CPT 90837 vs. 90834: Billing Psychotherapy Without Losing RVUs

 

Psychotherapy providers face an ongoing challenge when it comes to accurate CPT code selection. While CPT 90834 and CPT 90837 are both standard codes for individual therapy, understanding when to use each — and how to support them with proper documentation — is essential to avoid lost revenue and potential audits. The difference may seem minor, but billing errors involving these two codes can significantly affect your revenue cycle and compliance.

This guide explains the distinctions between CPT 90834 and 90837, when each should be used, how to meet payer expectations, and ways to strengthen your billing processes without sacrificing reimbursement.

Understanding the Basics: CPT 90834 vs. CPT 90837

CPT 90834 is designed for individual psychotherapy sessions lasting approximately 45 minutes, whereas CPT 90837 applies to longer sessions that are at least 53 minutes in duration, per CMS guidelines. However, the distinction isn’t just about clocking the time. These codes also reflect the complexity of the clinical interaction.

Providers often use 90837 in cases involving trauma recovery, emotional crises, or high-risk diagnoses, where the therapeutic depth requires extended time. In contrast, CPT 90834 may be sufficient for more structured or lower-intensity cases, such as managing generalized anxiety or progressing through a routine cognitive behavioral therapy session.

Clinical Necessity Drives Code Selection

Session duration alone doesn’t justify using CPT 90837. It must be backed by clinical need. If a patient is navigating deep emotional trauma, acute depressive episodes, or high-risk behavior, the extended time is warranted and expected. In contrast, sessions that are structured, solution-focused, and aimed at maintenance therapy often fall under CPT 90834.

What matters most is documenting why the longer session was necessary. Providers should avoid falling into patterns where 90837 is used for convenience, as this could raise red flags with insurers.

Documentation: Your First Line of Defense

For both CPT codes, accurate documentation is non-negotiable. For 90834, clinicians must document the session’s purpose, therapeutic techniques used, and progress made. Including session start and end times is also essential.

CPT 90837 requires all of the above, plus additional justification for the extended session length. For example:

• Active suicide risk assessments
• Trauma-focused therapy (e.g., EMDR)
• Severe mood instability or emotional dysregulation

It’s also helpful to align ICD-10 codes with session intensity — for example, using F33.2 (Major depressive disorder, recurrent, severe) for CPT 90837, rather than a milder diagnosis like F41.1 (Generalized anxiety disorder).

Watch for Payer-Specific Rules

Insurers closely monitor high-reimbursement CPT codes like 90837. While 90834 is generally accepted without much scrutiny, consistent use of 90837 without clinical justification may trigger audits, denials, or requests for additional records. Some payers also require pre-authorization for CPT 90837 or limit how often it can be billed per week.

Staying updated with each payer’s billing and documentation guidelines is critical to avoid revenue delays and rework. Having a dedicated billing team or partner who monitors these changes can make a significant difference.

What About Telehealth?

Both CPT 90834 and 90837 are reimbursable under many telehealth plans — especially post-pandemic. But accurate coding still depends on a few key elements:

• Use Modifier 95 to indicate that the service was delivered via telehealth.
• Document that the session was conducted on a HIPAA-compliant platform.
• Record the patient’s verbal consent for telehealth services.

Be aware that some payers reimburse less for telehealth-based 90837 sessions, or may request additional documentation. Always verify with the insurance plan beforehand to prevent denials.

Avoiding Revenue Loss: Don’t Undercode

One of the most common — yet costly — mistakes in mental health billing is undercoding. Many providers bill CPT 90834 even when sessions regularly run 55 or 60 minutes. This may feel safer, but over time, it results in significant lost revenue.

Here’s the math:

• CPT 90834 pays about $98.39
• CPT 90837 pays around $144.83

That’s a $46 difference per session. If a provider sees 20 patients per week and consistently undercodes, they stand to lose over $900 per month, or more than $11,000 per year. Simply selecting the appropriate code based on session time and medical necessity protects your income without compromising compliance.

Training and Systems to Improve Accuracy

To avoid errors, providers should implement regular billing audits and training programs for both clinicians and front-office staff. Everyone should understand when and how to use CPT 90834 vs. 90837 — and how to document accordingly.

Leveraging EHR systems that prompt for time tracking, therapy type, and session notes can help standardize documentation. Practices that are short-staffed or overwhelmed by administrative tasks may benefit from exploring offshore mental health billing services in India, which can offer cost-effective coding accuracy and reduce claim denials.

Conclusion

Accurate use of CPT 90834 and 90837 is more than a coding task — it’s a strategic approach to protecting both your revenue and your compliance. Providers should align clinical decision-making with proper documentation, while staying vigilant about payer-specific policies and session duration.

To simplify this process and ensure billing consistency, many behavioral health practices choose to partner with experienced medical billing and coding service providers in India like Info Hub Consultancy Services (ICS). With deep expertise in U.S. mental health billing, payer compliance, and CPT code management, ICS helps providers submit clean claims, recover more revenue, and reduce audit risk — all while letting you focus on patient care.

Read Detailed Blog @ https://infohubconsultancy.com/blog/cpt-90837-vs-90834-billing-psychotherapy-without-losing-rvus/