Picking a psychotherapy code can be tricky when the session times are close. Even a few minutes can affect which code fits the visit. Knowing the time rules for CPT 90837 matters when a behavioral health claim is being prepared.
The code covers a 60-minute psychotherapy service and CMS uses 53 minutes or more for it. A session scheduled for one hour does not automatically qualify for 90837 because the actual time spent in psychotherapy is what counts.
What Is CPT 90837?
CPT 90837 is used for a 60-minute psychotherapy session with the patient. It applies when psychotherapy takes place without an E/M service. Codes like 90836 and 90838 are different because they are used with an E/M service.
The 60-minute label can also be a little confusing. The session does not have to be exactly 60 minutes, since CMS puts 53 minutes or more in the 90837 range and shorter sessions can use another code.
How Much Time Is Needed for CPT 90837?
Here is the basic breakdown:
- 90832: 16 to 37 minutes
- 90834: 38 to 52 minutes
- 90837: 53 minutes or more
This can make code selection easier when the actual session does not match the time listed in the code description. It is still a good idea to check the payer’s own rules since they may have additional requirements.
Does a 50-Minute Session Qualify for CPT 90837?
A 50-minute psychotherapy session falls in the 90834 range under CMS guidance. It should not move to 90837 just because the appointment was scheduled for an hour. The actual psychotherapy time matters more than the time put on the schedule.
This can happen pretty easily. A patient may arrive late or the provider may finish the session earlier than expected. If the actual psychotherapy time comes to 50 minutes then the provider should code based on that time.
What If the Session Lasts 53 Minutes?
When psychotherapy reaches 53 minutes it falls within the CMS range for 90837. The provider should document the actual time and make sure the record matches the service that took place.
There is no need to keep a session going just to reach 53 minutes. The session should take the time the patient actually needs. If things are done after 45 minutes, there is no reason to add extra time just to use a higher code.
How Should Providers Document Time?
Time should be easy to find in the patient record. CMS allows providers to document psychotherapy time through start and stop times or by recording the total psychotherapy time.
Either method can work as long as the record reflects what actually happened. A billing team should be able to see how long the psychotherapy lasted without having to work it out from other parts of the note.
It is also worth checking that the time makes sense with the rest of the visit. If the note shows 55 minutes of psychotherapy but the rest of the record points to a much shorter encounter then someone reviewing the claim may have questions.
Does All Appointment Time Count Toward 90837?
Not all time connected to an appointment automatically counts as psychotherapy time. The time reported should relate to the psychotherapy service the provider actually delivered.
For example, unrelated administrative work should not get added to the psychotherapy time just to reach the 90837 range. The provider should keep psychotherapy time separate from other activities connected with the visit.
This matters more when a visit includes several different tasks. Clear time records also make it easier to tell what time actually goes toward the psychotherapy code.
What About Sessions Longer Than 60 Minutes?
Some psychotherapy sessions may run longer than an hour. A longer session does not automatically mean the provider should report extra time.
CMS guidance allows prolonged service reporting in certain situations when psychotherapy without an E/M service reaches 90 minutes or more and the requirements for that service are met. The record should support the additional time too.
Payer rules can differ so providers should check the requirements that apply before reporting prolonged services. A longer session does not automatically qualify.
CPT 90837 vs CPT 90834
The main difference between 90834 and CPT 90837 is the psychotherapy time. Under CMS guidance, 90834 covers 38 to 52 minutes while 90837 starts at 53 minutes.
The CPT descriptions also list different typical service lengths. 90834 has a 45-minute descriptor while 90837 has a 60-minute descriptor. Still, providers should look at the actual psychotherapy time when choosing between the two rather than only looking at the appointment schedule.
For example, an appointment booked for one hour may end after 50 minutes. In that case, the scheduled hour does not turn the visit into a 90837 service.
CPT 90837 vs CPT 90838
These codes can get mixed up because both involve longer psychotherapy services. The main difference is that 90837 is used for psychotherapy without an E/M service while 90838 is an add-on code for psychotherapy provided with an E/M service.
So the provider needs to look at what happened during the visit before choosing between them. If an E/M service was also provided then the billing situation changes and 90838 may apply instead.
Knowing this difference can help avoid choosing a code just because the session lasted around an hour.
When Should a Provider Use CPT 90837?
A provider should use CPT 90837 when the actual psychotherapy time reaches the applicable range and the service fits the code. The session should also make sense based on the patient’s treatment needs.
A longer session can make sense when the patient needs more time. But providers should not stretch a session just to reach the 90837 threshold. The code should match the service that actually took place.
The documentation should match the visit as well. When the recorded time and service line up, the claim is easier to review later.
Common Time-Related Billing Mistakes
Time-based psychotherapy codes can lead to some simple billing mistakes. These issues may seem small on their own but repeated problems can create trouble for a billing team or organization.
Some common examples include:
- Using 90837 when the psychotherapy time was under 53 minutes
- Using the scheduled appointment time instead of the actual psychotherapy time
- Adding unrelated activities to the psychotherapy time
- Leaving the psychotherapy time out of the note
- Reporting extra time without enough support in the record
- Using 90837 when the visit also involved an E/M service
- Assuming every one-hour appointment qualifies for 90837
A quick check of the actual session time can catch many of these issues before the claim is submitted.
How Chart Audits Can Catch Time Issues
Chart audits can help find time-related coding problems before they become a regular issue. A billing or compliance team can review a sample of records and compare the code on the claim with the time recorded in the note.
For example, an audit may find several 90837 claims where the notes show only 48 or 50 minutes of psychotherapy. That gives the organization something specific to look into instead of guessing where the problem is.
An audit can also show whether providers are consistently documenting start and stop times or total psychotherapy time. If the same information keeps getting missed, a behavioral health chart audit tool can help the team spot these patterns across records and see where more guidance may be needed.
Tips for Getting CPT 90837 Time Right
The simplest approach is to record the actual psychotherapy time and choose the code from there. Providers can use start and stop times or document the total psychotherapy time based on the process used by their organization.
It helps to look over the note before signing it too. Make sure the time matches the service and that unrelated time has not been added by mistake.
Sessions close to the 90834 and 90837 cutoff deserve a little more attention. Checking those minutes before billing can save the team from fixing the claim later.
Final Thoughts
Knowing the time rules for CPT 90837 helps when choosing the psychotherapy code. CMS puts 90837 at 53 minutes or more and 90834 at 38 to 52 minutes.
What matters is how long the actual session lasted. An appointment booked for one hour does not automatically mean 90837 should be used.
Providers should document the psychotherapy time clearly and make sure the record supports the code they report. When the time, service and documentation match, there is less to sort out later.
