As mental health providers navigate the complex world of medical billing, understanding CPT code 90837 is crucial for practice success. Proper utilization of this code is fundamental to maintaining a sustainable practice while ensuring quality patient care [1].
What is CPT Code 90837?
CPT code 90837 represents an individual psychotherapy session lasting 60 minutes. More specifically, this code applies to sessions that run for 53 minutes or longer. This code replaced the older 90808 code in 2013 and has since become one of the most frequently used billing codes in mental health practices [3].
When to Use 90837
Research indicates several appropriate applications for the 60-minute session code [4]:
- Complex trauma processing
- EMDR therapy sessions
- In-depth cognitive behavioral therapy
- Crisis intervention requiring extended time
- Complex case management requiring longer sessions
Documentation Requirements
Current guidelines emphasize that proper documentation is essential for 90837 claims [2]. Your clinical notes should include:
- Session start and end times
- Specific interventions used
- Patient’s response to treatment
- Progress toward treatment goals
- Plan for future sessions
- Clinical reasoning for 60-minute session length
Reimbursement Considerations
Recent studies indicate that understanding reimbursement for 90837 requires attention to several factors [6]:
Insurance Coverage
While most major insurance companies cover 90837, some prefer the shorter 90834 (45-minute) code. Experts recommend always verifying coverage before providing extended sessions [5].
Reimbursement Rates
Current industry data shows national average reimbursement rates for 90837 range from $120 to $200 [7], though rates vary significantly by:
- Geographic location
- Insurance provider
- Provider credentials
- Contracted rates
Medical Necessity
Insurance companies expect clear justification for using the longer session code [8]. Document specific clinical reasons why 53+ minutes were necessary for optimal treatment.
Common Challenges and Solutions
Challenge 1: Session Length Documentation
Solution: Use electronic health records (EHR) with integrated timers or standardized documentation templates [1].
Challenge 2: Insurance Authorization
Solution: Implement pre-authorization procedures and maintain clear communication with insurance providers [5].
Challenge 3: Frequency Limitations
Solution: Develop clear policies for determining appropriate session length and frequency based on clinical needs [4].
Best Practices for Using 90837
- Accurate Timing Current Medicare guidelines specify [2]:
- Start session timing when clinical intervention begins
- End timing when intervention concludes
- Document exact minutes in session notes
- Clinical Justification Professional standards require [8]:
- Clear documentation of therapeutic necessity
- Specific interventions requiring extended time
- Patient progress indicators
- Regular Audits Industry best practices include [7]:
- Monthly review of 90837 usage
- Documentation completeness checks
- Insurance reimbursement tracking
Impact on Practice Revenue
Research identifies several financial implications of 90837 [6]:
- Higher reimbursement rates compared to 90834
- Increased documentation requirements
- Potential for insurance scrutiny
- Need for efficient scheduling
Compliance Considerations
Current professional guidelines recommend maintaining compliance by [3]:
- Regular staff training on proper code usage
- Implementing documentation templates
- Conducting periodic internal audits
- Staying updated on insurance requirements
Future Trends
Recent industry analysis projects several evolving trends in the mental health billing landscape [5]:
- Increased telehealth adoption
- Changes in documentation requirements
- Shifting insurance preferences
- Integration with value-based care models
References
[1] American Psychological Association. (2024). Current Procedural Terminology (CPT) Coding Toolkit for Psychologists. Washington, DC: APA.
[2] Centers for Medicare & Medicaid Services. (2024). National Correct Coding Initiative Policy Manual. Baltimore, MD: CMS.
[3] American Medical Association. (2024). CPT 2024 Professional Edition. Chicago, IL: AMA.
[4] National Council for Mental Wellbeing. (2023). Mental Health Billing Guide. Washington, DC: NCMW.
[5] Healthcare Business & Technology. (2024). Mental Health Practice Management Guide. Retrieved from [website].
[6] Journal of Clinical Psychology. (2024). “Optimal Session Length in Psychotherapy: A Systematic Review.” Vol. 80(2), 156-178.
[7] Behavioral Healthcare Executive. (2024). “Insurance Reimbursement Trends in Mental Health.” Issue 45, 23-29.
[8] American Psychiatric Association. (2024). Documentation Requirements for Mental Health Services. Arlington, VA: APA.
