CPT code 90837 is used to report psychotherapy services involving approximately 60 minutes with a patient. It is a time-based psychotherapy code and is commonly associated with longer individual therapy sessions where the clinician needs sufficient time to assess symptoms, apply therapeutic interventions, address treatment goals, and evaluate patient progress. CMS guidance indicates that psychotherapy codes 90832, 90834, and 90837 are selected according to the actual psychotherapy time, with 53 minutes or more supporting 90837 under the cited Medicare billing guidance.
For behavioral health providers, correctly reporting CPT 90837 requires more than selecting the appropriate procedure code. The medical record should support the patient’s condition, medical necessity, psychotherapy time, therapeutic techniques, treatment goals, and progress. Payer requirements can also differ, so providers should verify individual plan policies before submitting claims.
For practices handling a large volume of behavioral health claims, accurate documentation, eligibility verification, coding, claim submission, and denial follow-up can make the billing process more organized and reduce avoidable administrative problems.
Introduction to CPT Code 90837
CPT 90837 represents psychotherapy, 60 minutes with the patient. Although the CPT descriptor refers to 60 minutes, Medicare billing guidance uses a time range and indicates that 53 minutes or more falls within the reporting range for 90837. CMS also states that psychotherapy codes are time-based and that the medical record should document the start and stop times or total psychotherapy time.
This code may be appropriate when a psychotherapy encounter requires a longer session to address clinically relevant concerns. For example, a patient may be receiving therapy for anxiety, depression, trauma-related symptoms, behavioral difficulties, or other mental health conditions that require ongoing therapeutic intervention. The AMA’s clinical example for 90837 describes psychotherapy involving assessment of symptoms, thoughts, feelings, behaviors, psychosocial stressors, coping styles, and therapeutic approaches designed to reduce distress and improve functioning.
A provider should not select 90837 simply because a patient is scheduled for a one-hour appointment. The actual psychotherapy service and documented time must support the code. If the psychotherapy time is shorter, another psychotherapy code may be more appropriate. CMS guidance identifies 90834 for 38–52 minutes and 90837 for 53 minutes or more in the cited Medicare billing framework.
It is also important to distinguish 90837 from related services. Codes 90832, 90834, and 90837 describe psychotherapy without medical evaluation and management, while 90833, 90836, and 90838 are psychotherapy add-on codes used with qualifying E/M services.
When Can CPT 90837 Be Used?
CPT 90837 may be reported when a qualified provider performs an appropriately documented psychotherapy service that meets the applicable payer’s requirements. The session should involve actual therapeutic services rather than simply administrative discussion or routine communication.
A longer psychotherapy session can allow the provider to:
- Evaluate current symptoms and behavioral changes.
- Discuss treatment goals and barriers.
- Apply appropriate therapeutic techniques.
- Review the patient’s response to previous interventions.
- Address psychosocial stressors affecting treatment.
- Develop or modify treatment strategies.
- Assess progress toward established goals.
Medical necessity remains an important consideration. CMS coverage guidance states that psychotherapy should be medically reasonable and necessary for the patient’s condition and that the type, frequency, and duration of treatment should be appropriate to the patient’s clinical circumstances.
Therefore, the decision to report 90837 should be based on the service actually provided and the documentation supporting that service—not simply on appointment length.
How Patients May Benefit From a 90837 Session
From the patient’s perspective, a longer psychotherapy appointment provides additional time for meaningful therapeutic work. Some patients may need more than a brief discussion to explore symptoms, identify behavioral patterns, or work through issues affecting their daily functioning.
During a longer session, a therapist may address several related treatment objectives while maintaining a structured therapeutic approach. Depending on the patient’s treatment plan, the session could involve cognitive or behavioral strategies, supportive interventions, problem-solving, coping techniques, behavioral modification, or other clinically appropriate psychotherapy approaches.
The AMA’s description of a typical 90837 encounter includes therapeutic communication, review of the patient’s current condition, examination of mental and behavioral changes, exploration of psychosocial stressors, and use of psychotherapy approaches intended to reduce distress and morbidity.
Patients should understand, however, that CPT 90837 is a billing and coding designation, not a guarantee that a payer will cover every 60-minute therapy session. Coverage, authorization, provider eligibility, frequency limitations, and other requirements can vary by insurance plan.
Documentation Requirements for CPT 90837
Documentation is one of the most important parts of accurate psychotherapy billing. CMS guidance requires the medical record to support the medical necessity of the service and document the psychotherapy time.
For 90837, documentation should generally make the following information clear:
- Date of service.
- Patient identification.
- Provider identification and signature, as applicable.
- Total psychotherapy time or appropriate
- start and stop times.
- Type of psychotherapy service.
- Clinical reason for treatment.
- Relevant symptoms or behavioral concerns.
- Therapeutic interventions used.
- Patient participation and response.
- Treatment goals.
- Progress toward established goals.
- Changes in symptoms or functioning.
- Updated treatment plan when appropriate.
CMS specifically identifies documentation of psychotherapy time and therapeutic maneuvers such as behavioral modification, supportive interaction, and interpretation as important elements of psychotherapy documentation. It also identifies session content, therapeutic approaches, patient participation, and progress toward treatment goals as relevant documentation components.
The note should tell a logical clinical story: why the patient required treatment, what occurred during the session, what intervention was provided, and how the patient responded.
How Providers Can Help Prevent 90837 Claim Denials
Claim denials can occur for many reasons, and no billing process can guarantee payment. However, providers can reduce avoidable problems by reviewing claims before submission.
