How To Bill Therapy Code 90837: The Do's and Don'ts of Filing Insurance Claims

What makes the daily grind enjoyable for you?

Is it the positive vibes from working with a good team? Or the feelings of accomplishment that you’ve helped someone in need? Maybe it’s the fact that you’re your own boss?

The little (and not-so-little) things that make each of our challenging work days enjoyable can be different for each person. Except for perhaps one thing: getting paid.

Of course, we love doing our jobs as therapists and seeing improvement in our clients is a great reward. It’s selfless and honorable work, but at the end of the day it's still a job – and we need to make sure we’re getting paid too. The promise of a payday is one of the best motivators to continue building our practices.   

For therapists that work with insurance, we’ll help you navigate filing and getting reimbursement for claims. Let's ensure you're getting paid to the fullest extent for your services. 

Billing Insurers By the Hour

With therapy, every minute counts — not just for our clients but also for us. This is especially true when it comes to billing insurance companies.

Depending on how you’ve set up your practice, sessions can run anywhere from 30, 45, or 60 minutes. Most therapy appointments run for a full 60 minutes. Some health insurers consider the “standard” length of a psychotherapy session to be only 45 minutes. 

It’s not a problem to submit a CPT code for an hour of therapy, but it can pose the small issue of greater scrutiny. Let's go over how to make sure you get reimbursed appropriately for your work. Here are a few important things to know, as well as some dos and don’ts. 

Therapy CPT Code 90837: The Full Hour

There are three codes commonly used when billing for individual psychotherapy services:

• 90832 - 30 minutes
• 90834 - 45 minutes
• 90837 - 60 minutes

The only difference between these codes is how long the sessions lasted for. 90834 is the “standard” for billing. Just because it considered so, doesn’t mean that you can't do 60 minute appointments and bill for code 90837. 

Let’s talk more about how to use CPT 90837 so you can get the maximum reimbursement and avoid any scrutiny or denial of claims.  

When Can Therapists Use CPT Code 90837?

You can use code 90837 any time you have an individual therapy session that lasts one hour or comes close to it. Although it is used for billing one hour, any session that lasts for 53 minutes or more would fall under this code.  

As we established earlier — every minute counts. If a session with your client takes even a minute less (like 52 minutes), then 90837 would be the wrong billing code to use. If you do use it, you could get some pushback from the insurance company. To be safe from this, you’ll have to use code 90834 instead.

Once your session passes the 53-minute mark, there’s no problem with using 90837. You can also provide additional documents. Your session notes or the client’s diagnosis can help to support your claims and cover your bases.

Who Can Use 90837?

Any licensed therapist can use 90837 to bill for individual therapy or counseling services that are for an hour.

Anyone with these licenses can use this code:

• Psychiatrists (MD)
• Clinical Psychologists (PsyD, PhD)
• Licensed Professional Counselors (LPC)
• Licensed Clinical Social Workers (LCSW)
• Licensed Marriage Family Therapists (LMFT)

How To Bill Therapy Code 90837: What Can Therapists Bill?

90837 is a CPT code used strictly for individual psychotherapy. This means one-on-one therapy sessions. These sessions are insight-oriented, supportive, and aim to modify or correct a client’s behavior or mindset. 

As you are aware, there are different types of psychotherapy. Talk therapy, counseling, and cognitive behavioral therapy fall within this realm. You can use 90837 to bill for any of these, as long as it’s for 53 minutes or more.

If you’re billing Medicare, you can also use the CPT code 90837 to bill for the following:

• Monitoring daily living activities
• Teaching common grooming skills
• Recreational therapy
• Social interaction

Always remember that 90837 is for individual psychotherapy. If your client’s partner or sibling is participating in the sessions, it turns into a family or group therapy session. These would fall under code 90847.

Can You Bill 90837 Twice For the Same Session?

CPT code 90837 can be billed up to two times in one week, but never twice in one day for the same client. If you bill 90837 twice for the same person, expect to be reimbursed for only one. Even if there are no issues with the claim, you will not get reimbursed for billing 90837 twice. 

How To Bill Therapy Code 90837 for Sessions Over One Hour

If you thought you were limited to one hour sessions, that's not the case. There aren’t any CPT codes for counseling over 60 minutes. You can use codes that are specific for adding on additional time to 90837. 

It can feel like a little bit more work to figure out multiple codes. But, don’t let that stop you from billing the full amount for your sessions. You worked hard and deserve compensation for your time.  

The add-on CPT codes for extended psychotherapy sessions start at a minimum time of 30 minutes. This means that if your psychotherapy sessions go beyond 60 minutes, but that extra time is less than 30 minutes, you can’t use code 99354yet.

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.

