Many providers think about should I use 90834 or 90837? Both 90834 and 90837 are intended to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time / duration of visit; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes. Many therapists have weekly or bi-weekly sessions with clients and are faced with scrutiny and uncertainty when utilizing the billing code 90837.
Limitation of psychotherapy codes
The limitation of psychotherapy codes to only three codes with a cap at 60 minutes encapsulates the problem facing therapists today when coding their claims; the AMA defines these CPT codes based on the duration of session, with the 90837 being used for any session over 53 minutes, with no way to account for sessions longer than an hour, which frequently can occur when conducting psychotherapy.
Similarly, the 90834 code should be used when you spend an between 38 and 52 minutes in therapy; not for any session over 30 minutes.
With all three of the separate psychotherapy codes; 90832, 90834, and 90837, the intention of the AMA is capturing only the face-to-face time spent on clinical discussion and therapy, not any administrative discussions, including scheduling questions, collecting fees, or time spent before or after the session for capturing documentation. While therapists may block off a straight hour for the session on their calendars, only the time spent on therapy can be billed for reimbursement.
Insurance Company Acceptance of CPT code 90837
Insurance companies have been unwilling to pay for 90837 and slow to get on board so it is best to check with the company. But BCBS ensures give appropriate value to this code and so do many other insurance companies. According to Care Paths, the denial rate for BCBS in 2017 was 1.29%, which is a down from 3 to 4% in 2013 and 2015. Denial rates for Medicare and Medicaid are higher but have also come down. Current 90837 denial rates for Medicaid is 5.9% and for Medicare it’s 4.12%.
Theoretically providers can use 90837 for all sessions, but practically the CPT code is based on face-to-face time, meaning you can only bill for the time actually spent with the client. If the client is late, you need to bill at 90834 (38 – 52 minutes). Otherwise, you risk insurance fraud.
According to BCBS, using 90837 “cannot be for the convenience of the provider.” This means, though specific documentation is not required, play it safe by including justification on your progress note.
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