Psychotherapy is a crucial part of mental health treatment, where billing accuracy plays a significant role in ensuring that providers receive a fair reimbursement for the services they provide to patients. CPT Code 90837 psychotherapy is the standard billing code for a 60-minute psychotherapy session, created for extended and detailed therapeutic interventions.
Mental health professionals should correctly use CPR 90837, as it ensures that their work is in accordance with the payer’s rules and supports financial stability. However, this code usually comes under heavy scrutiny as compared to other shorter psychotherapy codes, making proper documentation and billing practices important.
At RPM CCM Health, we understand the complexities of these documentations; therefore, our teams are more than ready to help you navigate to prevent claim denials and increase your practice’s revenue.
What is CPT Code 90837?
CPT Code 90837 is used to represent psychotherapy sessions lasting 60 minutes. Licensed clinicians who offer structured therapy use this. They are:
- Psychiatrists
- Psychologists
- Licensed Clinical Social Workers (LCSWs)
- Licensed Professional Counselors (LPCs)
- Marriage and Family Therapists (MFTs)
CPT 90837 is booked for longer sessions, demanding extended therapeutic engagement, unlike CPT Code 90834, which is for 45-minute sessions. The appointments for konger sessions might involve trauma-centric care, complicated mental health needs, or situations that need to be deeply explored.
90837 Billing Guidelines
Since 90837 falls in the list of the most frequently scrutinized psychotherapy codes, providers must follow the strict 90837 billing guidelines:
- When to Use: You have to use it only for the sessions that meet the quota of a full 60-minute psychotherapy visit.
- Session Scope: Include face-to-face psychotherapy without fail, not limited to medical management or evaluation.
- Time-Based Billing: Your conducted session length should meet the minimum time requirement, which is at least 53 minutes or more.
- Payer Expectations: Prepare yourself for payer expectations, as some insurers might request extra documents to justify why the session was extended beyond the assigned time.
- Audit Risk: 90837 is more audited than 90834, as the former is frequently overused.
Use the code correctly, and you can prevent claim denials and receive appropriate reimbursements.
90837 Time Requirements
Time-based coding is the core of psychotherapy billing, and CPT 90837 has strict limitations. The 90837 time requirements are as follows:
- Minimum Session Length
Sessions must last a minimum of 53 minutes to bill CPT code 90837 psychotherapy.
- Range of Time
90837 is for covering sessions between 53 and 89 minutes.
- 90834 vs. 90837
If your session lasts 38-52 minutes, CPT 90834 should be used for billing.
Quick Reference
90834 → 45-minute psychotherapy (38–52 minutes)
90837 → 60-minute psychotherapy (53+ minutes)
Track sessions accurately, meaning the starting and ending times, to support billing claims.
Documentation Tips for 90837
90837 documentation tips can make a difference between successful payment reimbursement and denied claims. Because it is at a greater payer review risk, providers should include the following details:
- Session Duration
Mention the start and end time of the session or total minutes.
- Therapeutic Approach
Pen down the kind of psychotherapy provided. For instance, CBT, DBT, and trauma therapy.
- The Progress of the Patient
Record the progress of the patient. This should include how the patient responded to the specific treatment and whether therapeutic goals were adequately addressed.
- Medical Necessity
Write why the session was extended. Was it a complicated case, a crisis management, or trauma being processed?
- Treatment Plan Linkage
Give evidence of how the session matches the patient’s care plan.
- Best Practice
To make documentation easier, the best practice is to use structured templates or EMR prompts. This ensures that the required elements have been included in the report and are audit-proof.
90837 and Medicare Reimbursement
While Medicare reimburses for CPT Code 90837 psychotherapy, you still need to follow the strict compliance requirements:
- Coverage
Medicare Part B covers 90837 for individual psychotherapy when it becomes medically necessary.
- Documentation
The documents you provide must show medical necessity and the length of the session.
- Modifiers
In particular situations or when a patient is managed via telehealth, modifiers like 95 for telehealth might be required.
- Place of Service (POS) Codes
Correct POS coding for office, telehealth, and facility promises claim acceptance.
- Commercial vs. Medicare
A few commercial insurers impose additional restrictions or prior authorization requirements that are not found in Medicare.
Don’t overlook 90837 Medicare reimbursement guidelines because then you will be struggling with claim denials.
Common Billing Challenges with 90837
Many providers encounter obstacles when billing 90837 due to its higher scrutiny level. Common billing difficulties include:
- Payer Denials
Be aware that some insurers may deny claims if they find the session documentation to be insufficient.
- Medical Necessity Questions
The extra time during the psychotherapy session must be justified with the necessary clinical details.
- Audit Requests
Payers usually request detailed notes for auditing purposes.
- Overuse Concerns
Frequently using 90837 without clear paperwork can trigger insurers, compelling them to move with detailed auditing.
Maintaining thorough documentation, including the critical details and understanding payer-specific regulations, can reduce billing challenges.
How RPM CCM Health Can Help Providers?
CPT code 90837 psychotherapy’s billing can be daunting; therefore, allow RPM CCM Health to take over. Our team supports practices and solo providers with the following services:
Our team supports practices and providers with:
- Coding & Compliance Support
We guide to select the correct CPT code and the payer’s rules.
- Billing Assistance
Our assistance during billing reduces denials with accurate claims submission.
- Telehealth Expertise
We ensure correct coding for telehealth so that no issue arises in offering remote psychotherapy services.
- Reimbursement Strategy
We assist you in staying current on Medicare and commercial payer rules.
- Practice Support
RPM CCM Health supports you by providing direct consultation and training for staff and providers.
Get help from us so you can pay attention to patient care and let us manage the behavioral health billing’s technicalities.
Connect With RPM CCM Health Today
If you ever require assistance in navigating CPT code 90837 billing and documentation requirements, connect with RPM CCM Health. We will guide and support you for accurate reimbursement and compliance.
Frequently Asked Questions (FAQ)
Q1: What does CPT code 90837 cover?
A: CPT code 90837 covers a 60-minute psychotherapy session with a patient, involving structured therapeutic interventions.
Q2: How many minutes are required for 90837?
A: 90837 typically requires 53 minutes or more of psychotherapy sessions to meet the compliance.
Q3: Does Medicare reimburse for 90837?
A: Yes, however, you need to follow strict 90837 Medicare reimbursement documentation and compliance rules to avoid claim denials.
Q4: Why is 90837 sometimes denied?
A: It is often denied when payers ask about the medical necessity of prolonged sessions or request extra dicuments of the patients.
