Blog, Behavioral Health Billing

90834 vs 90837: Psychotherapy Billing Guide for 2026

October 8, 2026

90834 vs 90837: What Is the Difference?

Understanding 90834 vs 90837 is essential when billing individual psychotherapy. Both codes describe psychotherapy delivered to a patient, but they represent different documented treatment times.

CPT 90834 generally corresponds to psychotherapy lasting 38–52 minutes, while CPT 90837 generally applies when psychotherapy lasts 53 minutes or longer. The appropriate code should reflect the actual psychotherapy time, clinical service performed, documentation, medical necessity, provider eligibility, and payer requirements.

Selecting the longer code simply because a session was scheduled for 60 minutes can result in denials, recoupments, or audit concerns. The medical record must support the code submitted.

Quick Comparison of 90834 vs 90837

Billing consideration	CPT 90834	CPT 90837
Service	Individual psychotherapy	Individual psychotherapy
Typical psychotherapy time	38–52 minutes	53 minutes or longer
Commonly described session	Approximately 45 minutes	Approximately 60 minutes
Time documentation required	Yes	Yes
Patient participation	Patient must be present for all or part of the service	Patient must be present for all or part of the service
Medical necessity	Must support the documented service	Must support the longer service
Telehealth availability	Subject to payer policy	Subject to payer policy
E/M included	No	No

This table provides general guidance. Practices must verify the patient’s benefits, provider contract, applicable coding instructions, and payer-specific policies before submitting claims.

What Is CPT Code 90834?

CPT 90834 is used for an individual psychotherapy service that generally involves 38–52 minutes of psychotherapy with the patient.

A qualifying session may address:

Symptoms associated with a diagnosed behavioral-health condition
Emotional or behavioral difficulties
Functional limitations
Treatment goals
Coping strategies
Cognitive or behavioral patterns
Progress since the previous encounter
Clinical interventions and the patient’s response
Risk and safety concerns when applicable
The ongoing treatment plan

The medical record should demonstrate that psychotherapy occurred and explain why the service was medically necessary. A calendar entry showing a 45-minute appointment is not sufficient by itself.

What Is CPT Code 90837?

CPT 90837 is used for an individual psychotherapy service lasting 53 minutes or longer.

The longer service should be supported by the patient’s clinical needs and the psychotherapy documented during the encounter. Circumstances that may support a longer session can include:

Complex symptoms requiring extended therapeutic intervention
Significant changes in the patient’s condition
Multiple clinically relevant issues addressed during treatment
Trauma-focused psychotherapy
Extensive safety planning
Acute functional deterioration
Complicated family or social circumstances affecting treatment
A need for additional time to complete and evaluate therapeutic interventions

These circumstances do not automatically justify 90837. The record should explain the psychotherapy provided, the patient’s response, the duration of treatment, and why the longer service was reasonable and necessary.

The Time Rules for 90834 vs 90837

Time is the central distinction when comparing 90834 vs 90837.

Common psychotherapy coding ranges are:

90832: 16–37 minutes
90834: 38–52 minutes
90837: 53 minutes or longer

CMS billing guidance states that psychotherapy codes are time-based and that start-and-stop times or total psychotherapy time should be documented. The code selected should correspond to the actual psychotherapy time—not merely the scheduled appointment length.

Review the official CMS psychiatric diagnostic evaluation and psychotherapy billing guidance and the patient’s specific payer policy before submitting a claim.

Scheduled Time vs Actual Psychotherapy Time

A scheduled 60-minute appointment does not automatically support 90837.

Time spent on unrelated administrative work generally should not be counted as psychotherapy time. Examples may include:

Scheduling the next appointment
Collecting a copayment
Completing routine registration forms
Waiting for the patient
Unrelated chart review
Preparing a claim
Time after the patient has left
General communication that is not part of the psychotherapy service

The documentation should reflect the time devoted to the psychotherapy service that was actually delivered.

Documentation Requirements for 90834 and 90837

Strong documentation for either code should support the patient’s condition, treatment, time, and medical necessity.

A psychotherapy note commonly includes:

Date and Location of Service

Record the date of service and whether treatment occurred in the office, another approved location, or through telehealth.

Psychotherapy Time

Document either the total psychotherapy time or the start-and-stop times according to applicable payer requirements.

