United Health Care 90837 vs 90834 Requirements for Mental Health Billing
Quickly learn how to make sure your individual psychotherapy sessions get paid with United Health Care 90837 CPT code.
United Health Care, Optum, and United Behavioral Health (UBH) have set limits for CPT code 90837 used by mental health outpatient providers.
CPT code 90837 represents a 60 minute individual therapy session and now requires authorization with UHC.
UHC does not require authorization for CPT code 90834, a 45 – 55 minute individual therapy session.
If you file to UHC with 90837 without authorization, your claim may be denied.
We help figure out how to handle this by calling the client’s insurance plan and asking if CPT code 90837 requires authorization and we let you know the situation. For help, reach out about our billing service. This task is super important which is why we do it for free.
United Health Care 90837 Sessions
Get authorization from United Health Care for 90837 sessions via a phone call: (800) 888-2998.
UHC sets limits on the number of 90837 sessions and provides you a unique authorization number for your approved sessions.
File your CMS1500 forms with that auth number!
Call before your auth expires for more 90837 sessions.
Ignore 90837 Authorization, Use 90834 with UHC
Most providers we know prefer to file with 90834. The increased hassle isn’t worth the time for their practice. Filing to United Health Care 90837 vs 90834 is your call.
And if you need help, drop us a line to talk about our mental health billing service.
UHC Oxford, New UHC 90837 Authorization Changes
As of 2019, some United Health Care and Optum plans have switched to allowing 60 minute individual therapy sessions without authorization, using CPT code 90837. Some plans still do require authorization.
To make sure you know what’s going on with your particular client, call the back of their insurance card to verify their benefits. During your call, ask about authorization requirements for 60 minute psychotherapy sessions using code 90837 and they will let you know. We do this for you in our insurance billing service as well!
Thanks for this! I ran into it the hard way with one of my clients that I have been billing 90837’s for. They didn’t reimburse for any of them. My office person tried to change it to 90834 only to have them say we are trying to double bill. Ugh! Another client of mine with UHC I’ve never had a problem with the 90837 though. I’m guessing it’s the plan they choose.
Hey Jason, it is actually a national policy for 90834 to be unauthorized by default and 90837 to require authorization by default. While some plans and carve out policies differ, it’s a good general rule that you’ll need to call to obtain authorization for 90837 sessions.
hi. Do you know what rate UHC/oxford pays in network for a 90834?
Thanks.
This is one of those unanswerable questions because it depends on your contracted rate which is unique to you based on your location, license, specialties, and other factors. Your rate is determined when your contract is signed or renegotiated.
Hi Denny, any idea where I could find this policy. had a 90834 claim denied stating required preauth from UHC…
It’s always stated when calling about eligibility and benefits so the rep will let you know prior auth is required for 90837 when/if you ask.
They also pay 90837’s without an auth based on the DX. Some plans that say they don’t allow 37’s will pay because the DX is valid. Also, some plans allow for 90837’s to be billed no hassle. It’s plan specfic.
I tend to agree, but rather we say that it is diagnosis specific. Optum doesn’t default to allowing 60 minute sessions and when there is a diagnosis that warrants a 60+ minute session, it is often for crisis therapy. In that case we bill differently. So yes, technically if you were to bill the same extreme diagnosis each time it may work, but this is often audited as it is unlikely to be based on medical necessity. We do not recommend doing this.
You should remove this statement: “You most definitely can get 90837 sessions authorized.” That is far from true. They will only approve 90837 for specific diagnosis such as PTSD with specific therapies such as exposure therapy. I say you most likely will never get a 90837 pre-authorized through UHC/Optum.
This does depend on the client’s needs and medical necessity. It’s always best to call in advance and ask if you do think there is a reason for 60 minute sessions. Most providers prefer to just bill UHC with 90834 for a 45 minute session and perhaps see the client slightly more often.
Does this apply if you are considered out of network with United or just for in-network providers?
Both, great question!