90837 CPT Code: Complete Guide to Billing, Documentation & Compliance
For mental health providers, the 90837 CPT code represents the cornerstone of psychotherapy billing—but it's also one of the most scrutinized codes by insurance auditors. This 60-minute individual psychotherapy session code carries specific documentation requirements that, when not met, can trigger claim denials, payment recoupments, and compliance violations.
Whether you're a solo practitioner or managing a large behavioral health organization, understanding the nuances of CPT code 90837 is essential for maintaining revenue integrity and avoiding costly audit findings.
This comprehensive guide breaks down everything you need to know about billing, documenting, and staying compliant with the 90837 CPT code.
What Is CPT Code 90837?
CPT code 90837 is defined as "Psychotherapy, 60 minutes with patient." It's the highest-level individual psychotherapy code and represents:
Face-to-face time: 53–60 minutes of direct patient contact
Service type: Individual psychotherapy (not group or family)
Provider types: Licensed mental health professionals including psychiatrists, psychologists, LCSWs, LMFTs, and LPCs
The 90837 CPT code description specifically requires that the entire session be dedicated to psychotherapy—not medication management, case management, or administrative tasks.
90837 CPT Code Reimbursement Rates
Reimbursement for the 90837 CPT code varies significantly based on:
Geographic location: Medicare rates range from $120–$180
Insurance type: Commercial payers often reimburse 10–30% above Medicare rates
Provider credentials: MD/PhD providers may receive higher rates than master's level clinicians
Facility vs. non-facility: Office-based services typically reimburse higher than hospital outpatient
Current 2024 Medicare national average for 90837 is approximately $152.48 for non-facility settings.
Documentation Requirements for CPT Code 90837
Insurance auditors expect specific elements in every 90837 CPT code documentation:
1. Time Documentation
Start and stop times must be clearly documented
Total face-to-face time must be 53–60 minutes
Any interruptions should be noted and time adjusted accordingly
2. Medical Necessity
Clear diagnosis supporting need for 60-minute sessions
Documentation of complexity requiring extended time
Treatment plan goals addressed in session
3. Session Content
Therapeutic interventions used
Patient response to interventions
Progress toward treatment goals
Any barriers to treatment addressed
4. Clinical Rationale
Why 60 minutes was clinically necessary (not just scheduled)
How extended time benefited the patient
Ongoing need for this level of service
Common 90837 CPT Code Billing Errors
Auditors frequently cite these documentation and billing mistakes:
Routine use without medical necessity
Billing 90837 for all patients regardless of clinical need
Solution: Match session length to patient acuity and document rationale
Time padding or rounding
Billing 90837 for 50-minute sessions
Solution: Use 90834 (45 minutes) when appropriate
Inadequate session notes
Generic or templated documentation
Solution: Include specific interventions and patient responses
Missing time documentation
No start/stop times recorded
Solution: Document exact session times, not scheduled times
When to Use 90837 vs. Other Psychotherapy Codes
Choosing the correct CPT code prevents compliance issues:
90832 (16–37 minutes): Brief sessions, crisis intervention
90834 (38–52 minutes): Standard therapy sessions
90837 (53–60 minutes): Complex cases requiring extended time
90838 (60+ minutes with E/M): Add-on code for crisis psychotherapy
The 90837 CPT code should be reserved for patients with:
Severe symptoms requiring intensive intervention
Complex trauma work
Multiple comorbidities
Crisis situations requiring extended stabilization
Insurance Audit Red Flags for 90837
Payers flag these patterns for review:
High volume billing: More than 50% of sessions billed as 90837
Consistent patterns: Every session with certain patients is 60 minutes
Diagnosis mismatch: Mild conditions billed with extended sessions
Documentation gaps: Missing time stamps or clinical rationale
Best Practices for 90837 CPT Code Compliance
1. Establish Clear Policies
Define when 60-minute sessions are clinically appropriate
Create documentation templates that capture required elements
Train staff on time tracking and documentation standards
2. Implement Quality Checks
Regular internal audits of 90837 claims
Compare billing patterns across providers
Review denied claims for documentation issues
3. Use Technology for Compliance
EMR prompts for required documentation elements
Automated time tracking to ensure accuracy
AI-powered compliance monitoring to catch errors before billing
How Brellium Helps with 90837 CPT Code Compliance
Managing 90837 CPT code compliance across multiple providers and locations is challenging. Brellium's AI-powered platform automatically:
Verifies time documentation: Flags sessions missing start/stop times or falling short of 53 minutes
Checks medical necessity: Ensures documentation supports the need for extended sessions
Identifies patterns: Alerts when providers bill 90837 at rates that may trigger audits
Prevents claim denials: Catches documentation gaps before claims submission
By automating these compliance checks, Brellium helps behavioral health organizations reduce audit risk, improve documentation quality, and maintain appropriate billing practices.
Learn more: Brellium's Clinical Compliance Platform
Telehealth Considerations for 90837
With the expansion of telehealth, additional considerations apply:
Modifier usage: Use modifier 95 for telehealth services
Platform documentation: Note the telehealth platform used
Technical issues: Document any interruptions and actual therapy time
State regulations: Ensure compliance with state-specific telehealth rules
Future Changes to 90837 CPT Code
Stay informed about potential changes:
CMS continues to review psychotherapy code valuations
Documentation requirements may become more stringent
Telehealth regulations continue to evolve post-pandemic
Regular training and compliance monitoring help practices adapt to changing requirements while maintaining revenue integrity.
External Resources for 90837 CPT Code
American Medical Association CPT Resources – Official CPT code descriptions and updates
CMS Physician Fee Schedule – Current Medicare reimbursement rates
APA Practice Central – Billing and coding resources for mental health providers
