CPT Code 90837: 60-Minute Therapy Billing (2026)

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• 90837

CPT Code 90837: 60-Minute Therapy Billing (2026)

90837 billing guide — 2026 reimbursement rates, 90834 vs 90837, payer scrutiny of 60-minute sessions, documentation, and facility billing rules.

Quick Reference

Code

90837

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Updated

Jun 12, 2026

Reading Time

17 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.

Overview of CPT Code 90837

CPT code 90837 describes individual psychotherapy lasting 53 minutes or more when provided in a face-to-face encounter. It is the full-hour psychotherapy code and is among the most frequently billed CPT codes in behavioral health. Substance use disorder treatment centers, outpatient mental health clinics, and private practices all rely on 90837 for standard individual therapy sessions.

The 90837 code sits at the top of the three time-based individual psychotherapy codes. CPT 90832 covers sessions of 16–37 minutes, CPT 90834 covers sessions of 38–52 minutes, and CPT 90837 covers sessions of 53 minutes or longer. Selecting the correct code depends entirely on the actual duration of psychotherapy delivered during the encounter — and because 90837 pays meaningfully more than 90834, it is also the code payers watch most closely.

90837 Reimbursement Rates by Year

Rates reviewed: June 2026. Medicare national non-facility amounts below are the baseline; actual payment varies by locality under GPCI adjustment. Pull current figures from the CMS Physician Fee Schedule lookup tool ↗ — third-party rate tables (including this one, until verified) drift out of date.

Two policy drivers explain the upward trend. The CY 2024 Physician Fee Schedule final rule adopted phased work-value increases for the timed psychotherapy codes, per the American Psychological Association’s summary ↗, and the CY 2026 final rule ↗ raised the conversion factor to a final $33.5675 for qualifying APM participants ($33.4009 for other clinicians), up from $32.3465 in 2025.

Beyond Medicare:

• Medicaid: varies by state, commonly $90–$150 per session; check the state behavioral health fee schedule.
• Commercial insurance: contract-dependent, often $120–$200 per session; the 90834-to-90837 rate differential varies by payer and drives the utilization scrutiny described below.

Definition and Purpose

CPT 90837 covers individual psychotherapy sessions running 53 minutes or longer in face-to-face time with the patient. The service involves the use of therapeutic communication techniques to treat mental health conditions and behavioral disorders. It includes ongoing assessment during the session, but the primary service is the delivery of psychotherapy.

The code is designed for individual therapy delivered face-to-face. It applies to a wide range of psychotherapeutic approaches, including cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, psychodynamic therapy, trauma-focused therapies such as EMDR and prolonged exposure, and other evidence-based modalities. The specific therapeutic technique does not change the code selection; what matters is the duration and the fact that psychotherapy was provided.

90837 is distinct from psychiatric diagnostic evaluation ( 90791 ), which is used for initial assessments rather than ongoing treatment. It is also distinct from the psychotherapy add-on codes ( 90833, 90836, 90838 ), which are used when psychotherapy is delivered in addition to an E&M service during the same encounter.

When to Use in Behavioral Health

In behavioral health treatment settings, 90837 is the standard code for full-hour individual therapy sessions. Treatment centers and outpatient programs use it for the following clinical scenarios.

Substance use disorder treatment. Individual therapy sessions addressing addiction, relapse prevention, coping skills, and recovery planning. Many residential and outpatient SUD programs schedule 60-minute individual sessions weekly or biweekly as part of the treatment plan.

Depression and anxiety treatment. Standard 60-minute sessions for cognitive behavioral therapy, interpersonal therapy, or other evidence-based approaches for mood and anxiety disorders.

Trauma-focused therapy. Trauma processing sessions, including EMDR, cognitive processing therapy, and prolonged exposure, often require the full 60-minute session to allow adequate time for trauma work and stabilization.

Co-occurring disorders. Patients presenting with both substance use disorders and mental health conditions frequently require the full 60-minute session to address the complexity of co-occurring issues.