Diagnoses and Symptoms

Identify the diagnoses being treated and the symptoms or functional problems addressed during the session.

Treatment Goals

Connect the psychotherapy service to established and measurable treatment goals.

Therapeutic Interventions

Describe the interventions used during treatment. The note should show that active psychotherapy occurred rather than only listing topics discussed.

Patient Response

Document how the patient participated in and responded to the interventions.

Progress and Clinical Status

Describe relevant progress, setbacks, changes in symptoms, functional status, or new clinical concerns.

Risk Assessment

Document suicidal ideation, homicidal ideation, self-harm risk, abuse, neglect, or other safety concerns when clinically relevant.

Plan and Follow-Up

Record the continuing treatment plan, recommended follow-up, referrals, safety measures, or changes in therapeutic strategy.

Provider Authentication

The note should identify the rendering professional and include the required signature or electronic authentication.

Medical Necessity for 90837

Because 90837 represents a longer psychotherapy service, some payers may review it more closely.

A note does not need exaggerated language, but it should clearly demonstrate why the patient required the documented treatment and time. Repeating a generic statement such as “patient needs 60-minute therapy” in every record may not establish medical necessity.

Instead, document the patient-specific clinical factors, interventions, response, and treatment needs that support the service.

Common 90834 vs 90837 Billing Errors

Many 90834 vs 90837 denials result from time, documentation, eligibility, authorization, or claim-submission problems.

Billing From the Scheduled Appointment Length

Do not select 90837 solely because the calendar reserved one hour. Use the actual psychotherapy time supported by the record.

Missing Psychotherapy Time

A note that describes treatment but does not document the required time may not support a time-based psychotherapy code.

Using 90837 for a Session Below 53 Minutes

If the documented psychotherapy time is 52 minutes or less, 90837 generally is not the appropriate selection. Determine whether the documented time supports 90834 or another code.

Assuming Every 60-Minute Session Is Medically Necessary

Time alone does not establish medical necessity. Documentation should connect the longer session to the patient’s clinical needs and treatment.

Copying the Same Note Between Sessions

Repeated or cloned documentation can make it difficult to determine what occurred during each encounter. Each note should reflect the patient’s condition, interventions, response, and plan for that specific date.

Counting Non-Psychotherapy Activities

Administrative tasks and unrelated activities should not be added to psychotherapy time merely to reach the threshold for a higher code.

Ignoring Authorization Requirements

Some plans may require authorization, limit the number of visits, or apply different rules to longer psychotherapy sessions.

Using the Wrong Telehealth Information

An otherwise accurate psychotherapy claim can be denied because of an incorrect place-of-service code, missing modifier, provider-location issue, or payer-specific telehealth rule.

Can 90834 and 90837 Be Used for Telehealth?

Both codes may be eligible for telehealth reimbursement when the payer covers the service and all applicable requirements are satisfied.

Before submitting a telehealth claim, confirm:

Whether the patient’s plan covers the psychotherapy code
Whether the rendering provider is eligible
The patient’s physical location during the session
The appropriate place-of-service code
Whether modifier 95, GT, or another modifier is required
State licensing requirements
Telehealth consent requirements
Platform or technology requirements
Any payer-specific documentation standards

Do not apply one payer’s telehealth rules to every insurance plan. Medicare, Medicaid programs, and commercial payers may process psychotherapy claims differently.

Can 90834 or 90837 Be Billed With an E/M Service?

CPT 90834 and 90837 are stand-alone psychotherapy codes and do not include an evaluation and management service.

When an eligible physician or qualified healthcare professional provides a separately identifiable E/M service and psychotherapy during the same encounter, the applicable psychotherapy add-on codes may need to be considered:

90833: Psychotherapy corresponding to 16–37 minutes with an E/M service
90836: Psychotherapy corresponding to 38–52 minutes with an E/M service
90838: Psychotherapy corresponding to 53 minutes or longer with an E/M service

The psychotherapy time must be documented separately from the E/M work. Practices should not report a stand-alone psychotherapy code and an overlapping psychotherapy add-on code for the same service.

Can Interactive Complexity Code 90785 Be Added?

CPT 90785 may sometimes be reported with 90834 or 90837 when qualifying communication complications are present and documented.

