CPT Code 90837: When and How to Maximize Reimbursement for Therapists

Longer therapy sessions often provide the depth and time needed to address complex issues that shorter sessions may not fully cover. If you’re looking to ensure fair compensation for these extended sessions, CPT Code 90837 is an essential billing code to master. It’s designed for individual psychotherapy sessions that last 53 minutes or more, but using it correctly can sometimes be tricky—leading to potential billing challenges or under-reimbursement if not applied properly.

Understanding how and when to apply CPT Code 90837 not only ensures that you're compensated fairly for your time but also reflects the comprehensive, in-depth care that longer sessions provide. Whether you regularly conduct hour-long sessions or occasionally extend your therapy time for particularly complex cases, this code helps you communicate to insurers the true value of the service provided.

In this guide, we’ll break down the specifics of CPT Code 90837, focusing on the criteria for its appropriate use, common pitfalls to avoid, and practical tips for optimizing reimbursement. 

What is the CPT Code 90837?

Therapists use CPT code 90837 to bill for psychotherapy sessions lasting 53-60 minutes. It replaced the previous code 90808 in 2013.

This code applies to individual psychotherapy sessions that need more time than the standard 45 or 50-minute session (billed under CPT code 90834). It lets therapists bill for longer, more intensive sessions when clinically necessary.

When to use CPT Code 90837

CPT code 90837 applies to individual psychotherapy sessions lasting 53+ minutes. Here are some situations where this code fits well:

• Complex or severe mental health conditions: Clients with more severe symptoms or complex diagnoses might need longer sessions to properly address their needs.
• Trauma-focused therapy: Processing traumatic experiences often requires extended sessions to ensure the client feels safe, supported, and not rushed through the healing process.
• In-depth exploration of emotions and thoughts: When a client needs more time to thoroughly discuss their feelings, beliefs, and experiences, a longer session might be necessary.
• Significant life transitions or crises: Major life changes or crises, such as divorce, job loss, or bereavement, might need additional time to process and develop coping strategies.
• Allowing space for culturally specific communication styles: Longer sessions can provide the necessary time to accommodate diverse ways of sharing information, such as storytelling, pauses for reflection, or indirect communication, ensuring clients feel respected and understood without rushing the therapeutic process.

To use CPT code 90837 correctly, consider these guidelines:

1. Medical necessity: The longer session length should be medically necessary and clinically justified based on the client's specific needs and treatment goals.
2. Documentation: Progress notes must clearly reflect the content and duration of the session, showing the need for the extended time.
3. Time spent: At least 53 minutes of the session must be spent providing direct psychotherapy services to the client.
4. Frequency: Use CPT code 90837 judiciously, as not every client will need extended sessions regularly.
5. Preauthorization: Some insurance companies require prior authorization and reauthorization before using CPT code 90837; therapists should verify and obtain necessary approvals to ensure coverage and timely reimbursement for extended psychotherapy sessions.

Remember, while longer sessions can benefit some clients, it's important to use CPT code 90837 correctly to ensure accurate billing and stay compliant with insurance requirements.

When not to use CPT Code 90837

While CPT code 90837 works well for longer therapy sessions, it's not always the right choice. Consider alternative codes in the following situations:

• Sessions under 53 minutes: If your session lasts less than 53 minutes, you'll need to use a different code, such as 90834 for 45-minute sessions or 90832 for 30-minute sessions.
• Group therapy: CPT code 90837 is specifically for individual psychotherapy. For group therapy sessions, use codes like 90853 for sessions longer than 45 minutes.
• Family or couples therapy: When treating multiple family members or a couple, 90837 doesn't apply. Instead, use codes 90847 for family psychotherapy with the patient present or 90846 for sessions without the patient.

