What is the difference between 90834 and 90837?

90834 is a 45-minute session (38-52 minutes of face-to-face time, Medicare ~$116) and 90837 is a 60-minute session (53+ minutes, Medicare ~$154). Always choose the code closest to your actual session time — a 50-minute session is 90834, not 90837.

When should I use the psychotherapy add-on codes (90833, 90836, 90838) instead of standalone codes?

Use add-on codes when you perform both an E/M service AND psychotherapy in the same visit. Bill the E/M code (like 99214) plus the appropriate add-on. The key requirement is that both services must be significant and separately identifiable, and E/M time does not count toward psychotherapy time.

What triggers a therapy note audit?

Common audit triggers include cloned notes (documentation copied between visits with minimal changes), missing mental status exams, no measurable goals or assessment scores, vague chief complaints like "I am fine," and failing to update treatment plans every 90 days. Insurers are increasingly using AI to detect these patterns.

Can I bill crisis psychotherapy (90839) and regular psychotherapy on the same day?

No. Crisis codes (90839/90840) cannot be combined with regular psychotherapy codes or diagnostic evaluations on the same date of service. If the session qualifies as crisis intervention, use crisis codes exclusively for that encounter.

Psychotherapy CPT Codes: The Complete 2026 Billing Guide for Therapists

If you’re a therapist, you know the drill: see the patient, write the note, pick the code, hope insurance pays. But psychotherapy billing is more nuanced than most therapists realize — and the wrong code or missing documentation can mean denied claims, recoupment demands, or audit flags.

This guide covers every psychotherapy CPT code you need to know in 2026, the documentation requirements that prevent denials, and how AI tools can automate the compliance checking.

Individual Psychotherapy Codes (Time-Based)

Unlike general E/M coding (which uses Medical Decision Making), psychotherapy is coded by time. Choose the code closest to your actual face-to-face time with the patient:

90832 — 30-minute session (16–37 minutes). Medicare: ~$82
90834 — 45-minute session (38–52 minutes). Medicare: ~$116
90837 — 60-minute session (53+ minutes). Medicare: ~$154

Critical rule: Do NOT report psychotherapy for less than 16 minutes. And always choose the code closest to the actual time — a 40-minute session is 90834, not 90837.

Psychotherapy + E/M Add-On Codes

When a therapist performs both an evaluation/management service AND psychotherapy in the same visit, use these add-on codes in addition to the E/M code:

90833 — 30-min psychotherapy add-on (16–37 min) + E/M code
90836 — 45-min psychotherapy add-on (38–52 min) + E/M code
90838 — 60-min psychotherapy add-on (53+ min) + E/M code

The key: the E/M and psychotherapy services must be significant and separately identifiable. E/M time does NOT count toward psychotherapy time.

Psychiatric Diagnostic Evaluations

90791 — Psychiatric diagnostic evaluation without medical services (~$195). Used by therapists and psychologists.
90792 — Psychiatric diagnostic evaluation with medical services (~$222). Used by psychiatrists and PMHNPs who also manage medications.

Crisis Psychotherapy

90839 — Crisis psychotherapy, first 60 minutes (~$183). Minimum 30 minutes required.
90840 — Each additional 30 minutes beyond 74 minutes (~$91 per unit). Add-on to 90839.

Crisis codes cannot be combined with regular psychotherapy codes or diagnostic evaluations on the same date.

Family and Group Therapy

90846 — Family therapy without patient present, 50 min (~$119)
90847 — Family therapy with patient present, 50 min (~$120)
90853 — Group psychotherapy (~$36 per patient)

Family therapy requires a minimum of 26 minutes. Below that, it’s not billable.

Important Add-On Codes

90785 — Interactive complexity (~$16). Use when communication barriers complicate delivery — language issues, family conflict, mandated reporting, young/nonverbal patients.
90863 — Pharmacologic management (~$35). When medication management is performed alongside psychotherapy.

Documentation Requirements That Prevent Denials

Insurance companies deny therapy claims for predictable reasons. Every note must include:

Chief complaint — not “I am fine” (insurers flag this as no medical necessity)
Session time — time in/out or total time documented
Mental status exam — must change every visit (cloned MSEs trigger audits)
Medical necessity — psychiatric illness or behavioral symptoms documented
Diagnosis — ICD-10 code matching the referring provider
Treatment interventions — what therapeutic techniques were used (CBT, DBT, EMDR, etc.)
Measurable goals — PHQ-9, GAD-7, or other assessment scores
Treatment plan — updated every 3 months
Patient participation — how the patient engaged and responded
Acute vs. chronic — designation on every note

The Cloning Trap

Insurers are increasingly using AI to detect cloned notes — sessions where the documentation is copied from a previous visit with minimal changes. Cloned documentation:

Does not meet medical necessity requirements
Triggers denial of services and recoupment of all overpayments
Can result in fraud investigations

Every note must contain unique, patient-specific content that reflects what actually happened in that session.

Re-Evaluation Every 90 Days

Insurance companies expect:

Updated test scores (PHQ-9, GAD-7) every 90 days
Goals marked as ongoing, partially completed, or attained
Updated treatment plans with current frequency and duration
Documented reasoning if there’s no improvement

A patient scoring 1–4 on the PHQ-9 may not meet medical necessity for continued therapy — that becomes a self-pay conversation.

How AI Compliance Checking Works

AI-powered compliance tools like CodeItRight analyze your therapy notes against these documentation requirements automatically. In seconds, you get:

A compliance score (0–100) with specific pass/fail checks
Missing element alerts — no MSE documented, no measurable goals, vague chief complaint
Cloning detection — flags generic language and template patterns
Code recommendation — the correct psychotherapy CPT code based on session time
Audit risk flags before you submit the claim

99% of therapists already use AI to write their notes. The missing piece is AI that checks those notes before billing — catching the documentation gaps that lead to denials.