What is the CPT code 90837 billing guideline?
Asked by: Mr. Leonel Tillman IV | Last update: February 16, 2025Score: 4.6/5 (63 votes)
What are the requirements for billing 90837?
- A 60-minute session length. Don't round up or down—bill only for the actual duration.
- A mental health diagnosis. The diagnosis must be from the current DSM.
- Medical necessity for the service. Explain why therapy is needed to treat the diagnosis.
- Progress notes that match the billed code.
How to justify 90837?
- Did the nature of the treatment justify the time length of the session? ...
- Does the nature of the treatment justify the frequency of treatment sessions? ...
- Was the treatment rendered medically necessary?
How do you bill for a 1.5 hour therapy session?
Psychologists who conduct sessions that require more than 60 minutes should report CPT® code 90837: Psychotherapy, 60 minutes with patient. Regardless of how long the session lasts, the psychologist's reimbursement will be based on the payment amount ultimately associated with 90837.
What is the reimbursement rate for 90837?
Therapists use this code when providing extended therapy services to their patients. Just like CPT Code 90834, the reimbursement rate for CPT Code 90837 may vary depending on the payer, location, like in New York the reimbursement rate for CPT code 90837 is $144.83.
CPT Code 90834: Billing Guide by TheraThink
Can I bill 90837 for 50 minutes?
Therapists use CPT code 90837 to bill for psychotherapy sessions lasting 53-60 minutes. It replaced the previous code 90808 in 2013. This code applies to individual psychotherapy sessions that need more time than the standard 45 or 50-minute session (billed under CPT code 90834).
How much is a 60 minute therapy session?
Even if you don't have benefits that cover mental health services, Talkspace is still more affordable than most in-person therapy. The average cost of a traditional in-person therapy session is $175 - $500 per session — a big departure from our plans!
How do you charge for therapy sessions?
One major factor to consider is the average cost of therapy in your area. Knowing that figure will give you a sense of how your rates compare to those of your peers! One way to do this is by using the Therapy Budget fee slider on Zencare to explore what other providers are charging near you.
What does Medicare pay for CPT code 90837?
The reimbursement rates for CPT Code 90837 vary depending on the year and insurance provider. As of 2023, the Medicare reimbursement rate for a 60-minute individual therapy session is $147.07. In previous years, the rates were $164.84 (2022), $152.48 (2021), and $141.47 (2020).
How do you bill billable hours?
- Set an hourly rate. If you charge a single rate for all your services and clients, this step is straightforward. ...
- Track the number of hours worked. ...
- Add up your billable hours. ...
- Multiply your hours worked by your hourly rate. ...
- Add any extra fees or charges.
Can you say too much in therapy?
While it is possible to overshare in therapy, therapy is a time and setting where oversharing is usually appropriate, welcomed, and helpful. That's because the more details a client shares about their experiences and feelings, the more a therapist can gain insight into who they are and help guide them toward growth.
How do you tell a therapy client they are not a good fit?
A good technique for turning away a client includes: Explaining why you are not a good fit for them. Explaining who they can see instead and why they're in a position to help. Techniques they could do for self-care while connecting with another therapist.
Can a therapist charge more than insurance allows?
The allowed amount is like a cap on what your insurance will pay for your therapy. If your therapist charges more than this cap, you might have to pay the difference. That's called "out-of-pocket" costs because it comes from your own pocket.
Can 90837 be telehealth?
90837 – Psychotherapy, 60 minutes with a patient. This code is used to bill for 60 minutes of psychotherapy with a patient in a telehealth setting.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
Can you bill 2 units of 90837?
It's important that you should have two separate sessions that last for at least 60 minutes. Each session must meet the criteria for billing 90837, including a minimum of 53 minutes of direct patient contact and appropriate documentation. You must bill each unit separately on your claim form.
Is telehealth billed differently?
Medi-Cal pays the same rate for professional medical services provided by telehealth as it pays for services provided in-person. Please see the Payments and Claims section on this page.
How many minutes is 90837?
90837 is defined as a session of 60 minutes, ranging from 53 minutes to longer. The only difference between 90834 (the other commonly used CPT code) and 90837 is the time.
How many therapy sessions does Medicare pay for?
Yes, Medicare does limit the number of counseling sessions, specifically under Medicare Part B. Initially, you're allowed up to 20 outpatient individual or group therapy sessions per year. However, it's important to note that further sessions may be authorized if deemed medically necessary by your healthcare provider.
How are therapy sessions billed?
You'll want to use your typical 90837 CPT code. Then you'll also want to use the Add On CPT code 99354 which declares an additional 30 to 74 minutes of therapy. So any time you do 90 to 2 hours and 14 minutes of therapy, make sure to use the combination of CPT Codes 90837 and +99354.
What is a normal amount of therapy sessions?
Recent research indicates that on average 15 to 20 sessions are required for 50 percent of patients to recover as indicated by self-reported symptom measures.
What is the copay for therapy?
A copay is the set fee you pay at every medical session, including therapy. When you see a therapist who is in-network with your insurance plan, you pay them a copay at each therapy session. Then, your therapist sends a claim to the insurance company to receive the remainder of the fee they're owed.
How do you justify 90837?
your client may have a trauma history: “90837 is medically necessary because significant trauma hx necessitates taking time to create safe space for disclosure and then containment.”
Is a 2 hour therapy session too long?
You might find it difficult to concentrate during a lengthy session. Or a session that's a couple of hours long might be emotionally draining for you, especially if you're discussing trauma. Keep in mind that therapy sessions that are an hour or a little less are standard in talk therapy.