90837 CPT Code for Therapy Sessions: How To Use It

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The 90837 CPT code is one of the most commonly used CPT codes for extended therapy sessions, but there are specific rules and requirements for using it. 

If you don’t document correctly or understand what qualifies, you could have insurance claims or audit issues.

Next, we’ll cover the key aspects of the 90837 CPT code, from its intended use to best practices for documentation. 

What Is the CPT Code 90837

CPT Code 90837 is used for 60-minute therapy sessions; it’s designed specifically for licensed mental health professionals who provide in-depth psychotherapy. 

It gives clients the space they need to express their concerns, develop coping methods, and manage emotional or behavioral difficulties.

This code works for various therapy types, like cognitive-behavioral therapy (CBT), eye movement desensitization and reprocessing (EMDR), and other psychotherapeutic methods.

To qualify for 90837, the session must include at least 53 minutes of face-to-face time. This ensures the patient benefits from a longer, more detailed session tailored to their needs.

Documentation Requirements

Documentation is necessary when billing for 90837. Insurers often closely review claims for longer sessions, so recording everything properly is vital to justify the duration. 

Here’s what should be included:

  • Session Details: Record the patient’s name, session date, start and stop times, and the location of the service. These basics are necessary for accurate billing.
  • Patient-Centered Observations: Note the patient’s emotional state, symptoms, and behavior. This information illustrates why the session required the full 60 minutes.
  • Clinical Interventions: Detail the therapeutic techniques used (e.g., CBT, EMDR). This shows the specific methods applied to address the patient’s needs.
  • Progress Assessment: Include observations on how the session contributed to the patient’s goals. This helps justify the extended session by showing progress or the need for continued support.
  • Clinical Risk Assessment: Document any acute symptoms like suicidal thoughts or severe anxiety. Highlighting these issues supports the necessity of a longer session.
  • Next Steps: Outline plans for future sessions or interventions. This demonstrates a structured approach and continuity in the patient’s care.

Time Frame for 90837

To bill using CPT Code 90837, the session must last at least 53 minutes and be direct, face-to-face. 

Make sure to record start and end times precisely. Remember, administrative tasks like scheduling, note-writing, or payment processing don’t count toward the session duration.

If the session is shorter than 53 minutes, using a different code is better. Accuracy is key to ensuring that billing aligns with actual session lengths.

Differences Between 90837, 90834, and 90832

Therapists have three main CPT codes for individual therapy sessions, each based on the duration; choosing the right one ensures accurate billing and documentation. 

Here’s a breakdown:

  • 90837: 60-Minute Sessions. As noted before, it applies to sessions lasting 60 minutes, with at least 53 minutes of direct interaction. Suitable for addressing complex issues needing extended time.
  • 90834: 45-Minute Sessions. This is used for sessions between 38 and 52 minutes. It’s suitable for situations that need more time than a brief session but don’t require a full hour.
  • 90832: 30-Minute Sessions. This code applies to shorter therapy sessions lasting between 16 and 37 minutes. It’s often used for brief check-ins or focused interventions.

Insurance Considerations for 90837

Insurance providers often closely review 90837 claims due to the longer session duration and higher reimbursement rate. 

Proper documentation is vital to avoiding issues. Ensure to keep in mind these aspects:

  • Scrutiny and Audits: Due to higher reimbursement, insurers may audit claims involving 90837. Clear documentation helps prevent disputes.
  • Justifying Medical Necessity: Explain why a shorter session code wouldn’t suffice, emphasizing symptom severity or case complexity.
  • Documentation to Support Use: Include detailed notes on the patient’s condition, treatment methods, and progress to justify the session length.

Licensing Requirements for Using CPT Code 90837

Not all mental health professionals can bill under CPT Code 90837; only these licensed providers can use this code:

  • Clinical Psychologists (PhD or PsyD).
  • Psychiatrists (MD).
  • Licensed Clinical Social Workers (LCSWs).
  • Licensed Professional Counselors (LPCs).
  • Licensed Marriage and Family Therapists (LMFTs). 

Importance of Accurate Documentation

Clear, precise documentation supports the claim for a 60-minute session by showing the patient’s needs and the interventions used. 

Include specific details like the session start and end times, a summary of the patient’s condition, and the therapeutic methods applied. This helps meet insurance guidelines and provides a solid record for future reference.

Using CPT Code 90837: Frequently Asked Sections

Wondering how to use CPT Code 90837 correctly? The following questions and answers cover the most important details about it:

1. What should I do if an insurance provider questions my use of 90837?

If that occurs, provide thorough documentation outlining the session’s medical necessity, including symptom severity or case complexity.

2. Are telehealth sessions eligible for billing under 90837?

Many insurers accept 90837 for telehealth sessions if they meet the time requirements. Always confirm with each insurance provider.

3. Can a trainee or intern bill for 90837 if supervised?

Generally, only licensed professionals can bill for 90837. However, some insurers may allow billing under a supervisor’s credentials if they oversee the session directly.

4. Are there limits on how often 90837 sessions can be billed?

Some insurance companies limit the frequency of 90837 sessions. Review policy guidelines to ensure compliance and avoid claim denials.

5. How can I justify the medical necessity for a 60-minute session?

Document the patient’s symptoms and therapeutic needs, such as trauma or severe conditions, and explain why shorter sessions wouldn’t be sufficient.

6. Is it possible to switch codes if the session duration changes mid-session?

Yes, if the session ends up being shorter (e.g., 45 minutes), you can switch to CPT Code 90834 and update the documentation accordingly.

7. Is 90837 appropriate for couples therapy?

No, 90837 is for individual therapy sessions. Use codes like 90847 (family therapy with the patient present) for couples therapy.

8. Do I need to update my billing practices based on changes to CPT codes?

Yes, staying updated on any annual changes to CPT codes and reimbursement rates is essential to ensure compliance.

9. How does CPT Code 90837 affect overall reimbursement rates for my practice?

90837 has a higher reimbursement rate, which can boost revenue per session. However, detailed documentation is necessary to support the code’s use effectively.

Manage Your Practice’s Billing The Smart Way

Getting the most out of CPT Code 90837 is crucial for delivering effective care and ensuring precise billing in your practice. This improves patient outcomes and strengthens your services’ financial health and efficiency.

If you need help with billing or understand the nuances of CPT codes, Medical Claims Billing is here to help. Our billing services for independent providers prioritize quality, detail, and responsiveness.

Ready to see tangible improvements in your billing? Let’s get started.

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