90836 Psychotherapy Add-On (2026): 45 Min

• CPT Codes
• 90836

90836 Psychotherapy Add-On (2026): 45 Min

CPT code 90836 for 45-minute psychotherapy add-on with E&M services. Billing rates, documentation, and reimbursement tips for behavioral health clinics.

Quick Reference

Code

90836

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Reading Time

7 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 90836: Psychotherapy Add-On, 45 Minutes

CPT code 90836 is an add-on code representing 45 minutes of psychotherapy (38-52 minutes face-to-face) delivered in conjunction with an evaluation and management (E&M) service during the same encounter. This code captures the clinical work of prescribing providers who deliver substantial psychotherapy alongside medication management, reflecting a deeply integrated treatment approach.

In behavioral health treatment centers, 90836 represents encounters where a psychiatrist, psychiatric nurse practitioner, or physician assistant goes beyond brief therapy and medication review to deliver a meaningful, extended therapy session within the same visit. This level of integrated care is particularly valuable for patients with complex co-occurring disorders who benefit from having their pharmacotherapy and psychotherapy managed by the same provider.

Definition and Purpose

CPT 90836 is defined as psychotherapy, 45 minutes with patient, when performed with an evaluation and management service. Like its shorter counterpart CPT 90833, it is an add-on code that must be billed alongside a primary E&M code (99202-99215) and cannot be submitted as a standalone service.

The purpose of 90836 is to reimburse prescribing providers for substantial psychotherapy delivered as part of a combined medical-therapeutic encounter. While 90833 captures brief therapy alongside E&M, 90836 recognizes that some encounters require more extensive psychotherapeutic intervention — particularly for patients in active crisis, those processing trauma, or those who benefit from fewer but longer combined appointments rather than separate therapy and medication visits.

This code is especially relevant in behavioral health treatment centers where psychiatrists and psychiatric NPs play an active therapeutic role beyond medication prescribing. In settings where the prescriber functions as both the pharmacotherapy manager and the primary therapist, 90836 accurately captures the full scope of the encounter.

When to Use 90836 in Behavioral Health

Use CPT 90836 when a prescribing provider delivers both an E&M service and 38-52 minutes of face-to-face psychotherapy in the same encounter. Common clinical scenarios include:

Do not use 90836 when the psychotherapy component lasts less than 38 minutes — use CPT 90833 for 16-37 minutes. Do not use 90836 when psychotherapy is provided without an accompanying E&M service — use the standalone code CPT 90834 instead. If the therapy is delivered by a different provider than the one performing the E&M service, each provider should bill their respective services independently.

• Extended psychiatric follow-up visits where the prescriber addresses medication management and provides substantial individual therapy during the same appointment
• Combined medication and trauma processing sessions where a psychiatrist manages psychopharmacology and delivers EMDR, CPT, or PE therapy within a single visit
• Integrated medication-assisted treatment (MAT) and counseling visits where a prescriber manages buprenorphine or naltrexone and provides 45 minutes of motivational enhancement therapy or relapse prevention counseling
• Complex psychiatric encounters with patients who have multiple co-occurring disorders requiring both medication adjustments and extended therapeutic intervention
• Treatment center visits where the attending psychiatrist or NP is assigned as both the prescriber and the primary individual therapist for select patients

Documentation Requirements

Documentation for 90836 must clearly support two distinct clinical services — the E&M service and the psychotherapy — delivered during a single encounter. The record should include:

E&M documentation (billed under 99202-99215):

Psychotherapy documentation (billed under 90836):

The combined documentation must make it clear that two separate clinical services were provided. The psychotherapy note should read as a distinct therapeutic encounter, not simply an extension of the medication discussion. Auditors evaluate whether the documented therapy content represents genuine psychotherapeutic intervention or whether it is a relabeling of clinical conversation that is inherently part of the E&M service.

