CPT Code 90837: The Complete Guide to Billing 60-Minute Psychotherapy

The 90837 CPT code is the most scrutinized code in outpatient behavioral health, and probably the most misunderstood. Most guides will tell you it's "the 60-minute code." That's the descriptor, not the rule.

The real threshold is 53 minutes. There's no upper limit. And a session you coded correctly can still come back paid at a lower rate without anyone telling you.

A lot of what's published about this code is simply out of date. Some of it still tells therapists to bill an add-on code that disappeared three years ago.

Here's what 90837 actually covers, what it pays, and what to do when a payer pushes back.

What Is CPT Code 90837?

The official AMA descriptor is short: "Psychotherapy, 60 minutes with patient."¹

It covers individual psychotherapy delivered face-to-face, either in person or by telehealth, with the client present. The whole session has to be psychotherapy. Medication management, case management, and administrative time don't belong under this code.

Licensed mental health professionals bill it: psychiatrists, psychologists, LICSWs, LMFTs, and LPCs or LPCCs. Your scope depends on your state license and how each payer has credentialed you.

One common mix-up worth clearing up early. 90837 is an individual code. A 60-minute couples or family session isn't a 90837, it's 90847 or 90846, and billing for family therapy follows its own rules.

So the descriptor says 60 minutes. The billing rule says something different.

The 90837 Time Requirement (And the Ceiling That Doesn't Exist)

You can bill 90837 at 53 minutes or more of face-to-face psychotherapy.¹ You don't need to reach 60. A 53-minute session qualifies.

Here's the part most articles get wrong: there is no upper limit. A 55-minute session and a 95-minute session are both 90837. Both pay the same.

That surprises people, and it leads to the second thing most articles get wrong. If you were taught to add a prolonged-services code to a long session, that option is gone. CPT codes 99354 and 99355 were deleted effective January 1, 2023.²

Their replacements don't help here. Codes 99417 and G2212 can't be billed alongside psychotherapy codes, which leaves no prolonged-services code that pairs with 90837 at all.³ Nobody says this plainly, so we will: past 53 minutes, the reimbursement stops changing.

A therapist in Duluth runs a 90-minute EMDR intensive and reasonably assumes there's a code for the extra half hour. There isn't, and hasn't been since 2023. It's a 90837, paid the same as a 55-minute session. That's worth knowing before you build a program around extended-format sessions, because the clinical case for the format is real, and the billing case for it isn't.

What counts toward the clock is active clinical work with your client. What doesn't count: writing notes, scheduling, collecting the copay, coordinating care, or waiting on someone who's running late.

And round down, never up. Fifty-two minutes is a 90834.

90837 vs. 90834: The Short Version

The individual psychotherapy codes are time-based, and the ranges are easy to keep straight:

• 90832 = 16 to 37 minutes
• 90834 = 38 to 52 minutes
• 90837 = 53 minutes or more

The rule is just as simple: bill the code whose range your actual session time falls into.¹

If you're weighing 90834 vs 90837 for a specific session, or you want the documentation differences and the revenue math behind each one, we've covered choosing between 90834 and 90837 in depth separately.

90837 Reimbursement Rates

Medicare's 2026 national non-facility rate for 90837 is roughly $167, up from $154.29 in 2025.⁴ The facility rate is lower.

Now the caveat that matters more than the number. That's a national average, not your rate. Medicare adjusts payment by locality, so your check depends on where you practice. Commercial rates are negotiated, and they vary a lot. Some behavioral health contracts pay above Medicare. Plenty pay below it.

This is where a lot of billing content does readers a disservice, quoting a confident figure with no year attached and no mention of geography, and then practice owners wonder why their remittance doesn't match.

Two places to get your real numbers: the CMS Physician Fee Schedule Look-Up Tool for Medicare in your locality,⁴ and your own contracted fee schedule for everything else. If those commercial numbers look thin, negotiating your reimbursement rates is a separate conversation worth having.

The gap between 90837 and 90834 runs somewhere around $40 to $55 per session depending on the payer. Hold onto that figure. It's why the last section of this post matters.

90837 Billing Requirements and Documentation

If you take one habit from this post, take this one: document start and stop time on every session. Actual time, not scheduled time.