Crisis-adjacent extended sessions. When a patient presents in acute distress and requires an extended session for stabilization and safety planning. Note that when crisis criteria are met, the dedicated crisis psychotherapy codes ( 90839 and add-on 90840) may be the correct choice instead — see the long-session section below.

Time Thresholds: 90832 vs 90834 vs 90837

Correct code selection is purely a function of documented face-to-face psychotherapy time:

If a session intended to last 60 minutes ends at 50 minutes, the correct code is 90834, not 90837. Document the actual start and stop time of psychotherapy in every note — the time band is the entire basis of code selection. The same table appears on the 90834 guide, where the selection question is examined from the 45-minute side.

Will Payers Push Back on Routine 90837?

Yes — 90837 is the most scrutinized psychotherapy code in outpatient behavioral health, for a simple reason: it pays more than 90834, so a clinician or facility whose claims are nearly all 90837 looks like an outlier worth auditing.

What scrutiny looks like for a solo clinician. Several large payers have historically sent letters to clinicians whose 90837 utilization is far above peer averages, asking them to justify routine 60-minute sessions or warning that records may be requested. The letter is not an accusation — it is payer profiling math — but it is a signal to review whether documented session times actually support the code.

How to document medical necessity for the full hour. When 90837 is the right code, the note should make the rationale visible: trauma processing protocols that cannot be safely compressed, clinical complexity from co-occurring disorders, acute symptom exacerbation requiring extended stabilization, or interpreter-mediated sessions that consume more clock time per clinical unit. A note that supports 53+ minutes of time but is silent on why the hour was needed defends the code; a note that explains both defends the claim.

When 90834 is the defensible choice. If sessions genuinely run 45–50 minutes, 90834 is not a downgrade — it is the correct code, and it draws almost no utilization attention. The audit risk runs in one direction: rounding 50-minute sessions up to 90837. The reverse error (billing 90834 for a 55-minute session) just leaves money on the table.

The facility version of the problem. For group practices and treatment centers, payers profile at the group or facility NPI level, not just per clinician. A program that schedules 60-minute individual sessions for every patient as a matter of template will show a 90837 rate near 100% across its entire roster — a far larger flag than any single clinician’s pattern. Facilities need utilization review -aware scheduling policy: define which tracks and presentations warrant the full hour, let documented time drive the code, and monitor the 90834/90837 mix by clinician and by program.

What an outlier review actually costs. When a payer moves from profiling to records requests, the facility absorbs the administrative load of pulling charts across the roster — and if documented times do not support the billed code, the exposure is not one claim but the extrapolated pattern. Payers can downcode historical 90837 claims to 90834 and recoup the difference across the lookback period, and repeated findings put network participation at risk. The defense is boring and procedural: exact start and stop times in every note, a visible clinical rationale whenever the full hour is billed, and an internal audit cadence that samples 90837 claims before a payer does. Programs that self-audit quarterly tend to find the same things payers find — template-cloned notes and time clusters at exactly 60 minutes — while they are still fixable.

Documentation Requirements

Thorough documentation is essential to support 90837 billing and to withstand payer audits. Each session note should include the following elements.

Start and stop times. Record the exact time psychotherapy began and ended. This is the single most important documentation element for time-based psychotherapy codes. The documented time must support at least 53 minutes of psychotherapy.

Type of psychotherapy. Identify the therapeutic modality or approach used during the session, such as CBT, DBT, motivational interviewing, or trauma-focused therapy.

Clinical content. Document the topics addressed, interventions used, and the patient’s response to treatment. Include the patient’s presenting concerns, therapeutic techniques applied, and progress toward treatment goals.

Treatment plan connection. Link the session content to specific goals and objectives in the patient’s treatment plan. Payers want to see that each session is clinically necessary and connected to documented treatment goals.

Mental status observations. Note the patient’s affect, mood, thought process, and any relevant behavioral observations during the session.

