CPT 90837: 60-Minute Individual Psychotherapy

Mukesh MakwanaFounder & CEO · 8+ years hands-on in medical billing & RCM · Reviewed September 29, 2026

CPT 90837 is the 60-minute individual psychotherapy code, and it is the single most scrutinised code in outpatient behavioral health. The descriptor is short, the time rule is unforgiving, and the reason claims fail is almost never the therapy itself. It is the clock, the note, and what else went on the same claim.

What CPT 90837 covers

90837 is psychotherapy, 60 minutes with patient. The number in the descriptor is a label, not a requirement. What decides the code is the CPT time rule for psychotherapy, which splits the three individual codes into ranges that do not overlap:

• 90832: 16 to 37 minutes.
• 90834: 38 to 52 minutes.
• 90837: 53 minutes or more.

There is no rounding and no flexibility at the boundaries. A 52-minute session is 90834. A 53-minute session is 90837. A session under 16 minutes is not billable with any of the three.

Psychotherapy time does not include the time spent arranging services, preparing reports, or communicating with other professionals. That work is real, but it belongs to other codes, not to the length of the session.

CPT 90837 vs 90834: the question every payer asks

90837 pays more than 90834 because it takes longer, and payers watch the ratio between the two across a clinician's panel. A practice that bills 90837 for nearly every patient will eventually be asked to justify it, usually through a records request rather than a straight denial.

That is not a reason to downcode. It is a reason to make the clock defensible. Where a clinician genuinely runs 55-minute sessions as a matter of clinical model, the note should say so, the start and stop times should be in the record, and the treatment plan should explain why that length is the plan rather than the habit.

Documentation requirements

• Start and stop times, or total face-to-face minutes. A session described only as "60-minute session" is weaker than one recorded as 2:00 to 3:00 pm, and far weaker than one recording 58 minutes of contact.
• The therapeutic modality actually used, named rather than implied.
• A current diagnosis the session addresses, and the link between the two.
• Target symptoms and measurable progress against the treatment plan, including where progress has stalled.
• Medical necessity for continued treatment, which is the item most often missing once an episode passes a few months.
• The plan for the next interval, including frequency and expected duration.
• Where the session was delivered by telehealth, the modality, the patient's location and the clinician's location.

Common denials and the exact fix

Modifier rules

• 95: synchronous telehealth delivered by real-time audio and video. This is the standard telehealth modifier on Medicare professional claims and with most commercial payers.
• 93: synchronous telehealth delivered by audio only. Behavioral health is one of the few areas where Medicare accepts audio-only.
• GT: the legacy audio and video modifier. CMS retired it for Medicare professional claims once the telehealth place of service codes arrived, and on the Medicare side it now survives mainly on Critical Access Hospital Method II institutional claims. A number of state Medicaid programmes and older commercial contracts still require it, so this is a per-payer setting rather than a national rule. Sending GT where 95 is expected, or the reverse, is a routine and avoidable rejection.
• 59, XE, XP, XS, XU: only where a second service was genuinely separate and distinct, and only on a pair whose edit allows a modifier. It will never release the 90837 to E/M pair.
• 25: belongs on an E/M, never on 90837.
• HJ, HK, HA, HO, HP and similar: Medicaid and state-program modifiers that identify the program or the clinician's licence level. They vary by state and are not Medicare modifiers.
• AJ, AH: identify a clinical social worker or a clinical psychologist where a payer requires the provider type on the line.

Telehealth: what applies in 2026

Behavioral health telehealth sits on firmer ground than the rest of Medicare telehealth. The Consolidated Appropriations Act, 2021 permanently removed geographic and originating site restrictions for behavioral health, so a patient can be at home in any part of the country. Two-way interactive audio-only technology is permitted for behavioral health telehealth.

The place of service on a 90837 telehealth claim is 10 when the patient is at home and 02 when the patient is anywhere else. Since 2024, claims for telehealth to a patient at home are paid at the non-facility rate, which is the higher of the two for this code. Getting place of service wrong is not a rejection, it is an underpayment, so it tends to go unnoticed for months.

The statutory in-person visit requirement for mental health telehealth is deferred. Beneficiaries may continue receiving mental health telehealth without a prior in-person visit, and the requirement is set to begin after December 31, 2027. Plan for it rather than being surprised by it.

NCCI bundling edits

These are Medicare procedure-to-procedure edits from the practitioner file effective October 1, 2026. A modifier indicator of 0 means no modifier will release the pair; 1 means a modifier may release it when the services were genuinely separate.

• 90837 with 90832, 90834, 90833 or 90836: indicator 0, mutually exclusive.
• 90837 with 99202 to 99215: indicator 0. Use the add-on codes instead.
• 90837 with 90839 or 90840: indicator 0. Crisis psychotherapy is not billed alongside a routine session on the same date.
• 90837 with 90845, 90865, 90870 or 90880: indicator 0.
• 90846, 90847, 90849 or 90853 with 90837: indicator 1. Family or group therapy may be reported with individual therapy where it was a separate and distinct service during a separate time interval, and the note has to show that interval.
• 90837 with the health behavior codes 96156, 96158, 96159, 96164 and 96167: indicator 0.
• 90837 with the adaptive behavior codes 97151, 97153, 97155 and 97156: indicator 0.
• 90837 with 96127: indicator 0.
• 90837 with 90867, 90868, 90869 or 96116: indicator 1.

