Are you tired of Long Therapy Sessions that go Underpaid? Explore How 90837 CPT Code Can Maximize Your Reimbursement! CPT 90837 is the typical billing code for extended psychotherapies, which allows professionals to be fairly reimbursed for extra therapeutic work. The code, which only symbolizes individual 60-minute psychotherapy, is becoming more and more important for mental health professionals who are trying to get paid fairly for complex therapeutic cases. While ensuring high-quality delivery to customers requiring more intense treatment, effective knowledge of appropriate documentation, invoicing, and maximum cpt code reimbursement becomes essential for a profitable business.
Understanding CPT Code 90837: Definition and Description
The psychological billing system experienced a major change in 2013 when CPT code 90837 was introduced, and code 90808 was phased out. This new code was designed to more precisely identify and pay for longer therapy sessions.
All therapy approaches such as behavior modification, supportive counseling, and interactive therapies, are covered by CPT code 90837 if the session lasts no more than sixty minutes. It is intended for longer sessions, even when family members are present, when major breakthroughs repeatedly occur.
The primary purpose of CPT code is to deliver enough billing options for in-person treatment of serious mental disease issues. These treatment codes set recognizes the clinical necessity of extended sessions for some illnesses and treatment types, in contrast to the 45-minute session code (90834). Keep in mind that 908377 should never be used to bill for services like social contact, recreational treatment (dancing, art, or play therapy), teaching grooming and monitoring actions of daily living.
When to Use CPT Code 90837
This code is particularly suitable for various clinical scenarios:
· Cases where additional intensive intervention is clinically revealed
· Complicated or intense mental health conditions that require in-depth treatment
· Deep analysis of emotions and thoughts that cannot be sufficiently addressed in shorter sessions
Time Requirements and Documentation Standards
Time Thresholds for 90837
For billing under code 90837, a client must receive direct or telephonic psychotherapy session of minimum 53 minutes. Billable time starts at 53 minutes without end, even though the code is for a 60-minute psychotherapy . To the contrary, code 90834 is for a specific sessions that are performed usually in between 38 to 52 minutes.
It is important to document the length of the therapy, including the start and end times or total minutes. This is especially important when billing Medicare because accurate documentation is required to receive reimbursement.
Multiple Units and Prolong Sessions
The ability to bill for longer sessions with multiple 90837 units is one of the most asked questions. If the psychotherapy session lasts at least 90 minutes, a doctor or other licensed healthcare provider may submit a comprehensive service code using CPT number 90837 and it involves direct patient contact. Instead of purchasing numerous units, it is essential to use add-on codes effectively, and this process requires accurate paperwork.
Reimbursement Rates for 90837 in the year (2024-2025)
Reimbursement for CPT code 90837 largely relies on payer source and the provider credentials. It is wise to consider these differences to conduct financial planning.
Medicare psychiatric reimbursement rates
These rates for CPT code 90837 are:
· 2025 rate: $154.29
· 2024 rate: $149.64
These standardized rates offer a starting point for understanding the value that is attributed to long therapy sessions in the Medicare system.
Private Insurance Reimbursement
These rates show much more divergence:
· Blue Cross Blue Shield: Approximately $124.64 per session
· Aetna: Approximately $144.75 per session
· United Healthcare: Around $109.59 per session
Depending on the provider’s qualifications, geography, and particular contract negotiations, these prices may differ even better. Reimbursement for 90837 is often 13–20% greater than that for the 45-minute session code (90834).
Medicare Coverage for Mental Health Services
LCSW Billing Requirements
With regard to psychotherapy, LCSWs are reimbursed by Medicare and are either required by law to “opt-in” as providers or expressly “opt-out.” Because they did not opt in or out, “Limbo status” affiliates flout Medicare regulations if they do not accept Medicare enrollees as private-paying consumers.
While opted-out LCSWs are demanded to sign formal opt-out agreements and create private contracts with beneficiaries, opted-in LCSWs are required to accept the Medically approved rate without charging beneficiaries additional fees.
Recent Medicare Changes
Recently, Medicare has increased its coverage of mental health treatments, which includes billing and payment information for mental health counselors and marital and family therapy. The additions show that the importance of mental health treatments inside Medicare is becoming more widely acknowledged.
Documentation Best Practices for Billing 90837
Proper documentation for 90837 billing must establish:
1. Clinical justification for the longer session duration
2. Interventions used in the session
3. Response of the patient to therapy
4. Advancement of therapeutic objectives
Claims denials can be avoided, and the higher cpt reimbursement rate is linked to 90837 if supported by clear documentation summarizing the reasons why a longer session was needed.
In some cases, mental health concerns like depression or trauma may be accompanied by physical symptoms such as unintentional weight loss, which also need proper diagnosis coding. Learn how to document this accurately using ICD-10 Code R63.4 for Abnormal Weight Loss.
Avoiding Common Pitfalls
To effectively use CPT code 90837 the providers should:
· Maintain precise time records.
· Clearly record any prolonged medical necessity.
· Keep thorough records of your interventions and patient progress.
· Make sure the service meets the specific needs of the payer for 908373.
These documentation practices lessen the possibility of audits, claim rejections, and payment hold ups.
Comparison of 90837 with Other Psychotherapy Codes
90837 and 90834 differ mostly in how long the sessions are. 38 to 52 minutes sittings are recommended, the sessions which are 53 minutes and above are mentioned as code 90834. Consequently, code 90834 catches approximately 70 to 80% of the money as compare to 90837.
The selection of the appropriate code is primarily based on clinical needs and insurance considerations. Even though 90837 has a higher reimbursement rate, some insurance corporations will limit or contest it. Providers need to find a balance between their clinical expertise and the realities of insurance.
Conclusion
An essential billing tool for mental health professionals who perform advanced code therapy sessions is CPT code 90837. sessions. Practitioners who are well-versed in its description, time commitment, reimbursement procedures, and documentation needs can make appropriate use of this code to receive fair remuneration for more intensive therapy services.
Maintaining the sustainability of practice in the face of altering reimbursement rate requires staying current with payer policy and coding guidelines. Mental health professionals can concentrate on providing high quality care and getting paid for their priceless services by becoming proficient in the right use of 90837.
