CPT Code 90837: How to Bill 60-Minute Psychotherapy Sessions Without Denials

Providing quality mental health care often requires flexibility, especially when patients need more than the typical 45 – 50 minute session. CPT code 90837 is designed explicitly for psychotherapy sessions that last 60 minutes or longer. This code allows clinicians to account for the extra time spent addressing complex emotional or behavioral issues, crises, or multiple co-occurring mental health conditions.

Unlike standard therapy sessions billed under 90834, 90837 requires detailed documentation to show why the extended time was medically necessary. Clear and complete notes not only justify the session length but also help prevent 90837 denials, protect your practice during audits, and ensure proper reimbursement. Therefore, understanding how to bill 90837 correctly is essential for every mental health provider.

In this blog, we will walk you through each step of billing 90837 accurately.

Step 1: Match Session Time with Medical Necessity

The first step is to make sure your session meets both the time and clinical requirements for CPT 90837. You must spend at least 53 minutes face-to-face with the patient. Additionally, your notes should explain why the patient needed the extra time. For example, longer sessions are appropriate for trauma therapy, crisis intervention, or patients with multiple mental health concerns. As a result, you set a strong foundation for your claim by matching session time with medical necessity.

Step 2: Document Clearly and Completely

When billing CPT code 90837, your notes must show not only the time spent but also why the extended session was necessary. In fact, writing clear details makes your claim stronger and protects you in case of an audit. Every 90837 note should include:

• Start & stop times (or total minutes) – Always write the exact session length, such as 10:05–11:12 or 67 minutes total.
• Clinical reasons tied to medical necessity – Explain why the patient required a full hour, such as crisis stabilization, trauma work, or severe anxiety.
• Interventions used – List the therapeutic approaches you applied, like CBT, DBT, trauma-focused therapy, or safety planning.
• Patient response and measurable progress – Show how the patient reacted to the session and note any progress, such as reduced anxiety or improved coping skills.
• Risk/safety statements (if relevant) – Document any safety concerns, including suicidal thoughts, and describe steps taken to address them.
• Plan for next session – Write what you will focus on moving forward, such as continuing exposure work or monitoring risk factors.

Step 3: Follow Telehealth Billing Rules

If you are delivering psychotherapy sessions through telehealth, make sure you follow payer-specific rules. You will need to add Modifier 95 and choose the correct place of service code, such as POS 10 for home sessions or POS 02 for other locations for most insurers. Medicare has extended telehealth coverage for 90837 through September 30, 2025, but private insurers may have different policies. Therefore, always double-check payer requirements before submitting a telehealth claim.

Step 4: Use Add-On Codes When Necessary

Sometimes, a session may go beyond the usual 60 minutes or involve extra complexities. In these cases, you should use the appropriate add-on codes to make sure you are paid correctly for the additional work. Every 90837 session with add-ons may include:

• Prolonged service codes (e.g., 99354) – Use these when the session extends past 90 minutes, if the payer accepts them.
• Psychotherapy with medication management (90838) – Bill this add-on instead of 90837 alone when therapy is provided alongside an E/M service.
• Interactive complexity (90785) – Apply this code when communication is especially challenging, such as working with children, patients with guardians, or when using interpreters.

Step 5: Know the Common Reasons for Denials

It is essential to take a few extra minutes to thoroughly document time and medical necessity, as this can prevent most denials before they occur. It can occur due to:

• Missing or incomplete session time – Not recording start and stop times or leaving out the total minutes makes the claim unsupported.
• Repetitive or identical session lengths – Using the same session time in every note raises red flags during audits.
• Weak medical necessity explanation – Failing to explain why the session required a full 60 minutes results in insufficient documentation.
• Billing under 53 minutes – Submitting 90837 for shorter sessions automatically leads to denials.
• Telehealth coding errors – Using the wrong modifier or place of service code can cause claims to be rejected.
• Overuse without justification – Insurers often flag providers who bill 90837 too frequently without clear clinical reasons.

Step 6: Build a Smooth Workflow in Your Practice

A well-designed workflow can significantly reduce billing errors and streamline your practice. In fact, every effective workflow should include:

• EHR templates – Customize templates to prompt for session start/stop times, interventions, patient progress, and next session plans.
• Billing team training – Ensure staff know how to enter the correct CPT code, modifiers, and place of service for both in-person and telehealth sessions.
• Quarterly audits – Review a sample of 90837 claims every few months to confirm documentation meets payer requirements and is audit-ready.
• Automated reminders – Use software prompts to help clinicians complete notes accurately and on time.

Step 7: Be Prepared for Denials or Reviews

Even if you bill carefully, some payers may still question your claims. When this happens, respond promptly with detailed documentation that clearly outlines the session length, the clinical need, and the interventions employed. If your practice is flagged for high usage of 90837, submit a utilization narrative that explains why longer sessions are necessary for your patients. Additionally, attach your complete session note along with a professional statement for appeals. This proves that your claim is valid and medically necessary.

Step 8: Double-Check with a Final Checklist

A final checklist helps catch errors before submitting a claim for ensuring your 90837 billing is clean and accurate. It should include:

• Exact session times – Verify that start and stop times, or total minutes, are clearly documented.
• Medical necessity – Ensure your notes explain why the session required 60 minutes.
• Correct CPT code, modifier, and POS – Confirm that 90837 and any telehealth or other required modifiers are used correctly.
• Add-on codes – Check that you are not billing 90837 with an E/M service unless the proper add-on (90838) is included.
• Payer-specific requirements – Review coverage rules for prolonged sessions, telehealth, or other special conditions.

Example Audit-Proof Documentation

Date: 2025-06-12

Start/End: 09:05–10:12 (67 min face-to-face)

Diagnosis: F41.1 Generalized Anxiety Disorder

Reason for extended time: Patient experienced a significant escalation of panic symptoms. The session required extra time for stabilization, cognitive restructuring and creation of a personalized safety plan.

Interventions used: Cognitive restructuring, guided exposure planning, in-session breathing exercises, and development of a 3-step safety plan.

Patient response & measurable progress: Patient identified two distorted thoughts and practiced breathing techniques until anxiety decreased; reported SUD 0/10 at session end.

Risk/safety statements (if relevant): Safety planning addressed; no imminent risk noted during session.

Plan for next session: Weekly 60-minute sessions x4, homework: daily 5-minute breathing practice, monitor panic episode frequency.

Bill: 90837, Modifier 95, POS 10 (telehealth)

Conclusion

Billing 60-minute psychotherapy sessions correctly is more than just tracking time. You also need to document why the extra time was necessary, which interventions you used, how the patient responded and any safety concerns. Additionally, following payer rules and telehealth guidelines is crucial to avoid denials. Without a structured process, mistakes can slow down payments and create extra work for your staff.

As a result, you can ensure that every 90837 claim is complete, accurate, and ready for audits by outsourcing to a professional medical billing company such as 24/7 Medical Billing Services. Their expert team takes care of selecting the correct codes, applying modifiers, managing telehealth rules and adding necessary add-on codes. Thereby, your practice can reduce errors, get faster reimbursements, and save staff time.

FAQs

Q1. Can 90837 be billed for group therapy?

90837 is only for individual psychotherapy sessions.

Q2. Is parental involvement allowed in 90837 sessions?

Yes, if it’s part of the therapy, but it must be documented clearly.

Q3. Can you bill 90837 with another psychotherapy code on the same day?

You should not bill overlapping psychotherapy codes for the same patient on the same day.