Note that the CPT instructions treat 90832 to 90838 as including psychotherapy provided with family members present as informants. Having a family member in the room does not by itself create a family therapy claim.

Local coverage: is there an LCD for this code?

There is no national coverage determination for psychotherapy or psychiatric evaluation, so coverage is set locally and it differs by jurisdiction. Several Medicare Administrative Contractors publish a local coverage determination for psychiatric services together with a billing and coding article that carries the actual code list. Novitas Solutions, for example, maintains LCD L35101 (Psychiatric Codes, effective January 1, 2024) with billing and coding article A57130, which is where the covered CPT and HCPCS codes and the covered diagnoses actually live.

Two practical consequences. First, the diagnosis list that supports CPT 90837 in one jurisdiction may not support it in another, so the article to read is the one from the contractor that processes your claims. Second, LCDs and their articles are revised without much notice, which is why a claim that paid last quarter can deny this quarter with nothing changed on your side. Search the CMS Medicare Coverage Database by code and by your contractor, and re-check it when a denial pattern appears.

What CPT 90837 pays

90837 is a physician-fee-schedule service with no technical component and no global period, so what varies is the setting and the locality rather than the structure of the code. Medicare publishes relative values rather than a single national price, and the amount your practice is actually paid depends on your locality's geographic adjustment. The CMS look-up tool linked below returns the figure for your own locality; commercial rates are whatever your contract says and are frequently set as a percentage of the Medicare amount.

2026 Medicare RVUs for CPT 90837

Source: CMS CY 2026 PFS Relative Value File, RVU26D (October release, published 08/26/2026). RVUs are national and unadjusted; commercial and Medicaid payers set their own rates and their own coverage.

In the 2026 CMS relative value file, CPT 90837 carries 3.78 work RVUs, with 5.00 total RVUs in a non-facility setting and 4.05 in a facility. The gap is practice expense: in an office the practice carries it, in a facility the facility does. Its PC/TC indicator is 0: CMS treats it as a physician service, so modifiers 26 and TC do not apply to it in any setting. Its global indicator is XXX: the surgical global period concept does not apply, so there is no postoperative period bundling other services into it. Across the individual psychotherapy codes, work RVUs run from 1.94 (90832) to 3.78 (90837), so 90837 carries the highest physician work in its group.

Units per day. Medicare's medically unlikely edit allows up to 2 units of CPT 90837 per patient per day (a date of service edit set on clinical grounds, rationale: clinical: CMS workgroup). MUE values are published quarterly in the Medicare NCCI practitioner services MUE table; the value above is from the table effective October 1, 2026.

To turn RVUs into payment, each component is multiplied by your locality's geographic practice cost index, the three are added, and the sum is multiplied by the 2026 conversion factor: $33.4009, or $33.5675 for qualifying APM participants (CMS-1832-F; CMS fact sheet). The CMS Physician Fee Schedule Look-Up Tool runs that calculation for your own locality.

Frequently asked questions

Sources

American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, CY 2026 PFS Relative Value File RVU26D (October release, published 08/26/2026): RVUs, PFS status indicator, PC/TC indicator and global indicator for 90837.
Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, CMS-1832-F: conversion factors.
Centers for Medicare & Medicaid Services, Medicare NCCI Practitioner Services medically unlikely edit table, effective October 1, 2026.
Centers for Medicare & Medicaid Services, Medicare NCCI procedure-to-procedure edits for practitioner services, 2026 Q4 file effective October 1, 2026.
Centers for Medicare & Medicaid Services, Medicare Coverage Database: Novitas Solutions local coverage determination L35101 (Psychiatric Codes, effective 01/01/2024) and billing and coding article A57130.
Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual for Medicare Services, revision date 1/1/2026, Chapter XI (Medicine), Section C, Psychiatric Services.

CPT® is a registered trademark of the American Medical Association. Payer policy, NCCI edits and MUE values change quarterly, so check your own contractor and your commercial contracts before submission. How we verify this guidance.

Related codes

• CPT 90791. The diagnostic evaluation that usually opens the episode, and which cannot be billed with psychotherapy on the same date.
• CPT 99492. Collaborative care, where the behavioral health work is billed by the primary care practice instead of by session.

Related reading

• Behavioral health & psychiatric billing. How we scrub session-based claims, track prior authorization and bill collaborative care.
• Psychotherapy add-on coding. How the add-on psychotherapy codes pair with an E/M visit and where the time rules bite.
• Behavioral health prior authorization in 2026. Why authorizations lapse mid-episode and what catching them early is worth.
• 2026 behavioral health code changes. What the CY 2026 fee schedule changed for collaborative care, digital mental health and telehealth.