Current Procedural Terminology (CPT) codes are a standardized language used by healthcare providers to describe medical procedures and services for billing and reporting. These codes ensure that services, such as a mental health session, are universally understood by clinicians and payers. CPT code 90837 is frequently used in mental health, representing a specific service offered by psychiatrists, psychologists, and licensed therapists. Understanding this time-based code is important because it directly communicates the nature and duration of an outpatient individual psychotherapy encounter to the payer.
The Extended Psychotherapy Session
CPT code 90837 specifically describes an individual psychotherapy session lasting 60 minutes. Officially, the code applies when the therapist spends at least 53 minutes of face-to-face time with the patient. This duration is longer than the standard 45-minute session, which is billed under CPT code 90834. Using 90837 signals that a more intensive, extended therapeutic encounter took place.
The service involves talk therapy aimed at alleviating emotional disturbances and changing maladaptive behavior patterns. It covers various modalities, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), trauma-focused therapies, and psychodynamic work. The code covers therapeutic interventions such as assessment, goal setting, treatment planning, and direct interactive communication. It is used exclusively for one-on-one sessions, distinguishing it from codes used for group or family therapy.
Clinical Rationale for the 60-Minute Session
The decision to use the extended 60-minute session, rather than the standard 45-minute length, is based on a clinical determination of medical necessity. This extended time allows for greater therapeutic depth, which is often required for complex or severe mental health conditions. Conditions such as post-traumatic stress disorder (PTSD), major depressive disorder, or personality disorders often necessitate more time for in-depth processing and intervention.
Longer sessions are frequently used for crisis intervention, where the patient requires an intensive focus on stabilization and safety planning. Certain structured therapeutic techniques, like Eye Movement Desensitization and Reprocessing (EMDR), often require a 60-minute block to effectively move through the phases of treatment without rushing the patient. The additional time provides a buffer for building rapport, exploring complex topics, and conducting a thorough summary and plan for the next session.
Understanding Patient Financial Responsibility
The use of CPT code 90837 directly influences a patient’s financial responsibility. When a therapist bills using this code, the cost associated with the longer session is communicated to the insurance provider. Because 90837 represents a longer duration of service, its reimbursement rate is typically higher than the rate for the 45-minute code, 90834.
The actual amount a patient pays depends on their specific insurance plan structure, involving copayments, deductibles, and coinsurance. The cost of the 90837 session contributes toward meeting the deductible, the out-of-pocket amount the patient must pay before coverage begins. Patients should also be aware that copayments may be higher for a 60-minute session.
Once the deductible is met, coinsurance is the percentage of the service cost the patient must pay, with the insurer covering the remainder. Coverage rates differ significantly between in-network and out-of-network providers. In some cases, the insurance may require the therapist to provide specific documentation to justify the medical necessity of the extended session before approving payment.