Billing for psychotherapy isn’t just about putting numbers on a claim form—it’s about selecting the correct CPT codes to reflect the service provided accurately. Whether you’re a psychologist, psychiatrist, social worker, or counselor, correct coding ensures you get reimbursed properly and stay compliant with payer requirements.
This guide walks you through the main psychotherapy CPT codes, key facts for using them, when to add the interactive complexity add-on, how to bill crisis sessions, and practical tips to avoid claim denials.
Why You Need to Utilize Psychotherapy Codes
Psychotherapy CPT codes are time-based and vary depending on the duration, patient age, and whether medical evaluation and management (E/M) are included.
The following are common psychotherapy codes used by psychologists and other mental health providers:
- 90832 – Psychotherapy, 30 minutes with patient
- 90834 – Psychotherapy, 45 minutes with patient
- 90837 – Psychotherapy, 60 minutes with patient
- 90846 – Family psychotherapy (without patient present)
- 90847 – Family psychotherapy (with patient present)
- 90849 – Multiple-family group psychotherapy
- 90853 – Group psychotherapy (other than a multiple-family group)
Interactive Complexity Add-On Code (90785)
The interactive complexity add-on code 90785 can be billed only in conjunction with a primary psychotherapy service (e.g., 90832, 90834, 90837, 90846, 90847).
Use 90785 when:
- Managing maladaptive communication during sessions (e.g., hostile silence, emotional outbursts).
- Working with young children requiring play therapy or non-verbal communication.
- Handling the presence of third parties like parents, guardians, or interpreters.
- Addressing situations involving mandated reporting or legal requirements.
Crisis Psychotherapy Codes
Crisis psychotherapy involves urgent situations where a patient’s safety is at risk and immediate intervention is required.
Common codes:
- 90839 – Psychotherapy for crisis, first 60 minutes
- 90840 – Each additional 30 minutes of crisis psychotherapy (used with 90839)
When to use crisis codes:
- Immediate assessment is necessary for suicidal or homicidal ideation.
- There is a sudden decline in mental health that requires immediate attention.
- Acute stress reactions follow traumatic events.
Documentation must include:
- The nature and urgency of the crisis are paramount.
- Interventions performed.
- Total time spent in crisis management.
How to Bill Psychotherapy Codes to Get Faster Reimbursements
Determine Session Type and Time.
Every psychotherapy service is tied to a CPT code based on what you did and how long you did it.
Match with the correct CPT code.
Here’s how:
- If you had a 30-minute individual session, code 90832 applies.
- A 45-minute session fits 90834.
- A session lasting 60 minutes, or at least 53 minutes, should be coded as 90837.
- For family therapy without the patient present, use 90846; with the patient present, use 90847.
Example: You see an adult patient for a 58-minute trauma-focused CBT session. Document the start and end times, and bill 90837, ensuring that your notes demonstrate the medical necessity of this extended session.
Add Modifiers or Add-On Codes When Applicable
Modifiers and add-ons help capture extra circumstances that affect the session.
- 90785 – Interactive complexity (e.g., interpreting for a non-English speaker, addressing child behavior through play therapy, or managing hostile communication).
- Modifier 95 pertains to the delivery of telehealth services through real-time audio and video.
- Modifier GT—Similar to 95, but used by specific payers (check their rules).
- Modifier 59—Sometimes required to indicate separate services on the same day.
Example: You provide a 45-minute session (90834) to a child through telehealth, and the parent is highly disruptive, requiring significant management. Bill 90834 + 90785, and append modifier 95 for telehealth.
Check Insurance Payer Rules
Not all payers treat psychotherapy codes equally. Some, especially for 90837, may flag claims for review if billed too often.
- Some insurers limit the use of code 90837 to a specific percentage of your total therapy sessions.
- Medicare allows it but may request documentation for prolonged use.
- Some require preauthorization for crisis codes (90839, 90840).
Example: If 70% of your sessions are billed as 90837, expect an audit unless you can justify the longer times with solid documentation.
Submit Claims with Detailed Documentation
Payers want proof that the service happened exactly as billed.
- Document start and stop times.
- Note the specific interventions (e.g., CBT, EMDR, supportive therapy).
- Tie the therapy to the patient’s diagnosis and progress toward treatment goal
Example: “The session lasted from 2:00 PM to 3:00 PM, totaling 60 minutes.” The patient used cognitive restructuring to address maladaptive beliefs related to trauma. The patient reported decreased intensity of flashbacks from daily to twice a week.”