Interactive complexity is not supported simply because:

The patient has severe symptoms
The encounter lasts longer
The patient is uncooperative
A family member attends
The case is generally difficult

The record should describe the qualifying communication complication and how it affected delivery of the psychiatric service. Payer coverage should also be verified.

Who Can Bill 90834 and 90837?

Eligible provider types depend on state law, professional scope of practice, payer enrollment, credentialing, and the provider’s contract.

Depending on the payer and jurisdiction, eligible professionals may include:

Psychiatrists
Clinical psychologists
Licensed clinical social workers
Licensed professional counselors
Marriage and family therapists
Psychiatric nurse practitioners
Clinical nurse specialists
Other qualified behavioral-health professionals

Holding a professional license does not automatically mean the provider is enrolled or contracted to bill every payer for these codes.

How to Reduce 90834 and 90837 Denials

Before submitting the claim, verify that:

The documented psychotherapy time supports the selected code
The note describes active psychotherapy interventions
The diagnosis supports medical necessity
The treatment connects to an established plan
The patient’s response and progress are documented
The rendering provider is eligible and credentialed
Authorization requirements have been satisfied
The correct place of service is reported
Required telehealth modifiers are included
The claim does not contain overlapping services
The payer’s current policy has been reviewed

A structured pre-submission review can identify many problems before they become denials or prolonged accounts-receivable balances.

90834 vs 90837: Which Code Should You Choose?

Choose 90834 when the documented psychotherapy time is generally between 38 and 52 minutes.

Choose 90837 when the documented psychotherapy time is 53 minutes or longer and the record supports the longer medically necessary service.

The correct 90834 vs 90837 decision should reflect the psychotherapy actually delivered—not the scheduled appointment, expected reimbursement, or code used during a previous session.

Behavioral Health Billing Support

Behavioral-health claims can be affected by psychotherapy time, documentation, provider credentialing, authorizations, telehealth requirements, code selection, payer edits, and medical-necessity policies.

The Ashez Group supports behavioral-health and psychiatry practices with:

Medical billing and claim submission
Coding and documentation review
Eligibility and benefits verification
Prior-authorization support
Denial management and appeals
Accounts-receivable follow-up
Provider credentialing
Payment posting and reporting

Learn About Our Mental Health Billing Services

Request a Behavioral Health Billing Consultation

Our team also provides medical coding services to help practices strengthen documentation alignment, code selection, modifier use, and claim accuracy.

Frequently Asked Questions About 90834 vs 90837

What is the main difference between 90834 and 90837?

The primary difference is documented psychotherapy time. CPT 90834 generally applies to 38–52 minutes, while CPT 90837 generally applies to 53 minutes or longer.

Is 90837 always a 60-minute session?

Although 90837 is commonly described as 60-minute psychotherapy, the generally recognized reporting threshold begins at 53 minutes. The record should contain the actual psychotherapy time.

Can I bill 90837 for a 52-minute session?

Generally, 52 minutes falls within the time range associated with 90834 rather than 90837. Verify applicable payer instructions before billing.

Does a scheduled one-hour appointment support 90837?

Not by itself. Code selection should reflect the actual documented psychotherapy time and the service performed, not merely the scheduled appointment length.

Does every 90837 note need to explain medical necessity?

Every psychotherapy record should support medical necessity. Longer services may receive additional payer scrutiny, so the note should clearly reflect the patient’s clinical needs, interventions, response, and treatment plan.

Can 90834 and 90837 be billed through telehealth?

They may be covered through telehealth when the patient’s payer permits the service and all provider, location, modifier, place-of-service, consent, and documentation requirements are satisfied.

Can 90834 and 90837 be billed on the same day?

Reporting both codes for the same patient, provider, and psychotherapy encounter would generally represent overlapping services. Any unusual circumstance should be reviewed against current coding guidance and the payer’s policy.

Strengthen Your Psychotherapy Billing Workflow

Accurate 90834 vs 90837 billing depends on actual psychotherapy time, complete documentation, medical necessity, provider eligibility, and payer-specific requirements.

The Ashez Group helps behavioral-health practices review coding workflows, prevent avoidable denials, manage accounts receivable, and improve the revenue cycle.

[Request a Behavioral Health Billing Consultation]