How to bill insurance for extended therapy sessions

When therapists provide clients extended sessions longer than 60 minutes, they face unique billing challenges.

Since the American Medical Association’s 2013 CPT code overhaul eliminated codes for extended sessions, therapists have needed to develop alternative strategies for appropriate compensation.

The standard individual psychotherapy codes remain limited to three timed options:

• 90832: 30-minute session (16-37 minutes)
• 90834: 45-minute session (38-52 minutes)
• 90837: 60-minute session (53+ minutes)
  

  The challenge of extended sessions

  With the 90837 code designated for sessions over 53 minutes, insurance companies have traditionally had no way to distinguish between a standard 60-minute session and longer therapeutic interventions, potentially limiting reimbursement for extended clinical work.

Current reimbursement landscape (2025)

Insurance reimbursement policies for the 60-minute code (90837) vary significantly between plans:

• Different Rate Plans: Many insurers now recognize the value of 60-minute sessions and reimburse at a higher rate than the 45-minute code (90834).
• Same Rate Plans: Some plans continue to reimburse 90837 and 90834 at identical rates, effectively discouraging longer sessions.
• Preauthorization Requirements: Certain plans (notably UnitedHealthcare/Optum) still require preauthorization for routine use of 90837, though they typically approve a limited number of extended sessions for specific evidence-based treatments like EMDR or prolonged exposure therapy.

Best Practice: Before regularly using the 90837 code, contact each insurance plan to verify their current policy on coverage, reimbursement rates, and any preauthorization requirements.

Crisis session billing options

For crisis intervention sessions, specialized codes remain available:

• 90839: First 60 minutes of psychotherapy for a crisis
• 90840: Each additional 30 minutes (add-on code used with 90839)

These codes require documentation that meets crisis criteria, including acute distress and the need for immediate intervention to stabilize the client.

The split-billing approach

A practical solution many therapists employ is a split-billing approach:

1. Bill the insurance company for one standard session (90834 or 90837).
2. Contract privately with the client to pay out-of-pocket for additional time.

This approach is permissible under most provider agreements, as clients can always privately contract for services not covered by their insurance. For network providers, best practice is to:

• Charge your contracted network rate for the additional time
• Provide a written Private Pay Agreement clearly explaining the arrangement
• Document the client’s informed consent to this payment structure

Example: If your network rate is $120 for a 60-minute session and you conduct a 90-minute session, you would bill insurance for the first 60 minutes (with the client responsible for any copay/deductible) and charge the client directly for the additional 30 minutes (typically $60).

Prolonged service codes in 2025

Since 2016, the AMA has allowed add-on codes for Prolonged Services (99354 and 99355) to be used with 90837 for sessions lasting 90 minutes or longer. As of 2025, these codes have gained wider acceptance among insurers for mental health providers, though coverage varies by plan.

When using these codes:

1. Bill 90837 for the first 60 minutes
2. Bill 99354 for the next 30-74 minutes
3. Bill 99355 for each additional 30 minutes beyond that

Billing examples:

• 90-minute session: 90837 + 99354 (first 30 minutes of extended time)
• 120-minute session: 90837 + 99354 (first 74 minutes of extended time)
• 150-minute session: 90837 + 99354 + 99355 (additional 30 minutes)

Important: Each code should be listed on a separate line for the same date of service. Always verify acceptance of these codes with each insurance payer before implementation.

Family and couples extended sessions

For extended family or couples therapy sessions, different billing protocols apply:

• Use 90847 (family/couples therapy with client present) or 90846 (family therapy without client present)
• The Prolonged Service add-on codes (99354/99355) cannot be used with family therapy codes
• Individual therapy codes can only be used when a family member briefly joins an individual session as an informant, with the identified client present for at least part of the session

In 2025, some insurers now recognize the extended family therapy code 90849 for multi-family group therapy sessions exceeding 75 minutes, though coverage varies significantly by plan.

Conclusion and extended session billing best practices

To maximize reimbursement for extended sessions:

1. Verify each insurer’s policies regarding 90837 and Prolonged Service codes
2. Document medical necessity for extended sessions
3. Consider a split-billing approach where appropriate
4. Obtain written informed consent for any out-of-pocket arrangements
5. Regularly review insurer policy updates, as reimbursement practices continue to evolve

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