Tips For Telehealth Services – Append Modifier 95 or GT as Required
Telehealth psychotherapy follows the same CPT codes, but modifiers identify the session as virtual.
- 95 is most common and used for synchronous (real-time) audio/video.
- GT is older but still required by some Medicaid plans and private insurers.
- Always verify if your payer requires a place of service (POS) code, such as 02 (telehealth) or 10 (telehealth in a patient’s home).
Example: A 45-minute therapy session over Zoom would be 90834-95, POS 10 if the patient is at home.
Tips for Psychologists and Other Relevant Providers
Keep Session Notes Detailed
Payer audits aren’t rare—they’re routine. Your notes are your defense.
Ensure that clinical notes for procedures are detailed and accurate.
Here’s how:
- Record the start and end times to the exact minute.
- Describe what you did (e.g., CBT, EMDR, supportive therapy).
- Connect the intervention to the patient’s diagnosis and treatment goals.
- Note progress or regression—payers want evidence of medical necessity.
Use Time Tracking Tools
Guessing your minutes can cost you revenue—or cause overbilling.
To avoid this critical issue:
- Enable the built-in timer in your EHR (e.g., SimplePractice, TherapyNotes).
- For in-person sessions, keep a clock in clear view.
- Only follow the CPT guidelines (not based on habit).
Train Staff on Code Differences
Your front desk and billing team are your first line of defense against denials.
To train them:
- Hold quarterly training on psychotherapy, E/M, and crisis codes.
- Offer them a quick-reference cheat sheet for common CPT codes.
- Teach when add-ons (90785, 90840) are appropriate.
Watch for Payer-Specific Restrictions on 90837
This code is a red flag for some insurers.
To avoid this:
- Keep a record of each payer’s rules for 90837.
- Use it only when the session is 53 minutes or longer and the extra time is clinically necessary.
- Include justification in your notes, explaining why shorter therapy would not have been effective.
Review Denials to Spot Trends
Denials are feedback in disguise—they show you exactly what to fix.
For this:
- Maintain a denial log with reasons, payer, and resolution.
- If missing modifiers are becoming a trend, consider creating a pre-submission checklist.
- Analyze quarterly to adjust billing workflows.
Conclusion
Psychotherapy CPT coding may feel like you’re decoding a secret language at first—but it’s just a system once you learn the patterns. When you know the time thresholds, understand when to use add-on codes like 90785, and can spot actual crises that justify 90839 or 90840, billing becomes a lot less stressful.
What is the true secret? Documentation is your shield and your ticket to faster payments. Detailed notes, accurate time tracking, and payer-specific knowledge mean fewer denials, fewer audits, and more time for actual patient care.
Remember: mental health providers should spend their time treating patients, not wrestling with insurance companies. By using the proper codes, checking payer policies in advance, and keeping a tight feedback loop on denials, you can keep revenue flowing without sacrificing care quality.
If this feels like a lot to juggle, partnering with an expert billing service like Medix Revenue Group can remove the guesswork so you can focus on therapy, not paperwork.
Medix Revenue Group — We Handle the Numbers, You Handle the Healing
We at Medix Revenue Group assist psychologists, psychiatrists, and mental health providers in receiving faster and more accurate payments. From code selection to denial management, we make sure your psychotherapy claims are compliant, complete, and payer-ready.
Contact us today
FAQs
Can I bill 90837 for every patient?
Do not bill 90837 unless the session lasts at least 53 minutes and your notes clearly explain why the extra time was medically necessary. Overuse can flag your practice for an audit.
Can 90785 be billed for every child therapy session?
Not necessarily. Just being a child session doesn’t qualify. You must document specific interactive complexity factors—like needing an interpreter, managing third-party interference, or addressing severe emotional dysregulation.
Can crisis codes be used for phone calls?
Only if the call meets proper crisis criteria (e.g., imminent safety risk) and you document the time spent. Most payers require real-time, interactive communication, not just leaving a voicemail or brief check-in.
Can I bill both 90846 and 90847 for the same day?
Usually no. Most payers won’t reimburse for both unless they are separate, medically necessary sessions with distinct notes—check your payer’s policies before billing.
Do all payers cover group therapy codes?
Coverage for 90853 and 90849 varies widely. Some payers require preauthorization; others exclude them entirely. Always verify with the insurance provider before offering group therapy as a billable service.
