How to bill a 90 minute therapy session?

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To bill a routine 90-minute individual therapy session to commercial insurance or Medicare, you must use CPT code 90837 (53 minutes or more), as prolonged services add-on codes (such as 99354/99355) were deleted by the AMA.

Current CPT Coding Rules

  • Standard Individual Therapy (90837): Covers any individual psychotherapy session lasting 53 minutes or longer. Because standard CPT rules cap routine psychotherapy at one unit per day without active prolonged service add-ons, a 90-minute session is billed simply as 90837.
  • Reimbursement Rate: You will typically be reimbursed at the standard 60-minute rate for 90837, regardless of the extra 30+ minutes spent, unless you have a specialized private-pay or contracted exception.

Alternative Scenarios & Codes

  • Crisis Sessions: If the 90-minute session meets the clinical criteria for an emergency or high-distress crisis, you can bill CPT 90839 (for the first 60 minutes) combined with add-on code CPT 90840 (for each additional 30 minutes).
  • Interactive Complexity (CPT 90785): If the session involves specific factors like high-conflict third parties or communication challenges, 90785 can sometimes be appended as an intensity add-on, though it does not cover extra time.

Best Practices for Documentation

  • Exact Times: Always record the exact start and stop times in your clinical notes.
  • Clinical Justification: Document clear medical necessity explaining why a 90-minute duration was clinically required (e.g., intensive trauma processing like EMDR).
  • Self-Pay Agreements: If insurance will not compensate for the extra 30 minutes, many providers utilize a separate Self-Pay / Extended Session Agreement to privately bill for the remaining time out-of-pocket.

Can you bill 2 units of 90837?

No, you generally cannot bill two units of CPT code 90837 for a single extended single session, but you can bill two units if you conduct two separate 53+ minute sessions on the same calendar day.

Single Session Rules

  • One unit maximum: CPT 90837 represents individual psychotherapy lasting 53 minutes or more.
  • No time scaling: You cannot use multiple units of 90837 to bill for a single 90-minute or 120-minute continuous session.
  • Audit and denial risk: Billing two units for one continuous encounter often triggers claim rejections, compliance flags, or insurance audits.

Same-Day Multiple Sessions

  • Separate encounters: You can bill two units of 90837 in one day only if they represent two distinct, medically necessary psychotherapy sessions.
  • Time threshold: Each separate session must meet the minimum requirement of 53 minutes of direct face-to-face patient contact.
  • Documentation: You must clearly record separate start and stop times, distinct clinical justifications, and separate claim notes for each encounter.

How many units is 90 minutes of therapy?

Ninety minutes of timed physical, occupational, or speech therapy equals 6 billing units under Medicare's 8-Minute Rule Reference Chart.

Unit Breakdown for Timed Therapy

Under the 8-Minute Rule Explained for Therapists, billable units are calculated in 15-minute increments based on total direct treatment time:

  • 1 unit: 8 to 22 minutes
  • 2 units: 23 to 37 minutes
  • 3 units: 38 to 52 minutes
  • 4 units: 53 to 67 minutes
  • 5 units: 68 to 82 minutes
  • 6 units: 83 to 97 minutes

Note: This rule applies specifically to timed rehabilitation services (like therapeutic exercise or manual therapy). It does not apply to mental health psychotherapy sessions, which are billed per session code rather than by 15-minute units.

How are therapy sessions billed?

Therapy sessions are billed using standardized codes that describe the type and length of the service provided.

Billing Methods

  • Private Pay (Out-of-Pocket): Clients pay the therapist a flat fee per session using cash, check, or credit card.
  • In-Network Insurance: The therapist bills the insurance company directly using standardized CPT Codes. The client pays only their copay, coinsurance, or deductible.
  • Out-of-Network Insurance: The client pays the therapist upfront. The therapist provides a document called a superbill (an itemized receipt), which the client submits to their insurance company for partial reimbursement.

