CPT Code 90838: Psychotherapy, 60 Min Add-On

• CPT Codes
• 90838

CPT Code 90838: Psychotherapy, 60 Min Add-On

CPT code 90838 for 60-minute psychotherapy add-on with E&M services. Billing rates, documentation, and reimbursement tips for behavioral health clinics.

Quick Reference

Code

90838

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 90838: 60-Minute Psychotherapy Add-On with E&M Services

CPT code 90838 is an add-on code for 60 minutes of psychotherapy provided in conjunction with an evaluation and management (E&M) service. For behavioral health providers, this code is essential when prescribing clinicians such as psychiatrists or psychiatric nurse practitioners deliver extended psychotherapy alongside medical management during a single encounter. Understanding how to properly bill 90838 helps behavioral health organizations capture appropriate reimbursement for these comprehensive visits.

In behavioral health treatment settings, it is common for prescribing providers to combine medication management with therapeutic interventions. When the psychotherapy component extends to approximately 60 minutes, 90838 is the appropriate add-on code to pair with the E&M service. This combination billing approach reflects the dual nature of the clinical encounter and ensures that both the medical and therapeutic components are properly reimbursed.

Definition and Purpose

CPT code 90838 is defined as psychotherapy, 53 minutes or more, when performed with an evaluation and management service. It is classified as an add-on code, meaning it must be reported alongside a primary E&M service code and cannot be billed as a standalone service.

The purpose of 90838 is to capture the psychotherapy component of a visit when a qualified provider delivers both medical management and extended psychotherapy during a single encounter. This code recognizes that certain patient populations, particularly those in behavioral health treatment, benefit from visits that integrate medication oversight with in-depth therapeutic work.

Key characteristics of 90838 include:

• Code type: Add-on code (cannot stand alone)
• Time threshold: 53 minutes or more of psychotherapy
• Required pairing: Must be billed with an E&M service code (99202-99215)
• Provider type: Prescribing providers who deliver both E&M and psychotherapy
• Distinction from 90837: 90837 is standalone; 90838 requires an E&M companion code

When to Use 90838 in Behavioral Health

90838 is appropriate in behavioral health settings when the following conditions are met:

Combined E&M and psychotherapy visit: The provider must deliver both an evaluation and management service and psychotherapy during the same encounter. The E&M component typically involves reviewing the patient’s medical history, assessing current symptoms, evaluating medication efficacy and side effects, and prescribing or adjusting medications.

Extended psychotherapy duration: The psychotherapy component of the visit must last 53 minutes or more. If the psychotherapy component is shorter, providers should use the appropriate lower-level add-on code: 90833 for 16 to 37 minutes or 90836 for 38 to 52 minutes.

Prescribing provider delivering therapy: This code is most commonly used by psychiatrists, psychiatric nurse practitioners, and psychiatric physician assistants who provide both medication management and psychotherapy. In behavioral health treatment centers, this scenario arises when patients need both medication adjustments and intensive therapeutic support.

Clinical scenarios in behavioral health: Common situations include patients in early recovery from substance use disorders who need both medication-assisted treatment (MAT) oversight and extended psychotherapy; patients with treatment-resistant depression requiring both medication optimization and intensive therapeutic intervention; and patients with co-occurring mental health and substance use disorders whose complex presentations warrant extended combined visits.

Providers should not use 90838 when only psychotherapy is provided without an E&M component. In those cases, the standalone code 90837 is appropriate.

Documentation Requirements

Accurate and thorough documentation is critical when billing 90838 because the claim involves two distinct service components.

Separate documentation for E&M and psychotherapy: The clinical note must clearly distinguish between the E&M component and the psychotherapy component of the visit. Document the medical decision-making, examination findings, and any medication changes under the E&M portion. Document the psychotherapy techniques used, therapeutic goals addressed, and patient response under the psychotherapy portion.

Time documentation: Record the total time spent on the encounter, with a breakdown of the time dedicated to the E&M service and the time dedicated to psychotherapy. The psychotherapy component must be 53 minutes or more to qualify for 90838. Be specific about start and end times for each component.

Medical necessity for both components: The note must establish that both the E&M service and the psychotherapy were medically necessary. Document why the patient required medical evaluation and management in addition to extended psychotherapy during the same visit.

Medication management details: If the E&M component includes medication management, document the medications reviewed, any changes made, the rationale for changes, and the patient’s response to current medications.

Treatment plan alignment: Connect the services provided to the patient’s treatment plan. Both the E&M and psychotherapy components should address documented treatment goals.

Billing and Reimbursement

As of March 2026, reimbursement for 90838 is paid in addition to the E&M code on the same claim. The combined reimbursement reflects payment for both the medical and therapeutic components of the visit.

Medicare: Medicare recognizes 90838 as a valid add-on code. Reimbursement for the psychotherapy add-on is typically in the range of $100 to $130, paid on top of the E&M code reimbursement. Rates vary by geographic locality per the Medicare Physician Fee Schedule.

Medicaid: Coverage and reimbursement vary significantly by state. Some state Medicaid programs have specific policies regarding combined E&M and psychotherapy billing. Verify coverage with the relevant state program.

Commercial payers: Most commercial payers recognize 90838, though reimbursement rates are determined by individual provider contracts. Some payers may require prior authorization for extended psychotherapy add-on codes.

Billing tips:

• Bill the E&M code as the primary code and 90838 as the add-on on the same claim
• Append modifier 25 to the E&M code to indicate that the E&M service was significant and separately identifiable from the psychotherapy
• Ensure the psychotherapy time documentation supports the 53-minute threshold
• Do not bill 90838 and 90837 on the same date of service for the same patient

Common Modifiers

Several modifiers may apply when billing 90838:

Always verify payer-specific modifier requirements. Incorrect modifier use is a common cause of claim denials for add-on codes.

• Modifier 25: Significant, separately identifiable E&M service — append to the E&M code (not to 90838) to indicate the E&M service is distinct from the psychotherapy
• Modifier 95: Synchronous telemedicine service — when the combined E&M and psychotherapy session is delivered via real-time telehealth technology
• Modifier 59: Distinct procedural service — used in rare circumstances when multiple sessions occur on the same date and need differentiation
• Modifier HE: Mental health program — some payers require this modifier for behavioral health services

Compliance Considerations

Billing 90838 involves compliance risks because it combines two distinct service types on a single claim.

Proper code selection: Ensure the psychotherapy time meets the 53-minute threshold. Upcoding from 90836 to 90838 without sufficient documented time is a compliance violation. If the psychotherapy lasted 38 to 52 minutes, bill 90836 instead.

Distinct services: The E&M and psychotherapy components must be genuinely distinct clinical services. If the provider is only managing medications with minimal therapeutic intervention, the psychotherapy add-on is not appropriate. The psychotherapy must involve recognized therapeutic techniques and modalities.

Provider qualifications: Only providers who are credentialed and licensed to deliver both E&M services and psychotherapy should bill 90838. Ensure that the billing provider has the appropriate scope of practice for both components.

Frequency monitoring: Track how often 90838 is billed relative to other psychotherapy codes. Consistently billing the highest-level add-on code may attract auditor attention. Billing patterns should reflect the clinical reality of varied session lengths.

Audit preparedness: Maintain documentation that clearly supports both the E&M and psychotherapy components. In an audit, the payer will evaluate whether the documentation justifies two separate services and whether the time thresholds were met.

Related Billing Codes

• 90834
• 90836
• 90837
• 90839
• 90840
• 90845

Common questions

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