Assessment and plan. Provide a clinical assessment of the patient’s current status and the plan for ongoing treatment, including any changes to the treatment approach or frequency.

Medical necessity for the duration. The documentation should clearly support why a 60-minute session was clinically necessary for this patient — see the payer-scrutiny section above. Medical necessity for the full hour is the question reviewers actually ask.

Billing and Reimbursement

Current Medicare amounts are in the rate table above; the mechanics below determine whether claims pay cleanly.

Billing With Add-On Codes

When psychotherapy is provided during the same encounter as an E&M service (such as medication management), use the psychotherapy add-on codes instead of the standalone codes. The add-on code corresponding to 90837 is 90838 (psychotherapy add-on, 53 minutes or more), which is appended to the E&M code for the visit.

Sessions Longer Than 60 Minutes

90837 has no upper time limit — a 75- or 90-minute session is still one unit of 90837. The harder question is whether anything extra can be billed for very long sessions, and the answer changed in 2023:

• Prolonged-service codes 99354 and 99355 were deleted effective January 1, 2023. Guides that still recommend adding 99354/99355 to a long psychotherapy session are out of date — those claims will reject. See the 99354 crosswalk page for what replaced the deleted codes.
• Crisis psychotherapy codes apply when crisis criteria are met. A long session driven by acute crisis — high distress, urgent assessment, safety planning — may be correctly reported with 90839 (first 30–74 minutes of crisis psychotherapy) plus 90840 for each additional 30 minutes, instead of 90837. The crisis codes are about clinical character, not just length.
• Planned long-format sessions (extended EMDR or trauma-processing protocols) are generally still one unit of 90837 for Medicare purposes; some commercial payers have their own policies for extended sessions, so check the provider manual before scheduling a 90-minute protocol you expect to be paid extra for.

Authorization Requirements

Whether routine outpatient 90837 needs prior authorization depends on the payer type:

For facilities, the leverage point is verification of benefits: verify auth requirements, session limits, and carve-out vendors at admission rather than discovering them at denial. runs automated, real-time eligibility verification via 270/271 EDI as part of that intake workflow.

• Traditional Medicare: no prior authorization for outpatient psychotherapy.
• Medicare Advantage and Medicaid managed care: plan-specific; many plans authorize a number of sessions and require concurrent review for continued care.
• Commercial plans: routine outpatient therapy frequently requires no auth initially, but some payers apply session-count thresholds, after which records or auth are required; behavioral carve-out vendors often run their own rules.
• EAP sessions: employee-assistance sessions are usually pre-authorized by definition and billed with EAP-specific codes or modifiers (commonly HJ) rather than standard 90837 claims — confirm the EAP’s billing instructions.

License-Level Requirements

90837 can be billed by providers licensed to deliver psychotherapy under state scope of practice, typically: psychiatrists and other physicians, licensed psychologists, LCSWs, LMFTs, LPCs/LMHCs, and psychiatric nurse practitioners or clinical nurse specialists. Medicare also enrolls marriage and family therapists and mental health counselors as billable provider types.

Provisionally licensed and pre-licensed clinicians are the compliance soft spot: most payers require billing under a supervising clinician with specific supervision documentation, and some payers do not credential provisional licenses at all. Verify state rules, payer credentialing, and supervision arrangements per provider — and for Medicare incident-to billing in office settings, ensure all incident-to requirements are met, including direct supervision and a physician-established plan of care.

90837 in Facility Programs

In residential, PHP, and IOP settings, the first billing question for an individual session is not which code — it is whether the session is separately billable at all.