• Relevant history updates since last visit
• Examination findings, including mental status changes relevant to medication management
• Medical decision-making: medication review, side effect assessment, dosage adjustments, lab review, and prescription decisions
• Time spent on E&M activities (documented separately from psychotherapy time)

• Start and stop times for the psychotherapy portion — separate from E&M time with no overlap
• Therapeutic modality identified (e.g., CBT, DBT skills, motivational interviewing, psychodynamic therapy)
• Session content describing specific therapeutic interventions and clinical issues addressed. This content must be distinct from medication management discussions
• Patient response to therapeutic interventions during the session
• Treatment plan connection linking the therapy to identified goals in the individualized treatment plan
• Plan for continued therapy including topics for future sessions and any skills or homework assigned

Billing and Reimbursement

As of March 2026, the approximate Medicare national average reimbursement for CPT 90836 is approximately $80. Because it is an add-on code, total encounter reimbursement includes both the E&M payment and the 90836 payment. Key billing considerations include:

Medicaid rates vary by state. Commercial payer rates are typically negotiated and may differ from Medicare rates.

• Combined reimbursement is substantial — A 99214 (approximately $130) plus 90836 (approximately $80) yields roughly $210 for a single encounter, making this one of the higher-reimbursing service combinations in outpatient behavioral health
• No modifier 25 needed — When using add-on psychotherapy codes (90833, 90836), modifier 25 is not required on the paired E&M code because the add-on code structure inherently indicates two distinct services
• Higher scrutiny than 90833 — Because 90836 represents more psychotherapy time and higher total reimbursement, it draws greater audit attention. Documentation must be proportionally stronger
• Facility versus non-facility rates — Both the E&M and 90836 components are affected by place of service. Treatment center providers should understand how facility billing affects per-encounter revenue
• Time accounting must add up — The total time documented for E&M plus psychotherapy should not exceed the actual duration of the encounter. A documented 30-minute E&M and 45-minute psychotherapy session requires at minimum a 75-minute encounter
• Provider must be the same — Both the E&M and psychotherapy services must be rendered by the same provider for 90836 to be appropriate. If different providers deliver these services, each bills their respective codes independently

Common Modifiers

Modifiers applicable to CPT 90836 include:

As with 90833, modifier 59 should not be used between 90836 and its paired E&M code. The add-on code relationship already establishes that these are distinct services within the same encounter.

The E&M code paired with 90836 may require its own modifiers depending on the specific clinical scenario and payer requirements.

• Modifier 95 — Synchronous telemedicine service. Apply to both the E&M code and 90836 when the combined encounter is conducted via telehealth. The psychotherapy must be delivered via real-time interactive audio and video
• Modifier 52 — Reduced services. Used when the psychotherapy component was started but not completed. Document the reason for early termination

Compliance Considerations

The compliance considerations for 90836 mirror those of 90833 but are amplified by the higher reimbursement and longer therapy time:

Genuine psychotherapy is required. The 38-52 minutes of documented psychotherapy must represent actual psychotherapeutic intervention, not extended conversation about medications, symptoms, or life events. Auditors distinguish between therapeutic work (applying specific techniques to address clinical issues) and supportive dialogue (which may be part of the E&M service). If the provider cannot articulate specific therapeutic interventions applied during the 90836 time, the claim is vulnerable to recoupment.

Time documentation under heightened scrutiny. Because 90836 involves more total time than 90833, the encounter is longer and the time separation between E&M and therapy must be carefully documented. An 80-minute appointment that documents 40 minutes of E&M and 45 minutes of therapy (85 total minutes) will trigger audit questions. Ensure documented time blocks are accurate and consistent with the actual encounter length.

Frequency patterns are monitored. Billing 90836 at every encounter may be clinically appropriate for some patients, but a pattern of every patient receiving E&M plus 90836 at every visit draws payer attention. Ensure medical necessity documentation supports the extended therapy component at each individual encounter.

Code selection accuracy is critical. If the psychotherapy portion of the encounter lasts only 30 minutes (16-37 minutes), bill 90833, not 90836. Upcoding from 90833 to 90836 is a common audit finding. Conversely, if therapy time genuinely reaches 38 minutes or more, billing 90833 instead of 90836 results in underpayment.

Combined with other same-day services. In treatment center settings, a patient may receive E&M + 90836 from the psychiatrist and also attend group therapy ( 90853 ) or family therapy ( 90846 ) with a different provider on the same day. Each service must have distinct documentation, non-overlapping time, and separate provider credentials supporting each claim.

Related Billing Codes

• 90832
• 90833
• 90834
• 90837
• 90838
• 90839

Common questions

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