected code, the medical record demonstrates medical necessity, therapeutic interventions and patient progress are appropriately documented, and payer-specific requirements are followed.
CMS guidance generally places 90837 in the 53-minutes-or-more psychotherapy range and requires time-based psychotherapy documentation to support the service billed.
By strengthening documentation, reviewing claims before submission, monitoring denial patterns, and staying current with payer requirements, behavioral health organizations can reduce unnecessary claim denials and build a more efficient revenue cycle.
Ultimately, accurate billing for 90837 supports both compliant reimbursement and a smoother operational process, allowing behavioral health providers to focus more of their attention on delivering quality patient care.