Common CPT Codes for Therapy

Insurers require specific codes based on what happens during the appointment:

  • 90791: Initial psychiatric diagnostic evaluation or intake session.
  • 90832: Individual psychotherapy for 30 minutes (16 to 37 minutes).
  • 90834: Individual psychotherapy for 45 minutes (38 to 52 minutes).
  • 90837: Individual psychotherapy for 60 minutes (53 minutes or more).
  • 90847: Family or couples therapy with the patient present.
  • 90853: Group therapy.

Telehealth Billing

  • Virtual Sessions: Billed using the same standard CPT codes as in-person visits.
  • Modifiers: Therapists add specific codes (like modifier 95) and a telehealth place-of-service code to let the insurer know the session was remote.

What is the CPT code for a 90-minute crisis psychotherapy session?

A 90-minute crisis psychotherapy session is billed using a combination of CPT code 90839 for the initial portion and one unit of CPT code 90840 for the additional time.

Billing Breakdown

  • 90839: Covers the first 30 to 74 minutes (referred to as the first 60 minutes) of an acute crisis psychotherapy session.
  • 90840: Serves as an add-on code for each additional 30 minutes, which applies when the session exceeds 74 minutes (reaching the 90-minute mark). It cannot be billed by itself.

Requirements for Crisis Codes

  • Clinical urgency: The patient must be in high distress from a complex or life-threatening situation (such as acute suicidal ideation or severe trauma).
  • Core elements: Documentation must reflect an urgent assessment, a mental status exam, psychotherapy, and safety planning or resource mobilization.

New 2023 Updates: Billing for Prolonged Therapy Sessions

9 related questions found

Can I bill for 90 minutes of psychotherapy?

You cannot bill insurance for an explicit 90-minute standard psychotherapy session because no specific 90-minute CPT code exists.

How to Bill Insurance

  • Use CPT 90837: Bill standard individual sessions lasting 53 minutes or longer (including 90 minutes) using CPT Code 90837.
  • Accept standard reimbursement: Insurance pays the same flat rate for a 90-minute session using 90837 as it does for a 53-minute session.
  • Avoid extra units: Do not bill multiple units of 90837 or combine codes like 90837 and 90834 on the same day; most insurers reject this, and it carries a high risk of audit or claim denial.
  • Check crisis exceptions: Use crisis codes CPT Code 90839 for the first 60 minutes and add-on code 90840 for each additional 30 minutes, but only if the session meets strict emergency criteria for high-distress crisis care.

Alternative Options

  • Private pay for extra time: Contract directly with the client out-of-pocket for the remaining 30 minutes via a written private-pay agreement, while billing insurance for the standard 60-minute portion.
  • Document duration: Always record exact start and stop times and clinical necessity for longer sessions in your notes.

Can you bill 90837 and 90840 on the same day?

No, you cannot bill routine psychotherapy code 90837 and crisis add-on code 90840 on the same day.

Billing Rules for 90837 and 90840

  • Code Definitions: 90837 is a standard 60-minute individual psychotherapy code, while 90840 is an add-on code for each additional 30 minutes of crisis psychotherapy (which must be billed alongside primary crisis code 90839).
  • Same-Day Restrictions: National Correct Coding Initiative (NCCI) edits and payer rules explicitly forbid combining crisis codes (90839 and 90840) with standard psychotherapy codes (such as 90832, 90834, or 90837) on the same date of service.
  • Handling Mixed Sessions: If a routine session shifts into an acute crisis, you should bill the primary crisis code 90839 (and add-on 90840 if the total crisis time exceeds 74 minutes) for the total encounter, rather than splitting the visit between standard and crisis codes.

What is the time range for CPT code 90837?

The time range for CPT code 90837 is 53 minutes or longer.

Although the official American Medical Association (AMA) description lists the code as "Psychotherapy, 60 minutes," the strict billing threshold begins at 53 minutes of actual, face-to-face therapeutic interaction.