Avoid these common pitfalls when using CPT code 90837:

1. Overusing the code: Not every client needs 60-minute sessions every time. Use 90837 only when medically necessary.
2. Insufficient documentation: Your progress notes must clearly justify the need for the extended session time. Failing to document properly can lead to denied claims or audits.
3. Upcoding: Don't use 90837 if you didn't spend at least 53 minutes in direct psychotherapy with the client. Using this code for shorter sessions is considered upcoding and can result in legal issues.

Accurate coding ensures proper reimbursement and compliance. When uncertain, consult the latest CPT guidelines or seek guidance from a qualified billing specialist.

Requirements and Billing Criteria for CPT Code 90837

Therapists must meet certain documentation and billing criteria to receive proper reimbursement and remain compliant when using CPT code 90837. Here are the key requirements:

• Preauthorization: Some insurance companies require authorization for the use of the 90837 CPT code prior to the start of session to. Ensure your actions are in compliance with the requirements of the different insurance companies you are paneled with. 
• Session length: The psychotherapy session must last at least 53 minutes to qualify for CPT code 90837. Time spent on documentation or other administrative tasks does not contribute to the 53-minute minimum.
• Medical necessity: The extended session length must be medically necessary and clinically justified based on the client's particular needs and treatment goals. This should be clearly documented in the progress notes.
• Documentation: For reimbursement, progress notes must include elements such as:some text
  • Start and end times of the session
  • Specific therapeutic interventions used
  • Client's response to the interventions
  • Progress towards treatment goals
  • Rationale for the extended session length, which may include client symptoms and functional impairment
• Diagnosis: The client's diagnosis must support the need for the extended session time. Use the correct ICD-10 codes to establish medical necessity.
• Frequency: Although some clients may benefit from longer sessions, CPT code 90837 should not be used for every session. Overuse of this code may result in audits or denials from insurance companies.
• Proper billing: When submitting claims, use CPT code 90837 along with the appropriate ICD-10 code(s) and any required modifiers. Double-check the accuracy of all codes and documentation before submitting.

Keeping informed about the latest billing guidelines and regulations is important for maintaining compliance. Regularly review updates from professional organizations, insurance providers, and government agencies to ensure your billing practices align with current standards.

Common Pitfalls to Avoid for CPT Code 90837

When using CPT code 90837, therapists should be aware of potential pitfalls that can lead to denied claims or compliance issues. Here are some common errors to avoid:

1. Insufficient documentation: Without detailed progress notes that justify the need for extended sessions, claims may get denied. Ensure your documentation clearly shows the medical necessity for the 53-60 minute session.
2. Overusing the code: While longer sessions can benefit some clients, using CPT code 90837 for every session might raise concerns with insurance companies. Save this code for situations where the extended time is truly necessary and well-supported by documentation.
3. Upcoding: Using CPT code 90837 for sessions lasting less than 53 minutes is considered upcoding and can lead to audits, denied claims, or legal consequences. Only use this code when you have spent at least 53 minutes providing direct psychotherapy services to the client.
4. Incorrect diagnosis codes: Pairing CPT code 90837 with an incorrect or unsupported ICD-10 diagnosis code can result in denied claims. Make sure the client's diagnosis justifies the need for extended sessions and that you use the correct codes.
5. Neglecting time requirements: Failing to track and document the start and end times of the session can make it difficult to prove that the 53-minute minimum was met. Implement a consistent method for tracking session duration to avoid this issue.

To prevent these mistakes, stay updated on the latest coding guidelines, use templates or checklists to ensure comprehensive documentation, and regularly review your billing practices for accuracy and compliance. When uncertain, consult with a qualified billing specialist or seek guidance from professional organizations to ensure correct use of CPT code 90837.

