Procedure code 90837, is one of the most frequently billed CPT codes for licensed behavioral health providers. It is used to bill insurance for a 60 minute individual psychotherapy session and is considered a routine outpatient appointment. It’s billed by Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Marriage Family Therapist (LMFT), clinical psychologists and psychiatrists.
How Long are 90837 Sessions? What’s the Difference between 90834 and 90837?
90837 is defined as a session of 60 minutes. The only difference between 90834 (the other commonly used CPT code) and 90837 is the time. 90837 is 60 minutes and 90834 is 45 minutes. Not every therapist does sessions at these exact time intervals. So what about sessions in between?
- 90834 should be billed for sessions between 38-52 minutes. Sessions shorter should be billed with 90832.
- 90837 should be billed for sessions 53 minutes or longer.
Extended Sessions. Individual Sessions Longer than 60 Minutes
There is no CPT code for sessions greater than 60 minutes. So are you out of luck and stuck with just billing 90837? 99354 is defined as a prolonged services code and is defined as an extra 30-74 minutes of therapy. 99354 used to only be allowed by Medical Doctor’s, but has since expanded and is applicable to 90837 and 90487. Since it is an add-on code it must be billed with 90837 or 90847 (90791 and 90834 are not allowed).
Will this always be reimbursed? It depends heavily on the insurance plan, but not always. We recommend calling if you know that you will have an extended session or if you want to check before you file a claim. If you bill with us we can also call on your behalf to find out. Many therapists get extra reimbursement while others have just been reimbursed for 90837.
Finally, another add-on code 99355 can be billed for sessions that are even longer. 99355 is billed once for each additional 30 minutes, beyond 99354. In other words 99355 can be used multiple times for one appointment. Confused? Take a look at our quick cheatsheet below.
- 90837 + 99354 should be billed for 90-134 minutes.
- 90837 + 99354 + 99355 should be billed for 135-164 minutes.
- 90837 + 99354 + 99355 + 99355 should be billed for 165-194 minutes.
Is Authorization Required for Optum/United Healthcare Claims?
Typically no, authorization is not required. Up until very recently one of the largest insurers, United Healthcare required authorization for 90837. The pre-authorization requirement was not extended onto the other frequently used procedure codes, 90791 or 90834. This was an exceedingly common and frustrating error to run into for anyone that billed United Healthcare. Many providers that exclusively scheduled 60 minute sessions were forced to downcode their 90837 into 90934 or call to get authorization. Other insurers have warned providers for billing 90837 too much. Still, the vast majority of insurance companies consider 90387 to be routine and will cover it as they would other mental health procedure codes.
Thankfully, United Healthcare has reversed course and as of 2019 has started accepting 90837 without prior authorization. We still recommend that you call the insurance companies in cases where you’re not sure if 90837 is covered.
Due to the extended length, 90837 does indeed pay more than 90834. Depending on your credentials, we’ve found that 90837 can pay between $9-20 more on average than a 90834 appointment. This amounts to typically ~13-20% more per session.