90837 CPT code

90837 CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Examples

90837 CPT code describes a 60-minute individual psychotherapy session with a licensed mental health professional. 90837 is one of the most often used CPT codes for billing and coding mental health insurance claims. Examples of services include insight-oriented, behavior-modifying, supportive, and interactive psychotherapy.

90837 CPT Code Description

Among the services that Medicare thinks should be included in a 90837 bill are:

  • Providing instruction in grooming methods
  • Keeping a record of one’s daily routine (ADL)
  • Recreation for rehabilitation (dance, art, play)
  • Involvement with other people

90837 CPT code is the code for a 60-minute session, which can be 53 minutes or longer. It’s merely the time difference that separates the 90834 and 90837 CPT codes. Sessions will not always schedule at these exact times with all therapists. The 90837 CPT code designates a 60-minute session, but it might be as short as 53 minutes or as long as 63 minutes.

The following license is required To conduct 60-minute individual treatment sessions,

  • A license requires for anyone who practices clinical social work (LCSW)
  • (LPC) Marriage and Family Therapist,
  •  Licensed Professional Counselor (LPC) (LMFT)
  • Specialists in clinical psychology are psychologists (PsyD or Ph.D.)
  • Psychiatrists (MD)

Authorization isn’t always required. Insurers such as United Healthcare required 90837 CPT code permission until recently. Other regularly used procedure codes, such as 90791 and 90834, were not subject to the requirement for prior authorization.

For United Healthcare billers, this was a frustrating and typical blunder. To avoid having to download to 90934 or contact for authorization, many providers who only scheduled 60-minute sessions had to do so.

Overcharging for 90837 has been flagged by several insurers. 90837 CPT code is considered normal by most insurance carriers, and they will cover it like other mental health codes. We are happy to report that United Healthcare has decided to allow CPT code 90837 without prior approval as of 2019. 

cpt code 90837

The American Medical Association maintains the Current Procedural Terminology (CPT®) CPT code 90837, a medical procedural code in the range – Of psychotherapy Services and Procedures. The supplier of this service provides psychotherapy, a set of techniques for treating the patient’s psychological illnesses. A typical treatment session lasts at least 53 minutes.

Along with 90834 and 90791, CPT code 90837 is one of the most commonly used CPT codes among mental health providers. Insurers will only cover this code once each day, and others will only reimburse it twice a week.

The following is the definition of 90837 CPT code:

“Individual psychotherapy, 60 minutes with the patient and family member, insight-driven, behavior modifying, and supportive (time range 53 minutes or more)”

Let’s take a closer look at this. Because psychotherapy relies on speech to help patients gain insight and change their behavior, insurers do not consider it medically necessary when provided to cognitively challenging patients and unable to communicate.

 Psychotherapy with someone who has severe dementia or other psychiatric problems is an example of this. It’s worth noting that the description states that the minimum time required to charge 90837 CPT code is 53 minutes with a patient or family member. 

You might be able to apply the add-on 90785 for interactive difficulty if your encounter with a patient will complicate by interpreters, maladaptive communication, or the presence of other third parties.

99354 and 99355 are two other key add-on codes. Don’t get too enthusiastic; these codes indicate that you are consuming more time than 90837 CPT code. You add a 99354 CPT code to the first 30-74 minutes of a 60-minute session. You add a 99355 CPT code for every 30 minutes your session lasts longer than that.

Here are several examples:

A 90837 and 99354 CPT code will use to bill a 120-minute session.

90837 CPT code (60 minutes), 99354 (+74 minutes), and 99355 (+30 minutes) would be the charges for a 170-minute session.

Working outside of business hours is possible with additions. One is 99050. You utilize this code when you do a session outside of your typical business hours. For example, if you have a client meeting on a Saturday, you can use 99050 unless it is your regular schedule. If you work on Saturdays as part of your regular schedule, you’d need to add 99051 because it’s still outside “standard” office hours.

90837 CPT Code Billing Guidelines

Psychiatric treatment offers by this service’s provider, who delivers psychotherapy. Fifty-three minutes is the average length of a regular therapy session. Then there is the fact that they make no indication of who would benefit from the treatment or surgery they are offering.

