CPT 90837
Psychotherapy, 60 Minutes
How it is billed
- Met at 53 minutes and beyond, with no upper boundary — a 75-minute session is still this code rather than a longer one, and the extra time is not separately reportable
- Some payers require prior authorisation for routine use of the 60-minute code where they do not for the 45-minute one
- The interactive complexity add-on may accompany it where a specific communication factor complicated the session
- Where the same clinician provides both an evaluation and management service and psychotherapy, the psychotherapy add-on codes replace this standalone code
- Session time is psychotherapy time — an encounter running 60 minutes of which 15 were spent on paperwork is not a 60-minute psychotherapy session
What the record must show
- Start and stop times, recorded at the time rather than reconstructed, are the foundation of any defence of this code
- The note should show why the longer session was clinically indicated — the modality, the complexity of the presentation, or the phase of treatment — because medical necessity for the duration is what utilisation review actually tests
- Identical durations across an entire caseload, or session times that always begin and end on the hour, are the specific patterns that draw scrutiny
A worked example
A patient in trauma-focused treatment attends a session running 58 minutes, using a modality where the processing phase cannot be safely truncated. The note records the times, the modality and the clinical reason the session runs long. 90837 is correct and defensible.
A different provider reports 90837 for every patient on the caseload, with no recorded times and a template stating '60-minute session' in each note. The individual claims may all be legitimate, but there is nothing in the record capable of proving it, and a post-payment review can recoup the difference against the 45-minute code across the whole population.
The asymmetry is what makes this code worth handling carefully: the documentation cost of recording times is trivial, while the exposure from not recording them scales with volume.
What decides payment
Payer treatment of this code varies more than the code itself does. Some require authorisation after a set number of sessions, some review utilisation quarterly, and some simply pay it — so the operationally correct answer is payer-specific and belongs in the practice's payer matrix rather than in a coding rule.
The clinical reality is that many modalities do not fit in 45 minutes. Exposure-based and trauma-focused therapies have structural session lengths, and a policy of defaulting to the shorter code to avoid scrutiny both understates the work and, over a caseload, materially reduces revenue.
Where authorisation is required, obtaining it is an eligibility and authorisation workflow question rather than a coding one. The claim fails before it is coded, and the failure is invisible in coding metrics — which is why behavioural health denial analysis should segment by cause before anyone examines code selection.
Denials this code attracts
Modifiers that apply
Codes billed alongside or confused with this one
Billed most in — Mental & Behavioral Health · Pain Management · Pediatrics
Terms used here — Prior Authorization · Medical Necessity · Denial · Appeal
How we handle it — Prior Authorization · Denial Management · Medical Coding
Primary sources
What the code-set maintainers and payers actually publish about billing 90837.
- Medicare Benefit Policy Manual (opens in a new tab)
Centers for Medicare & Medicaid Services — What Medicare covers and under what conditions, as distinct from how a claim is processed. The starting point for any coverage or medical necessity question.
- Medicare Coverage Database (LCD/NCD) (opens in a new tab)
Centers for Medicare & Medicaid Services — Searchable national and local coverage determinations. The direct answer to whether a diagnosis supports medical necessity for a given procedure.
- CPT code set (opens in a new tab)
American Medical Association — Maintainer of CPT. Annual changes to CPT are the most common cause of a sudden, unexplained rise in denials each January.
Questions about CPT 90837
Individual psychotherapy of approximately 60 minutes, met by any session of 53 minutes or more. There is no upper limit — longer sessions are still reported with this single code.
It depends on the payer. Several require authorisation for routine use of the 60-minute code where they do not for the 45-minute one, and some review utilisation retrospectively instead. It belongs in the practice's payer matrix rather than being assumed either way.
It pays more than the 45-minute code, the boundary between them is a single minute, and utilisation ratios are easy for a payer to profile across providers. Reviews are usually triggered by the ratio, then settled by whether individual notes record session times.
Contemporaneous start and stop times, plus a clinical rationale for the session length — the modality, presentation complexity or treatment phase. Times alone prove duration; the rationale is what answers a medical necessity review.
Find out what your denials are costing you
A free billing audit reviews your denial rate, AR aging and clean claim rate against industry benchmarks. Takes about two minutes to request. No sales pitch.
No setup fees · You pay when we collect · Pricing from 3% of net collections