Choosing between CPT codes 90834 and 90837 is not only about documenting session length, but also about aligning clinical practice with billing accuracy to ensure full reimbursement without triggering audits. Though these codes may seem similar, they have key differences that impact provider payment and long-term revenue based on Relative Value Units (RVUs). With insurers enforcing strict policies and closely reviewing claims, using every code correctly has become more important than ever.

This guide walks through the differences, documentation expectations, and billing strategies so providers can bill confidently without losing RVUs.

CPT Codes 90834 vs. 90837: Choosing the Right Psychotherapy Code for Accurate Billing

CPT 90834 and CPT 90837 are two commonly used billing codes for individual psychotherapy, whereby each serves a specific purpose. Thereby, it is important to understand when and how to use them correctly to help providers maintain both clinical integrity and financial sustainability. Let’s have a look at such differences

• Session Duration and Clinical Need

CPT 90834 is used for psychotherapy sessions lasting around 45 minutes, whereas CPT 90837 applies to sessions lasting at least 53 minutes, as per CMS guidelines. The longer duration of 90837 typically reflects more intensive clinical work. Providers must align the length of the session with the patient’s needs, not just their scheduling patterns. A patient undergoing trauma recovery, severe depression, or active suicidality may require longer sessions billed under 90837, whereas someone in maintenance or structured cognitive therapy may fit well under 90834.

• When to Use 90834 vs. 90837

Use CPT 90834 when the therapeutic session is shorter, more structured, and the emotional or psychological concerns are moderate or well-managed. In contrast, CPT 90837 should be used when the clinical situation requires extended therapeutic engagement. This includes in-depth trauma processing, crisis intervention, or dealing with complex diagnoses like PTSD or major depressive disorder, recurrent and severe. The decision must be clinical but not financial.

• Documentation Essentials for Each Code

Although accurate documentation is crucial for both codes, 90837 demands greater detail. Don’t forget to record the start and end time of the session for either code. When billing for CPT code 90834, you should focus on the therapeutic techniques used and the patient’s progress. But when billing 90837, you must also include a clear clinical justification for the extended time, such as active risk assessment, deep trauma exploration, or emotional dysregulation. It is also important to align the diagnosis to the therapy level (e.g., F33.2 for severe depression vs. F41.1 for generalized anxiety).

• Billing Accuracy and Insurance Expectations

Payers review claim patterns, especially with higher-value codes like 90837. Though 90834 is generally accepted without much scrutiny, repeated use of 90837 without strong documentation may trigger claim audits or denials. Some insurers require pre-authorization for 90837, and many expect to see clinical notes supporting the medical necessity for longer sessions. Reviewing each payer’s policy is critical to avoiding rejections or delays.

• Telehealth Billing Rules

Both 90834 and 90837 are eligible for telehealth reimbursement under many plans. To bill these codes correctly

• Use Modifier 95 to indicate the session was conducted via a virtual platform.
• Ensure the platform is HIPAA-compliant.
• Always document verbal consent for receiving care remotely.

It is important to note down that not all payers reimburse 90837 equally for telehealth sessions. Some insurers may pay less or require extra documentation compared to in-person visits.

• Avoiding Revenue Loss and Audit Triggers

Many providers unknowingly lose significant revenue by consistently billing CPT 90834 for sessions that actually last closer to 55 or 60 minutes. This undercoding can result in a substantial loss of RVUs and reimbursement over time. On the other hand, routinely billing CPT 90837 for nearly every session can draw attention from insurance companies and increase the risk of audits, irrespective of clinical need.

To avoid these issues, it is essential to find a balance by matching billing with actual session duration and medical necessity. Keeping track of your practice’s billing patterns and ensuring proper documentation will help maintain compliance while securing fair reimbursement.

• RVUs and Reimbursement Comparison

Each CPT code carries a different RVU which is a standardized measure used by Medicare and many insurers to determine payment rates. RVUs represent the value of the provider’s work, practice overhead, and liability costs. Simply put, higher RVUs = higher reimbursement.

• CPT 90834 reimburses around $98.39.
• CPT 90837 reimburses about $144.83.

This $46 difference per session may not seem significant at first, but it adds up over time. For instance, a provider seeing 20 patients per week and consistently undercoding by choosing 90834 instead of a justified 90837 may lose over $900 per month, or more than $11,000 annually. That’s why choosing the right code is a business-critical decision.

• Examples of Appropriate Use

Understanding the real-world application of each code can make billing decisions easier. For example, CPT 90834 is best suited for a patient with mild anxiety who attends a structured 45-minute cognitive behavioral therapy session. The treatment is focused and does not require extended emotional processing.

On the contrary, CPT 90837 is appropriate for more complex cases, such as a patient undergoing trauma-focused therapy like EMDR for PTSD, where the session extends beyond 53 minutes and involves deeper therapeutic engagement. Thereby, the selected code must reflect both the session duration and the complexity of clinical care provided.

• Billing Mistakes to Avoid

Even experienced providers can fall into billing traps that either leave money on the table or risk compliance issues. One common mistake is undercoding – billing 90834 for sessions that consistently run over 53 minutes. Though this may feel “safe,” it leads to lost income over time.

Another frequent error is overcoding, such as using 90837 for nearly all sessions without documentation to justify the extended time. This is a red flag for insurers and could trigger audits. In fact, failing to note start/end times, skipping the Modifier 95 for telehealth, or not updating ICD-10 codes to reflect clinical severity are other oversights that delay or reduce reimbursement.

Therefore, these pitfalls should be avoided using the regular chart audits, staff training, and clear documentation practices.

• Self-Auditing and Staff Training Tips

Maintaining accurate billing practices depends on regularly reviewing internal processes. Conducting monthly audits of psychotherapy billing helps identify patterns that may indicate overuse or underuse of certain codes. It is also important to train both clinical and administrative staff on the proper use of CPT 90834 and 90837 so as to emphasize session timing, documentation, and payer requirements.

Electronic health records (EHR) can support this by using templates that prompt providers to record session start and end times and clinical rationale for extended sessions. With regular training and consistent auditing, practices can maximize reimbursement. Furthermore, partnering with offshore mental health billing services in India can help practices stay on top of varying payer requirements and reduce the risk of denials.

Outsourcing Mental Health Billing and Coding Services

Accurately selecting between CPT 90834 and 90837 can significantly impact a provider’s revenue and compliance standing. In such scenarios, outsourcing can be a reliable solution to reduce administrative burden, improve accuracy, and speed up payments. In fact, outsourcing mental health billing through experienced medical billing and coding service providers in India, such as Info Hub Consultancy Services, ensures that 90834 and 90837 are used appropriately, claims are submitted cleanly, and reimbursements are maximized without compliance risk.

FAQs

1. What documentation is needed to support psychotherapy billing audits?

Notes should include session time, goals, progress, and client response.

2. How often can I bill 90837 in a week?

Frequency depends on payer limits and medical necessity documentation.

3. Can interns or supervised therapists bill 90834 or 90837?

Only if allowed by payer rules, and the supervising provider is listed correctly.

4. Can 90834 and 90837 be billed for couples or family sessions?

No, use family therapy codes like 90847 for those situations.

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