How to Improve Your CPT Code 90837 Reimbursement

As a therapist, getting the most out of your reimbursement for CPT code 90837 is important for keeping your practice successful. Here are some strategies to help you achieve better reimbursement:

1. Accurate documentation: Make sure your progress notes clearly justify the medical necessity for extended sessions. Use templates or checklists to capture all required information, such as start and end times, interventions used, and client responses.
2. Proper coding: Always use the correct CPT and ICD-10 codes when billing for 90837. Double-check your codes before submitting claims to avoid denials or audits.
3. Stay updated: Keep informed about the latest billing guidelines and regulations. Regularly review updates from insurance providers, professional organizations, and government agencies to ensure compliance.
4. Leverage technology: Implement practice management software or EHR systems with built-in coding assistance and automated claim scrubbing. These tools can help reduce errors and improve efficiency.
5. Analyze your data: Use data analytics to identify trends in your billing performance. Regularly review your claim data to spot areas for improvement and compare against industry standards.
6. Train your staff: Invest in ongoing education for your billing staff to ensure they are familiar with the latest coding standards and best practices. Cross-train staff to improve efficiency and coverage.
7. Build payer relationships: Establish open lines of communication with insurance provider representatives. This can help you stay informed about policy changes and navigate any issues that arise.

Frequently Asked Questions (FAQ)

What is the difference between CPT codes 90834 and 90837?

• Session length: CPT code 90834 applies to psychotherapy sessions lasting between 38-52 minutes, while 90837 is for sessions lasting 53+ minutes.
• Reimbursement rates: Because of the longer session time, CPT code 90837 generally comes with a higher reimbursement rate than 90834.

Can I use CPT code 90837 for every therapy session?

While some clients may benefit from longer sessions, using CPT code 90837 for every session isn't always appropriate. This code should only be applied when the extra time is medically necessary and well-documented. Overusing 90837 can lead to audits or denied claims from insurance providers.

What documentation is required for using CPT code 90837?

To correctly apply CPT code 90837, your progress notes must include:

1. Start and end times of the session
2. Specific therapeutic interventions used
3. Client's response to the interventions
4. Progress towards treatment goals
5. Clear rationale for the extended session length, which may include client symptoms and functional impairment

How often can I bill using CPT code 90837?

There is no specific limit on how often you can use CPT code 90837, as long as the extended session time is medically justified and properly documented. However, be cautious about frequent use, as it may raise concerns with insurance providers. Use your clinical judgment to decide when longer sessions are truly necessary and obtain preauthorization if required.

What happens if I bill CPT code 90837 for a session that lasts less than 53 minutes?

Billing CPT code 90837 for sessions lasting less than 53 minutes is considered upcoding and can lead to denied claims, audits, or even legal consequences. It's important to use this code only when you have spent at least 53 minutes providing direct psychotherapy services to the client.

CPT Code 90837 Billing Limitations

While CPT code 90837 allows therapists to bill for longer sessions, it's important to be aware of the limitations and restrictions associated with this code. These limitations can impact billing, reimbursement, and compliance. Here are some key points to keep in mind:

• Overuse: Frequent use of CPT code 90837 may raise concerns with insurance companies. If a therapist bills this code for most of their sessions, it can lead to audits or denied claims. Use 90837 thoughtfully and ensure that the extended session time is medically necessary and well-documented.
• Reimbursement rates: Although CPT code 90837 generally comes with a higher reimbursement rate than shorter session codes like 90834, the exact amount can vary significantly depending on the therapist's contract with the insurer. Review your contracts carefully to understand the payment structure for this code.
• Documentation requirements: Proper documentation is important for billing CPT code 90837. Progress notes must clearly justify the need for the extended session and include specific details such as start and end times, interventions used, and client responses. Insufficient documentation can result in denied claims or audits.
• Time thresholds: CPT code 90837 requires at least 53 minutes of direct psychotherapy with the client. Billing this code for shorter sessions is considered upcoding and can lead to serious consequences. Therapists must carefully track session duration to ensure they meet the minimum time requirement.

As CPT codes are subject to periodic updates and revisions, therapists need to stay informed about any changes or new guidelines related to CPT code 90837. Failing to stay current can result in billing errors and compliance issues. Regularly review updates from professional organizations, insurance providers, and the American Medical Association to ensure your billing practices align with the latest standards.