"Session: 2:05 PM to 3:02 PM (57 minutes)."

That's five seconds of typing, and in a records request it's the difference between a defensible claim and a downcoded one.

Beyond the clock, your note should show:

• Medical necessity, meaning the diagnosis, the symptoms, and why this presentation called for a session of this length
• The interventions you used and how your client responded, rather than a recap of what they talked about
• Clinical rationale connecting the session length to the treatment plan

Some modalities run long by design, and that's worth naming in the note: EMDR, prolonged exposure, trauma processing, some DBT protocols, and active risk assessment.

Telehealth is where our guidance splits from a lot of what you'll read. On professional claims, use POS 10 when your client is at home and POS 02 when they're somewhere else.⁵ Don't append modifier 95. The POS code already tells the payer this was telehealth, and the extra modifier can trigger denials. You'll find plenty of published guides saying the opposite, which is exactly why we wrote up how telehealth modifiers work on their own.

Two more code interactions worth knowing. Add-on code 90785 for interactive complexity can accompany 90837 when the criteria are met. And the crisis codes, 90839 and 90840, don't get billed alongside 90832 through 90838 on the same date of service.⁶

Consider a group practice in St. Paul writing genuinely strong clinical narratives, with no start and stop times anywhere. A records request arrives. The payer can't verify the 53-minute threshold, so eleven months of claims get downcoded to 90834. The therapy was excellent. The clock just wasn't on the page.

When the Payer Pushes Back

At some point you may get a letter saying you bill 90837 more often than your peers in the same specialty and market. Anthem and other payers send these in waves, to thousands of providers at a time, and they're usually explicit that they're educational.⁷

Don't panic-downcode. If your documentation supports 53 minutes or more, keep billing accurately. Reflexive downcoding is voluntary revenue loss, often in response to a letter that never asked you to do anything.

Variation in your coding is expected and defensible. A trauma-focused caseload runs longer than a general one. And having some 90834s in the mix, from late arrivals and early endings, is what honest coding looks like.

A solo practitioner in Minneapolis gets one of these letters and downcodes everything to 90834 for six months, just to be safe. Her documentation supported 90837 the entire time. At roughly $45 per session across about 15 sessions a week for 26 weeks, that caution cost her somewhere near $17,500. Nobody had asked her to change a thing.

A few other things payers do that the CPT book won't tell you:

• Some plans, including Optum and UBH-style policies, restrict 90837 to complex presentations or extended-by-design modalities, and may hold claims pending records.⁷
• Some require prior authorization or reauthorization once you use 90837 frequently. Verify before the session, not after the denial.

Then there's the quiet one: silent downcoding. The payer pays you at the 90834 rate, with no denial and no notification. Nothing bounces. The money is just smaller. Reading remittances line by line is the only way this surfaces, and recovering underpayments starts with noticing them. When your documentation supports the code you billed, a downcode is appealable.

Final Thoughts

The 90837 CPT code isn't complicated once the facts are straight. Fifty-three minutes or more, no upper limit, document the clock, bill what actually happened. The code isn't the hard part. Everything that happens after you submit it is.

Payer letters, silent downcoding, and records requests are pattern problems. One downcoded session is invisible. Ninety of them is a five-figure hole in your year. Patterns only surface when someone's watching month over month, reading the remittances, noticing your 90837s came back at the 90834 rate, and doing something about it before it's a year old.

That's the job a dedicated coordinator does, and it's hard to do for yourself between sessions.

If you'd like a second set of eyes on how your psychotherapy codes are actually getting paid, BreezyBilling is happy to take a look. Reach out to start a conversation.

Footnotes

1. Psychotherapy codes for psychologists — APA Services, American Psychological Association

2. CPT Deleted Code 99354 — AAPC

3. Prolonged Service Codes Discontinued in 2023 — Navigating the Insurance Maze, 2023

4. Physician Fee Schedule Look-Up Tool — Centers for Medicare & Medicaid Services, 2026

5. Telehealth and Remote Patient Monitoring (MLN901705) — Centers for Medicare & Medicaid Services

6. Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520) — Centers for Medicare & Medicaid Services

7. Did You Get a 90837 Letter? — Navigating the Insurance Maze