CPT Code 90837: Definitive Guide +Reimbursement Rates [2020]

CPT Code 90837 is a procedure code that describes a 60 minute individual psychotherapy session performed by a licensed mental health provider.

90837 is considered a routine outpatient CPT Code and is one of the most common CPT codes used in mental health insurance claims coding and billing.

We’ll teach you the ins and outs of coding 90837 but if you’d prefer to have a pro team handle your mental health insurance billing, consider reaching out to TheraThink to learn how we can help.

CPT Code 90837 Description

Centers for Medicare Services CPT Code 90837 definition:  individual outpatient psychotherapy services rendered for 60 minutes.  

Code 90837: Psychotherapy, 60 minutes with patient and/or family member

Services represent insight oriented, behavior modifying, supportive, and/or interactive psychotherapy.

Medicare deems the following services should be be included when billing 90837:

  • Teaching grooming skills
  • Monitoring daily living activities (ADL)
  • Recrational therapy (dance, art, play)
  • Social interaction

Likewise when treating clients with intellectual disabilities, use other CPT codes.  This is also true of clients with severe dementia.

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CPT Code 90837 Time Frame

90837 is defined as a session of 60 minutes, ranging from 53 minutes to longer.

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.

What’s the Difference between 90834 vs 90837?

  • CPT Code 90834 should be billed for sessions between 38-52 minutes.
  • Sessions from 16 to 37 minutes should be billed with 90832
  • CPT Code 90837 should be billed for sessions 53 minutes or longer.

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How to Bill Extended Sessions for Individual Psychotherapy

Billing

Billing 90837.

There is no CPT code for sessions greater than 60 minutes. So are you out of luck and stuck with just billing 90837?

Add-on CPT Code 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 90837 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.

90837 Add On Codes for Extended Therapy Services

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 90837 billing cheat sheet 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.

CPT Code 90837 Reimbursement Rates

90837 reimbursement ratesDue 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.

Medicare has published their 60 minute individual therapy reimbursement rates.

CPT Code 90837 Reimbursement Rate (2020, Medicare):  $141.47

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90837 License Level Requirements:

The following license is required for rendering 60 minute individual therapy sessions:

  • Licensed Clinical Social Workers (LCSW)
  • Licensed Professional Counselors (LPC)
  • Licensed Marriage Family Therapist (LMFT)
  • Clinical Psychologists (PsyD or PhD)
  • Psychiatrists (MD)

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.

If you need help ensuring you’re billing 90837 correctly and with authorization, feel free to reach out!

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