It is up to the CPT Editorial Panel to oversee the lengthy process of ensuring that the CPT code set keeps pace with the rapid advancements in medical knowledge and investigation. 

TL;DR: A psychotherapy session lasting more than 53 minutes is designated by the 90837 CPT code. In a typical psychotherapy session, it’s one of the most frequently utilized codes. Compared to CPT code 90834, it offers slightly better compensation for shorter sessions.

Mental health practitioners frequently use 90837 CPT code and 90834, and 90791. The definition of CPT Code 90837 is as follows:

  • approximately 60 minutes of insight-driven, behavior-modifying, and supportive individual psychotherapy for the patient and their family (time range 53 minutes or more)

Let’s take a closer look. As a result, insurers don’t consider speech treatment for mentally challenged individuals who cannot talk to be medically required. Psychotherapy with a person who has severe dementia or other mental health concerns falls under this category.

Time spent in face-to-face therapy with a patient or family member will describe as “clock-time,” which excludes the time spent making appointments, collecting money, and dealing with late patients.

If the presence of translators, maladaptive communication, or other third parties complicates your encounter with a patient, you might be able to apply the interactive difficulty add-on 90785.

In addition, the add-on codes 99354 and 99355 are significant considerations as well. Not to worry; this means you are taking up more time than 90837 CPT code permits. Don’t get too excited! The first 30-74 minutes of a 60-minute session should have a CPT code of 99354. 

It’s possible to work after regular business hours with the additions. One is 99050. Because it is not part of your regular schedule to meet clients on Saturdays, you might use the code 99050 instead. It is necessary to have the add-on 99051 if you work on Saturdays as part of your routine.

A case note is a typical document that follows a therapy session that you will bill using CPT code 90837. The case report pertains to the diagnosis, treatment plan, and how the therapy session links to the biopsychosocial concerns affecting the client. 

Case notes can contain justifications for employing add-ons and why the 53+ minute session is medically required. 90837 CPT code doesn’t have to be billed by a licensed medical doctor. Certified mental health practitioners mostly use it.

Typically, Licensed Clinical Social Workers, Licensed Professional Clinical Counselors, Licensed Marriage and Family Therapists, and Clinical Psychologists will bill CPT code 90837.

90837 CPT Code Modifiers

It is the modification for teletherapy use. Since the release of COVID-19, many have. However, some procedures mandate the use of their proprietary teletherapy system. Before utilizing this modification or setting up teletherapy with your patient, be sure their plan covers it.

Read the terms and conditions of each program carefully because there may be additional restrictions.

A “real-time audio and visual telecommunications system” provides “synchronized telemedicine service,” according to the 95 modifiers. A Telehealth session will describe in this way. In the past, the extent to which an insurer has to cover telehealth has varied dramatically.

It is possible to call TheraThink to ensure that the service is insured and paid correctly.

Psychotherapy for someone with dementia or other mental health issues is an example. A patient or a member of their family must be present for a minimum of 53 minutes to charge 90837 CPT code. The 90837 may be used for sessions lasting more than 45 minutes by some therapists

The modifier for CPT code 90837 is 95.

Reimbursements

90837 CPT code pays more than 90834 because of the greater length. Depending on your qualifications, the appointments spend an average of $9 to $20 more than 90834 appointments. It often equates to an increase of 13-20% every session. 

You may want to double-check with your insurance company to see if 90837 is covered. BCBS, as well as numerous other insurance companies, adhere to this code of conduct. 1.29 percent of BCBS claims were denied in 2017, decreasing from 3% to 4% between 2013 and 2015, according to Care Paths. 

However, the rate of Medicare and Medicaid denials has risen, but the incidence of denials has reduced. Denial rates for Medicaid and Medicare currently stand at 5.9 percent and 4.12 percent, respectively.

Examples

As a doctor explains, “90837 is medically necessary since major trauma  requires taking time to offer a safe place for disclosure and then confinement.” Code 90837 is used in medicine to address an extremely challenging clinical and diagnostic situation.

“A wonderful 72-year-old guy is one of my Medicare clients, and he has few outside contacts and a lot to process as he makes sense of the decisions that have shaped his life.

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