Here are some examples of how to use CPT 90837 with add-on codes:

• 99354: 90 to 134 minutes long, or an additional 30 to 74 minutes
• 99354 + 99355: 135 to 164 minutes long, an additional 75 to 104 minutes
• 99354 + 99355 + 99355: 165 to 194 minutes long ,or an additional 105 to 134 minutes

Note that these are add-on CPT codes, which means you can’t use them on their own. They always need to be accompanied by 90837. If you bill an insurer for just the add-on CPT code, you can expect it to be denied. 

How To Use CPT 90837 with Sessions Outside of Normal Business Hours

If for some reason you decide to see a client outside of your normal working hours, you would still use 90837, if the session was 53 minutes or more. There are also add-on codes to indicate these sessions are as such.

There are two add-on codes you can use: 99050 and 99051.

99050 is used for any therapy session that starts outside of your own regularly scheduled business hours. If you take Fridays off, but decide to meet with a client on that day, then this code would be used. The same applies to working on holidays. 

Meanwhile, 99051 is added on for any session that falls outside of “normal” office hours. This includes weekends, evenings, and agreed upon holiday office hours. For example, if your holiday hours or even weekend office hours are only from 10:00 AM to 2:00 PM, but the client requested to meet for a session at 6:00 PM, then that still counts as outside your normal office hours.

Heads up — the Centers for Medicare & Medicaid Services (CMS) does not reimburse for these two add-on codes. 

Do I Still Use 90837 for Crisis Sessions?

Despite our best effort with clients, the need for a crisis session can still arise. Distressing or potentially life-threatening situations arise. You might need to perform an emergency psychotherapy session. 

Emergency sessions are coded differently, even if they lasted an hour. You would instead use CPT 90839. 

Take a look at these examples for billing in crisis situations:

90939 - Crisis sessions, 30-74 minutes 90839 + 90840 - Crisis session over 75 minutes 90832 - Individual psychotherapy, up to 30 minutes

You might be noticing that the regular individual therapy code, 90832, is being used for crisis sessions that last up to half an hour. If this happened outside of your normal hours, just remember to use either 99050 or 99051 as an add-on code. 

How To Use CPT 90837 Without Triggering Audits 

Insurance billing is like a double-edged sword. Client referrals and reimbursements can keep us going. However, it's common to run into issues when submitting claims. Small mistakes like data entry errors can lead to these getting denied. 

Longer sessions and even the slightest suspicions that you used the wrong billing code can trigger an audit. Try not to let this worry you though. In fact, you’re well within your right as a therapist to bill your client and their insurer for a full hour of your time.

Here’s a quick recap of the key dos and don’ts when using CPT code 90837 to keep pesky audits and other issues from cropping up, while ensuring you get paid correctly.

• Do: Bill for any psychotherapy session that’s at least 53 minutes long with 90837.
• Don’t: Bill for a 90837 session twice on the same day.
• Do: Remember that the 90837 CPT code is only for actual face-to-face time spent with the client and actually providing psychotherapy, not pleasantries or chit-chat.
• Don’t: Bill for time you spent waiting for your client — if they’re late by eight minutes or more for an hour-long session, then you’ll be billing for 90834 instead.
• Do: Play it safe by including documents, notes, or proof justifying your use of 90837.
• Don’t: Use 90837 to bill for an hour-long therapy session together with your client’s family or significant other — use 90847 instead.
• Do: Use the right add-on codes when billing for really long sessions upwards of 90 minutes.
• Don’t: Submit claims with just add-on codes; these are always paired with a 90837 code first.
• Do: Call the insurer to check whether your client’s plan covers your services or whether they have any limits and preauthorization requirements for 90837 claims.
• Don’t: Submit claims for 90837 without meeting the preauthorization requirements.
• Do: Bill for therapy hours outside your normal work schedule using either 99050 or 99051 add-on codes.
• Don’t: Use 99050 or 99051 to bill for therapy appointments that start within your normal office hours but extend beyond them.

Be Confident With Billing Therapy CPT Code 90837

We understand that there’s always going to be some uncertainty involved when billing insurance companies — especially when they've started scrutinizing a code you need to use. As long as you do things by the book and follow all our dos and don’ts, you shouldn’t have any major issues with using CPT code 90837.

An easy way to keep track of your codes and client notes together is by using our Therapy Notes Generator. This tool is already filled with CPT codes and brief descriptions that you can pick and choose first then continue on with your notes. If you’re able to have good documentation of your session, you’ll be prepared to provide backup for any claims. 

Here at Clarity Cooperative, we’ve created a resource section and a community where you can seek advice and support other mental health professionals. 

Try out our free two week trial to gain access to some of the tools we created with access to our Pro subscription. We’re here for you as you continue to grow your confidence with insurance billing.