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90837 CPT Code: A Complete Guide for Therapists Billing 60-Minute Sessions

Stanley Efrem

Feb 19, 2025

The 90837 CPT code gives therapists up to $30 more in reimbursement than shorter session codes and serves as a valuable option for your practice's billing. This code specifically covers psychotherapy sessions that last 60 minutes, making it the longest available duration for individual therapy.

The CPT manual allows you to use the 90837 code when sessions extend beyond 53 minutes. Current denial rates stay low with 5.9% for Medicaid and 4.12% for Medicare, but your claims need proper documentation and a clear understanding of billing requirements.

This complete guide will show you everything about the 90837 CPT code. You'll learn about documentation needs, insurance coverage, and practical ways to implement it in your practice.

Understanding the 90837 CPT Code Basics

What the 90837 code represents

CPT code 90837 represents extended individual psychotherapy sessions. Mental health practitioners like psychologists, psychiatrists, counselors, and social workers use this code when they need to conduct in-depth therapeutic work. The code encompasses several therapeutic approaches. These include discussions about client history, crisis management and detailed treatment plan reviews.

Time requirements for 90837

90837 has specific time requirements. Your sessions must last at least 53 minutes to use this code [2]. You need to document the exact session time in your clinical notes because rounding up or down isn't allowed. The code applies to any session that runs longer than 53 minutes.

Key differences from 90834

The biggest difference between 90837 and 90834 is session length. 90834 covers sessions that run 38 to 52 minutes [2], while 90837 applies to sessions of 53 minutes or more [4]. This time-based difference affects how much you get paid, with 90837 usually bringing higher reimbursement rates [5].

Insurance providers watch 90837 usage carefully. Major insurers like Highmark BCBS and Anthem examine high-volume submissions of this code [3]. You must keep proper documentation that shows why longer sessions are needed medically.

Documentation Requirements for 90837

Documentation is the life-blood of successful 90837 CPT code billing. Medicare Administrative Contractors (MACs) have strict requirements for session documentation [2].

Everything in documentation

Your clinical notes need these key components:

Session Timing: Record exact start and stop times or total duration [6]
Patient Details: Complete name and service dates on every page [6]
Treatment Plan: Document type, frequency, and duration of services [7]
Clinical Progress: Detail symptoms, functional status, and measurable goals [8]
Risk Assessment: Document safety evaluations and any necessary interventions

Your treatment plan needs measurable goals that show progress. Specific metrics work better than general statements. Here's an example: "Patient will reduce anxiety attacks to 2 per week by following techniques learned in sessions for a period of 3 months" [8].

Sample documentation templates

The SOAP (Subjective, Objective, Assessment, Plan) format provides an effective framework for session documentation. This structure includes:

Subjective: Record the patient's self-reported symptoms and concerns Objective: Detail observable behaviors and responses during the session Assessment: Document mental status examination findings Plan: Outline next steps and treatment adjustments

Each note should give a full picture of therapeutic interventions and patient responses. We focused on documenting medical necessity for extended sessions, especially when you have the 90837 code. Your documentation should also show clear connections between interventions and treatment goals [10].

Note that you should complete documentation within 24 hours of the session, but no later than 72 hours. This helps maintain accuracy and meets insurance requirements.

Common Insurance Coverage Challenges

Getting insurance coverage for 90837 sessions comes with its own set of challenges. You need to know each payer's specific policies to get proper reimbursement.

Medicare policies

Medicare currently reimburses 90837 at $147.07 [12]. The Centers for Medicare & Medicaid Services (CMS) lets you bill for several services under this code. These services include monitoring daily living activities, teaching grooming skills, recreational therapy, and social interaction [13].

Private insurance variations

Private insurers have their own distinct policies for 90837 coverage. UnitedHealthcare/Optum has made big changes to their coverage rules. Some UnitedHealthcare and Optum plans now allow 60-minute sessions without prior authorization since 2019 [14]. But some plans still limit the number of extended sessions you can provide.

