What is the criteria for billing 90837?
Asked by: Mr. Garth Lynch | Last update: August 20, 2025Score: 4.4/5 (55 votes)
What are the requirements for 90837 billing?
- 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.
What documentation requirements are necessary for reimbursement for psychotherapy?
When documenting therapy sessions, it's vital to include the client's name and medical record number, the service date, start and end times, reason for visit, diagnosis, symptoms, assessments, goals, treatment plans, and client progress.
What is the rationale for 90837?
Key Takeaways: CPT Code 90837 represents a 60-minute individual psychotherapy session. Medicare requires certain additional services to be included when billing for 90837. The duration of a 90837 session ranges from 53 minutes to longer.
Who can bill health and behavior codes?
Health Behavior Assessment and Intervention (HBAI) services described by CPT codes 96156, 96158, 96159, 96164, 96165, 96167, and 96168, and any successor codes, are billed by clinical social workers, marriage and family therapists (MFTs), and mental health counselors (MHCs), in addition to clinical psychologists.
The Value of CPT Code 90837
Who can bill psychotherapy codes?
All mental health professionals including psychologists, psychiatrists, nurses, and social workers delivering psychotherapy services use the same applicable CPT® codes when billing clients and filing health insurance claims with third-party payers, including Medicare, Medicaid, and private health insurance carriers.
Who can write a behavior plan?
FBAs and BIPs are created by someone with training and experience in behavioral psychology, like a clinical social worker or psychologist. They will suggest strategies based on what's causing your child's behavior.
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.
What is the difference between 90834 and 90837?
Both 90834 and 90837 are intended to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time / duration of visit; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes.
Can you bill 90791 and 90837 together?
The CPT code for family therapy without the patient present is 90846 CPT code. Can you bill 90791 and 90837 together? Generally, 90791 CPT code (psychiatric diagnostic evaluation) and 90837 CPT code (60-minute psychotherapy) should not be billed together on the same day for the same patient.
Can a client request therapy notes?
Client Requests
It is vital to know that clients have the legal right to access their medical records, which include psychotherapy notes. However, if you believe releasing private or sensitive information may cause harm, you can deny the request. In such a case, you must provide a written explanation for the denial.
What is required for reimbursement?
Expenses that require receipts for reimbursement
If your employee made a purchase using their own money, a receipt is necessary to trigger reimbursement; if the purchase was made with company funds—for example, with a corporate card—you still need a receipt for your business records.
How to bill 90837 and 99354?
Let's say you had a 120-minute therapy session. The right way to bill this is to submit a claim for 90837 for the first hour then include the add-on CPT code, 99354 for the remaining time. However, if you only met with your client for 80 minutes, then you can only use 90837 to bill for the session.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
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.
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 much do psychotherapists make per session?
Private pay prices are generally considerably higher, allowing you to make far more money per session. Of course, there are always exceptions to the norm. Some therapists charge less than $75 per hour while others request more than $150.
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 time is required for 90837?
The 90837 CPT Code represents individual psychotherapy sessions lasting approximately 60 minutes. During these sessions, therapists engage with clients using various modalities to address mental health concerns, emotional well-being, and behavioral patterns.
Can therapists bill for phone calls?
Typically, therapists will charge for phone calls with the client if the conversation exceeds a certain amount of time. Calls to family members: Sometimes therapists need additional information from family members, especially if the client is a child.
What is modifier 59 in medical billing?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.
What are the three parts of a behavior plan?
- antecedent and setting event supports and strategies,
- teaching new behaviors, and.
- increasing reinforcement for the new behavior while changing the team's response to the problem behavior.
What are the four R's of behavior intervention?
A simple and easy way to remember all the steps of a BIP is the 4 Rs: reduce, replace, reinforce and respond. The first step in a BIP is to be proactive and attempt to reduce the chance of interfering behavior.
Can an RBT write a behavior plan?
It's important to note that an RBT does not create plans or treatment strategies. They play a critical role, in implementing the treatment techniques created by a BCBA or BCaBA who supervises them and services a wide variety of patients.