Key Time Rules for 90837

  • Minimum Time: 53 minutes. A session lasting 52 minutes cannot use this code and must instead be billed as 90834 (the 38–52 minute code).
  • Maximum Time: There is no upper time limit or ceiling for 90837, making it the open-ended code for individual psychotherapy sessions that run 53 minutes and beyond.
  • What Counts: Only active, face-to-face (or telehealth) psychotherapy time spent with the patient or family member counts toward the clock.
  • What Excludes: Administrative tasks, scheduling, waiting for a late client, and non-therapeutic note-taking do not count toward the required 53 minutes.

What are the CMS billing guidelines for physical therapy services?

Centers for Medicare & Medicaid Services (CMS) billing guidelines for physical therapy require explicit modifiers, strict adherence to timed coding rules, and comprehensive documentation of medical necessity.

Core Billing and Coding Rules

  • GP Modifier: All outpatient physical therapy claims must include the GP modifier to denote services provided under a physical therapy plan of care.
  • CQ Modifier: Append the CQ modifier alongside the GP modifier if a physical therapist assistant (PTA) provides more than 10% (the de minimis standard) of a specific service. Services billed with a CQ modifier are reimbursed at 85% of the standard Physician Fee Schedule amount.
  • The 8-Minute Rule: For time-based (constant attendance) 15-minute codes, you must provide direct one-on-one care for at least 8 minutes to bill a single unit. To bill multiple units, the cumulative time determines the total allowable units based on specific 8-minute thresholds per day (e.g., 1 unit = 8–22 minutes, 2 units = 23–37 minutes).
  • Multiple Procedure Payment Reduction (MPPR): Medicare applies a 50% payment reduction to the practice expense component for the second and subsequent "always therapy" services furnished to a patient on the same calendar day.

Documentation and Medical Necessity

  • Plan of Care (POC): A physician or non-physician practitioner must review, sign, and date the plan of care within 30 days of the initial treatment.
  • Recertification: The POC must be formally recertified by a physician or NPP at least every 90 days or when there is a significant change in the patient's condition.
  • Skilled Care Requirement: Documentation must clearly show that the interventions require the specialized skills of a physical therapist and yield measurable functional progress, evaluated at least every 10 treatment days.

You can review official regulations and annual code changes directly on the CMS Therapy Services portal.

What are the CPT codes for psychotherapy in 2026?

The primary CPT codes for psychotherapy in 2026 are organized by session length, format, and whether they include medical evaluation and management.

Individual Psychotherapy (Stand-Alone)

  • 90832: 30 minutes (16 to 37 minutes of face-to-face time)
  • 90834: 45 minutes (38 to 52 minutes of face-to-face time)
  • 90837: 60 minutes (53 minutes or more of face-to-face time)

Psychotherapy with Evaluation and Management (E/M) Add-Ons

Used by prescribers delivering both medication management and psychotherapy in the same visit alongside an office visit code (such as 99212–99215).

  • +90833: 30-minute psychotherapy add-on (16–37 minutes of therapy)
  • +90836: 45-minute psychotherapy add-on (38–52 minutes of therapy)
  • +90838: 60-minute psychotherapy add-on (53+ minutes of therapy)

Family and Group Psychotherapy

  • 90846: Family or couples psychotherapy without the patient present
  • 90847: Family or couples psychotherapy with the patient present
  • 90849: Multiple-family group psychotherapy
  • 90853: Group psychotherapy (non-family)

Crisis Psychotherapy

  • 90839: Psychotherapy for crisis, first 60 minutes (30–74 minutes)
  • +90840: Each additional 30 minutes (75+ minutes), used with 90839

Diagnostic Evaluation & Special Add-Ons

  • 90791: Psychiatric diagnostic evaluation without medical services
  • 90792: Psychiatric diagnostic evaluation with medical services
  • 90785: Interactive complexity (add-on for communication factors like high-conflict or interpreters)

You can review a complete breakdown of rules and documentation standards in this 2026 Mental Health CPT Cheat Sheet.