One of the most important steps is ensuring that the documented psychotherapy time supports the reported code. CMS states that 90837 is a time-based service and that the medical record should contain the start and stop times or total time.
Providers should also check:
Medical necessity: The diagnosis and clinical documentation should support why psychotherapy was needed.
Accurate coding: The reported CPT code should correspond to the actual service and time.
Complete notes: Missing treatment details can make it difficult for a payer to validate the service.
Eligibility: The patient’s insurance should be active for the date of service.
Authorization: If the payer requires prior authorization or a specific number of therapy sessions, those requirements should be checked.
Provider enrollment: The rendering provider’s payer enrollment and credentialing information should be accurate.
Claim information: Patient demographics, diagnosis codes, CPT code, modifiers, payer information, and other required claim fields should be reviewed before submission.
CMS notes that each reported service must be supported by the medical record and that medical necessity should be clearly demonstrated.
What Role Do Payers Play in CPT 90837?
Insurance payers play an important role in determining whether a submitted 90837 claim meets their coverage and reimbursement requirements. Although CPT establishes the procedure code, the payer may have additional policies concerning medical necessity, provider qualifications, authorization, frequency, documentation, telehealth, and reimbursement.
This distinction is important because CPT coding does not automatically mean a service is covered or payable. The AMA itself notes that its CPT information does not dictate payer coverage or reimbursement policies.
Providers should therefore verify payer-specific requirements before rendering and billing services whenever possible. Medicare policies, commercial insurance policies, Medicaid requirements, and individual health plans may differ.
Payer policies may also change over time. A billing team should therefore maintain current payer information rather than relying on outdated requirements.
Common Billing Issues Associated With 90837
Several administrative and documentation problems can create complications when submitting psychotherapy claims.
Common issues include:
- Incorrect psychotherapy code selection.
- Insufficient documented time.
- Missing or incomplete psychotherapy notes.
- Diagnosis information that does not support medical necessity.
- Missing authorization where required.
- Incorrect provider or payer information.
- Eligibility problems.
- Incorrect claim modifiers or place-of-service information.
- Duplicate claims.
- Failure to follow payer-specific billing policies.
Another important distinction involves psychotherapy performed with an E/M service. CMS identifies 90833, 90836, and 90838 as psychotherapy add-on codes used with appropriate E/M services, while 90832, 90834, and 90837 represent psychotherapy without medical management.
Correctly distinguishing these services can help prevent coding inconsistencies and unnecessary claim corrections.
How Medical Billing Companies Support 90837 Billing
Medical billing companies can assist behavioral health practices by handling administrative tasks associated with the revenue cycle. Their role may include patient eligibility verification, insurance verification, authorization checks, charge entry, claim submission, payment posting, denial management, accounts receivable follow-up, and reporting.
For CPT 90837 specifically, a specialized billing team can review claims for common administrative issues before submission and identify missing information that may require provider clarification.
A billing company can also monitor rejected and denied claims, determine the reason for the payer response, prepare appropriate corrections or appeals when supported by the record, and follow up on outstanding accounts.
This allows clinicians to spend more time on patient care while administrative staff or a billing partner manages the financial workflow.
Importantly, billing professionals do not replace the provider’s responsibility for clinical judgment and documentation. The clinician remains responsible for accurately documenting the service and selecting the appropriate clinical information, while the billing team can support the administrative and claims process.
CPT 90837 and Revenue Cycle Management
Effective revenue cycle management involves much more than sending claims. For behavioral health practices, the process can begin before the appointment and continue until the claim is fully adjudicated.
A structured workflow may include:
Before the visit: Verify eligibility, benefits, authorization requirements, and provider information.
During documentation: Ensure the clinical record accurately reflects the service provided and the time involved.
After the visit: Review charges and claim information for accuracy.
Claim submission: Send a clean claim with appropriate patient, provider, diagnosis, procedure, and payer information.
Payment posting: Record payer payments, adjustments, and patient responsibility.
Denial management: Investigate rejected or denied claims and take appropriate follow-up action.
Accounts receivable: Monitor unpaid claims and outstanding balances.
This process can help practices identify problems earlier instead of discovering them after a claim has already been denied.
Building a Consistent 90837 Billing Process
A consistent billing workflow can make CPT 90837 management easier for behavioral health practices. Providers and billing teams can establish internal checklists covering documentation, coding, eligibility, authorization, and claim submission.
For example, a practice may review whether:
- The patient’s insurance was verified.
- The provider is properly enrolled with the payer.
- Authorization requirements were checked.
- The actual psychotherapy time was documented.
- The treatment note supports medical necessity.
- The therapeutic interventions are described.
- Patient response and progress are recorded.
- The correct CPT and diagnosis codes are reported.
- The claim was reviewed before submission.
Denials are tracked and addressed promptly.The exact requirements should always be confirmed against the applicable payer policy and current coding guidance.
Conclusion
CPT code 90837 is an important psychotherapy billing code for longer therapy sessions. While it is commonly described as psychotherapy for 60 minutes, Medicare guidance uses 53 minutes or more for reporting 90837 within the applicable psychotherapy time ranges.
Successful 90837 billing depends on more than choosing a CPT code. Providers need documentation that supports the patient’s condition, medical necessity, actual psychotherapy time, therapeutic interventions, treatment goals, and progress. Payer-specific requirements should also be verified because coverage and reimbursement policies can differ.
For behavioral health practices, professional medical billing support can help organize eligibility verification, claim preparation, submission, payment posting, denial management, and accounts receivable follow-up. A well-managed billing process can reduce administrative burden and help providers maintain a more consistent revenue cycle.