Insurance companies take a close look at frequent use of 90837. They believe 45-minute sessions work well enough for routine therapy. Extended sessions usually get approval for:

Complex cases
Post-Traumatic Stress Disorder
Panic Disorder
Obsessive-Compulsive Disorder
Specialized treatments like EMDR or Systematic Desensitization [15]

Pre-authorization requirements

Pre-authorization plays a key role for many insurance providers. Your claims might get denied if you don't get the needed approvals. Here's how to avoid payment delays:

Call the insurer before providing services
Check coverage details for extended sessions
Document why the treatment is needed
Get unique authorization numbers when required [14]

Insurance companies keep track of claims data to spot patterns in 90837 usage [17]. This extra attention means you need solid documentation and must follow coverage guidelines to get paid.

Implementing 90837 in Your Practice

The right implementation of the 90837 CPT code needs smart planning and good practice management. Clear policies and procedures will help you stay compliant and maximize your reimbursement potential.

Session scheduling strategies

You need reliable timekeeping methods to track session duration with precision. Practice management software is a great way to get scheduling and documentation support, with features like integrated client management and automated appointment reminders [18]. Set up specific time blocks for 60-minute sessions and add buffer periods between appointments. This prevents burnout and helps maintain quality care [18].

Spread your complex cases throughout your schedule to keep your energy and focus balanced. This way, you can give optimal care to each client throughout the week.

Client communication tips

Your practice's success depends on open dialog about session length and billing. These points need discussion with clients:

How longer sessions benefit complex cases
What to expect in copayment differences
Requirements for insurance coverage verification
Rules for cancelations and scheduling procedures

Document informed consent for extended sessions after discussing it with clients. Check if the session length still matches therapeutic goals as treatment moves forward.

Payment policies

Strong payment policies protect your practice's financial health. Make sure to verify insurance coverage before providing services. Some carriers want specific documentation or pre-authorization for 90837 sessions [21].

Keep detailed records of face-to-face therapy time, but don't include administrative work in the session duration [22]. A prepayment system for appointments might help reduce cancelations and secure steady revenue.

Watch cancelation patterns and no-show rates for 60-minute sessions. This data supports future talks with insurance providers about extended session coverage [23]. Medicare currently reimburses these sessions at $147.07, which makes proper implementation vital for practice sustainability [24].

Conclusion

The right implementation of the 90837 CPT code is crucial to discover the full potential of your therapy practice. Extended sessions need precise documentation and careful insurance navigation. The higher reimbursement rates make them valuable for suitable cases.

Your success with 90837 billing relies on three factors: accurate time tracking, complete documentation, and clear client communication. Medicare's current reimbursement rate of $147.07 definitely makes these sessions financially viable with proper management.

Extended sessions work best for complex cases that need deeper therapeutic intervention. Insurance providers might inspect 90837 claims more closely. However, detailed records and clear medical necessity help ensure successful reimbursement.

You should begin with a few 60-minute sessions and gradually increase their frequency as you improve your documentation and scheduling systems. This measured approach gives you time to refine processes while maintaining quality care standards.

FAQs

What is the 90837 CPT code and when should it be used?

The 90837 CPT code is used for individual psychotherapy sessions lasting 53 minutes or longer. It's designed for extended therapeutic interventions and allows for more in-depth work with clients.

How does the 90837 code differ from the 90834 code?

The main difference is session duration. The 90837 code is for sessions lasting 53 minutes or longer, while 90834 covers sessions between 38 to 52 minutes. The 90837 code typically offers higher reimbursement rates.

What documentation is required when billing with the 90837 code?

Essential documentation includes exact session timing, patient details, treatment plan, clinical progress, and risk assessment. It's crucial to document the medical necessity for longer sessions and complete notes within 24-72 hours of the session.

How do insurance policies vary for 90837 sessions?

Insurance coverage for 90837 sessions varies by provider. Medicare currently reimburses at $147.07, while private insurers may have different policies. Some require pre-authorization, especially for frequent use of this code. It's important to verify coverage specifics with each insurer.

What strategies can therapists use to implement 90837 sessions effectively?

Therapists should invest in reliable timekeeping methods, use practice management software for scheduling, and stagger complex cases throughout their schedule. Clear communication with clients about session length, billing, and cancelation policies is crucial. It's also important to regularly review the appropriateness of session length as treatment progresses.