• Per-diem and bundled contracts. Many payer contracts reimburse program levels of care through per-diem or case rates — H0015 for intensive outpatient, H0035 or revenue-code-based billing for partial hospitalization, negotiated day rates for residential. Under these contracts, scheduled individual therapy is typically inside the bundle, and a separate 90837 line is double billing.
• Carve-outs. Some contracts carve professional psychotherapy services out of the per diem, allowing fee-for-service 90837 alongside the program rate. The contract language — not the CPT book — decides.
• Same-day code pairs. When 90837 is billed fee-for-service on the same date as group therapy ( 90853 ) or family therapy ( 90847 ), the services must be separate encounters with non-overlapping times and independent documentation, with modifier 59 or XE on the distinct service where NCCI procedure-to-procedure edits apply. Check the current NCCI Policy Manual ↗ psychiatric services chapter for the active edit pairs.
• Medicaid H-code routing. Several state Medicaid programs pay facility-based individual therapy through state-defined HCPCS codes rather than 90837 for certain program types. Check the state behavioral health fee schedule before assuming the CPT code applies.

Place of Service Considerations

The place of service code affects which rate (facility vs non-facility) applies. Common POS codes for 90837 include:

Facility-based rates are typically lower than non-facility rates because the facility is expected to absorb overhead costs.

• 02 — Telehealth, patient not at home
• 10 — Telehealth, patient at home
• 11 — Office
• 22 — On campus outpatient hospital
• 55 — Residential substance abuse treatment facility
• 57 — Non-residential substance abuse treatment facility

Common Modifiers

Several modifiers are commonly used with CPT code 90837.

Modifier 95 — Synchronous telemedicine. Used when the psychotherapy session is delivered via real-time audio and video telehealth. Pair with POS 10 (patient at home) or POS 02 (other locations). Medicare permits audio-only delivery of mental health services when the patient is at home and cannot or does not consent to use video — confirm 90837’s current status and any in-person-visit requirements on the CMS telehealth services list ↗.

Modifier GT — Via interactive audio and video. Some payers require modifier GT instead of or in addition to modifier 95 for telehealth sessions. Check payer-specific requirements.

Modifier 59 — Distinct procedural service. Used when 90837 needs to be distinguished from another service provided on the same day that would otherwise be considered bundled.

Modifier 76 — Repeat procedure by same physician. Used when the same provider delivers two separate 90837 sessions to the same patient on the same day, which is uncommon but may occur in intensive treatment settings.

Modifier XE — Separate encounter. A more specific alternative to modifier 59, used when 90837 is provided during a separate encounter on the same day.

Compliance Considerations

Accurate billing of 90837 requires attention to several compliance areas.

Time documentation accuracy. The most common audit finding for 90837 is insufficient time documentation. If your note does not clearly support 53 or more minutes of psychotherapy, payers can downcode the claim to 90834 or 90832 and recoup the difference. Use exact start and stop times rather than vague references to session length.

Medical necessity for session duration. Some payers may question why a 60-minute session is needed rather than a 45-minute session. Ensure documentation supports the clinical rationale for the longer session, particularly for patients who are stable or making consistent progress.

Utilization-pattern exposure. Beyond any single claim, payers profile 90837 utilization at the clinician and group-NPI level. Monitor your own 90834/90837 mix before a payer does it for you — see the payer-scrutiny section above.

Frequency limitations. While there is no universal frequency limit for 90837, some payers impose limits on the number of individual therapy sessions per week or per month. Review payer contracts and authorization requirements to avoid denials.

Supervision and credentialing. Verify that the rendering provider is credentialed with the payer and that supervision arrangements (if applicable for provisionally licensed clinicians) meet payer requirements — see the license-level section above.

Concurrent services. 90837 should not be billed concurrently with group therapy ( 90853 ) or other individual services for the same patient at the same time. Each billed service must represent a distinct, separately identifiable encounter.

Related Billing Codes

• 90833
• 90834
• 90836
• 90838
• 90839
• 90840

Reference tables

Common questions

Official sources

• CMS Physician Fee Schedule lookup toolcms.gov
• CY 2026 final rulecms.gov
• NCCI Policy Manualcms.gov
• CMS telehealth services listcms.gov