Understanding the 90837 CPT Code
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Understanding when to use the 90837 CPT code is an essential part of running a private practice for mental health practitioners who accept insurance.
To be knowledgeable about psychotherapy CPT codes, you’ll need to understand the documentation requirements for each code, which codes to use for in-person versus telehealth appointments, and the time range to bill for.
This guide provides a comprehensive overview of psychotherapy CPT codes and, specifically, details on the 90837 CPT code.
What are psychotherapy CPT codes?
The American Medical Association (AMA) created Current Procedural Terminology (CPT®) to describe healthcare procedures and services.
Using CPT codes allows clinicians to use a uniform language to improve accuracy, streamline reporting, and track health information.
Mental health clinicians use CPT codes for insurance reimbursement with federal agencies like Medicare, Medicaid, and commercial insurance plans. They can also be used when providing clients with superbills, so they can submit a claim to their insurance.
Understanding common psychotherapy CPT codes ensures you use uniform language to denote services rendered so you can avoid delays in insurance reimbursements.
What is CPT code 90837?
The 90837 CPT code description denotes a 60-minute psychotherapy session with a licensed mental health professional for outpatient care.
This CPT code is also referred to as a time-based code. While most psychotherapy sessions last 45 minutes, there may be occasions where it is clinically necessary for sessions to run longer—when treating a client who is processing trauma, for example.
In these instances, clinicians should reflect on the duration of the psychotherapy session and bill the correct CPT code.
CPT code 90837 time range
Psychotherapy CPT codes generally reflect a time range. For example, the difference between CPT code 90837 vs 90847 is simply in the duration of the therapy session.
The following three psychotherapy CPT codes are time-based codes:
- 90832 (30 minutes of psychotherapy)
- 90834 (45 minutes of psychotherapy)
- 90837 (60 minutes of psychotherapy)
According to the American Psychological Association, while there is some flexibility in the application of CPT codes, clinicians must apply a time rule by choosing the code closest to the actual time of the session. For example, the CPT code 90837 time range is 53 minutes or longer.
The 90837 CPT code is the most commonly used psychotherapy code, according to SimplePractice’s list of the Top 10 Mental Health CPT Codes in 2022.
CPT 90837 documentation requirements
There is a history of insurance companies auditing providers who use the 90837 CPT code.
For example, in 2015, EquiClaim—on behalf of Anthem Blue Cross Blue Shield—sent a letter to therapists stating that clinicians using code 90837 in their billing practices may lead to a request for “medical records of members with the intention of identifying any improper coding and recovering associated overpayments.” While they did later apologize, other health plans have sent similar letters.
Thus, it is important that mental health clinicians keep documentation to substantiate their use of psychotherapy CPT codes, like 90837, which includes:
- The understanding that 90837 CPT code should only be used for sessions of 53 minutes or longer
- Client records must indicate the start and stop time of the session
- The time billed only accounts for time in the therapy session and does not include waiting time, scheduling, or documentation
90837 CPT code reimbursement rates
Reimbursement rates vary depending on the insurance provider, type of insurance, location, and expertise of the clinician.
For example, 90837 CPT code is currently reimbursed as follows:
- Medicare pays $147.07 on average nationally
- Payers in New York may pay an average of $144.83
- A clinician in Palo Alto, CA may be reimbursed $200 compared to an average of $150 in Los Angeles
- Psychologists in Oregon may be paid $136.50 versus a licensed counselor in the same state who would be paid a median average of $100.10
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