Billing for Therapy Sessions 90834 vs 90837 and When to Use Them

Billing for Therapy Sessions: 90834 vs 90837 and When to Use Them

In the world of psychological therapy billing, understanding the nuances between CPT codes 90834 and 90837 is essential for accurate billing, timely reimbursement, and compliance with payer guidelines. These two codes are widely used by mental health providers to bill individual psychotherapy sessions, but are differentiated primarily by session length and clinical complexity. This blog will guide you through what each code represents, when to use them, and best practices in billing for therapy sessions to optimize your practice’s revenue cycle.

What Are CPT Codes 90834 and 90837?

CPT (Current Procedural Terminology) codes are standardized codes used in healthcare billing to describe medical, diagnostic, and therapeutic services. In psychotherapy, these codes classify session lengths to provide clarity for insurers and ensure correct reimbursement.
CPT Code Session Length Description
90834
38 to 52 minutes
Standard individual psychotherapy session (approximately 45 minutes)
90837
53 minutes or longer
Extended individual psychotherapy session (typically 60 minutes)

Key Differences Between 90834 and 90837

The primary distinction between these two codes is the duration of the psychotherapy session:
  • 90834 is used for sessions lasting at least 38 minutes but less than 53 minutes. It is the most common code for a standard therapy session.
  • 90837 is designated for longer sessions, with a minimum face-to-face time of 53 minutes. These sessions often accommodate more complex clinical cases requiring in-depth therapeutic intervention.

Clinical Implications

  • 90834 sessions can be considered standard individual therapy, focusing on a range of emotional and behavioral issues that can typically be addressed in a 45-minute session.
  • 90837 sessions often represent enhanced therapeutic complexity, such as trauma-focused therapies, deeper emotional processing, or multiple clinical issues warranting extended time.

When to Use Each Code

Correctly differentiating between these codes ensures compliance and maximizes reimbursement:
  • Use 90834 when the session lasts between 38 and 52 minutes.
  • Use 90837 for sessions that reach 53 minutes or longer, reflecting an extended therapeutic encounter.
  • If a session is shorter than 38 minutes but more than 16 minutes, consider other codes like 90832 (16-37 minutes).
  • For family or group therapy sessions, different CPT codes apply and should be used instead (e.g., 90846, 90847).

READ MORE: Mental Health Billing Guide: CPT Codes for Therapy & Psychiatry

Important Billing Considerations

  • Accurate start and end times should be documented to support the billed CPT code.
  • Avoid undercoding by using 90834 for longer sessions exceeding 53 minutes, which can result in revenue loss.
  • Clear session documentation, including therapeutic interventions, patient progress, and clinical rationale, supports appropriate coding.
  • Pay attention to payer-specific guidelines as reimbursement rates and documentation requirements can vary.

Financial Impact of Accurate Coding

The reimbursement difference between 90834 and 90837 can be significant. For example, 90834 may reimburse around $98 per session, while 90837 can reimburse up to approximately $145, depending on the payer and location. Consistently undercoding can lead to substantial financial losses over time.

READ MORE: 7 Revenue Cycle Management Mistakes

Summary Table of CPT Codes for Psychotherapy Sessions

CPT Code Session Duration Common Use Case Average Reimbursement*
90832
16-37 minutes
Brief individual psychotherapy
Lower than 90834
90834
38-52 minutes
Standard individual therapy session
~$98
90837
53+ minutes
Extended therapy, complex cases
~$145
90846/90847
Variable
Family therapy (patient present or not)
Varies

Best Practices for Billing Psychology Therapy Sessions

The reimbursement difference between 90834 and 90837 can be significant. For example, 90834 may reimburse around $98 per session, while 90837 can reimburse up to approximately $145, depending on the payer and location. Consistently undercoding can lead to substantial financial losses over time.

Best Practices for Billing Psychology Therapy Sessions

  • Track Session Duration Accurately
    Use timers or reliable documentation methods to record session start and end times.
  • Document Thoroughly
    Note session goals, interventions, patient responses, and time spent.
  • Review Payer Policies
    Insurance companies may have unique policies on time increments or require modifiers.
  • Educate Your Billing Staff
    Ensure your billing team understands the differences and coding rules.
  • Leverage Technology
    Use electronic health record (EHR) systems and billing software to streamline coding and claims submission.
Best Practices for Billing Psychology Therapy Sessions

How MaxRemind Can Help

At MaxRemind, we offer specialized medical billing services tailored to behavioral health providers, including expert coding for psychotherapy sessions like 90834 and 90837. Our advanced coding software, powered by AI and revenue cycle management solutions, ensures you maximize reimbursements and minimize claim denials. With our support, your practice can focus on delivering quality patient care without billing hassles.

Billing for therapy sessions can be complex, but understanding and applying the correct CPT codes 90834 and 90837 will improve your practice’s financial health and compliance. Use the guidelines above to confidently bill your psychotherapy sessions, ensuring you get paid fairly for the valuable services you provide.
How MaxRemind Can Help

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FAQs
What happens if my therapy session lasts exactly 53 minutes? Should I bill 90834 or 90837?

If your session lasts 53 minutes or longer, you should bill 90837, as it meets the minimum time requirement for an extended psychotherapy session. Always document your session start and end times clearly for compliance.

Can I bill 90837 for every session if my sessions typically last around 60 minutes?

You can bill 90837 when your documentation supports the duration and clinical need for extended sessions. However, some payers flag frequent use of 90837, so it’s best to ensure clinical justification is consistently recorded.

What code should I use if a session ends early due to a patient emergency or cancellation?

If a session lasts between 16 and 37 minutes, use 90832. If it’s shorter than 16 minutes, it may not qualify for billing unless payer-specific rules apply. Always note the reason for early termination in your documentation.

Are reimbursement rates for 90834 and 90837 the same across all insurance companies?

No. Reimbursement rates vary depending on the payer, region, and provider contract. On average, 90837 reimburses higher than 90834 due to the longer duration and higher complexity.

How can I minimize claim denials when billing 90834 and 90837?

Ensure accurate time documentation, detailed clinical notes, and adherence to payer-specific policies. Using an EHR and billing service like MaxRemind can help automate coding accuracy and reduce rejections.