CPT codes (Current Procedural Terminology) are a standardized language used by healthcare providers to describe medical services for billing and insurance purposes. Maintained by the American Medical Association (AMA), these codes ensure uniformity in reporting procedures across the medical industry. CPT code 90837 is a specific designation used by mental health professionals to bill for a particular type of psychotherapy session. Understanding this code helps patients review their explanation of benefits, as it represents a distinct service defined primarily by the time spent with the patient.
The Specific Service Defined
CPT code 90837 covers individual psychotherapy, which is a therapeutic intervention focused on treating mental health conditions, symptoms, or maladaptive behaviors. The service requires a face-to-face interaction between a qualified mental health provider and a patient. This code reports various psychotherapeutic approaches, such as insight-oriented, behavior-modifying, supportive, or interactive therapies.
Although the code often refers to a “60-minute” session, the actual clinical content is what defines the service. During this time, the therapist engages in therapeutic communication to alleviate emotional disturbances and encourage personal growth. The service can also include the involvement of family members or other informants, provided the focus remains on the individual patient’s treatment.
Time Requirements and Clinical Necessity
The defining characteristic of CPT code 90837 is its time requirement, which sets the boundary for its use in billing. This code is designated for psychotherapy sessions where the direct, face-to-face service lasts 53 minutes or longer. The exact start and stop times of the session must be accurately documented in the provider’s clinical notes to support using this specific code.
This extended duration must be medically necessary and clinically justified based on the patient’s condition and treatment goals. Longer sessions are often required for complex clinical scenarios, such as intensive trauma work or comprehensive diagnostic assessments. The necessity for the extended time must be documented to explain why a shorter session would not adequately address the patient’s needs. Documentation must clearly reflect that the time billed was spent on direct psychotherapy, not administrative tasks like scheduling or writing notes.
Distinguishing 90837 from Shorter Psychotherapy Codes
CPT code 90837 is differentiated from its counterparts primarily by the documented length of the service provided. The clinical content, such as the type of therapy (e.g., Cognitive Behavioral Therapy or trauma therapy), generally remains the same across different codes. However, the duration determines which code is submitted to the payer for reimbursement.
The two most common shorter codes are 90834 and 90832, representing standard and brief therapy sessions, respectively. Code 90834 is used for sessions lasting between 38 and 52 minutes, often called the “45-minute” session. Code 90832 covers the shortest sessions, lasting 16 to 37 minutes, which may be used for targeted interventions or follow-ups. Selecting the appropriate code based on time spent is required for compliance and ensures the provider is compensated for the time commitment to the patient’s care.