Most behavioral health practitioners know 90837 and 90834 as the two individual psychotherapy codes they bill most often. What many do not know is exactly how the time requirement works, and what documentation is necessary to bill the higher-paying code defensibly.
This is not a complicated topic. But it is one where imprecise practice costs money either way: underbilling because you are not documenting correctly, or overbilling because you are rounding up without support.
The Three Codes in Plain English
Code 90832 covers individual psychotherapy from 16 to 37 minutes of face-to-face time and carries the lowest reimbursement of the three tiers. Code 90834 covers 38 to 52 minutes and is the standard code for sessions that run close to 45 minutes. Code 90837 covers 53 minutes or more and carries the highest reimbursement; it is the standard code for full 60-minute sessions.
The time ranges are not suggestions. They are the defining criteria for which code applies. Billing 90837 for a 48-minute session is not a gray area; it is a misrepresentation, regardless of whether it is intentional. Members can find the complete CPT Reference with all 14 behavioral health codes, time requirements, and billing tips in the member portal.
| CPT Code | Time Requirement | Typical Session | Reimbursement Tier |
|---|---|---|---|
| 90832 | 16–37 minutes | Short/brief sessions | Lowest |
| 90834 | 38–52 minutes | Standard 45-min session | Mid |
| 90837 | 53+ minutes | Full 60-min session | Highest |
What “Face-to-Face Time” Actually Means
For psychotherapy codes, the time counted is face-to-face time with the patient, the time spent in direct therapeutic contact during the session itself. It does not include time spent writing the clinical note after the session, time spent reviewing records before the session, phone calls between sessions, or coordination of care calls with other providers.
The stopwatch starts when the therapeutic encounter begins and stops when it ends. Everything else is outside the count.
This distinction matters most for practices that schedule 60-minute appointment slots but consistently run 50 to 55 minutes of direct contact. That is squarely in 90837 territory — but only if the note reflects it accurately.
Why Documentation Is the Deciding Factor
In an audit, the code on the claim means nothing. What matters is what the clinical note says.
For time-based codes like 90837 and 90834, documentation should include the start and stop time of the session, or at minimum a clear statement of total face-to-face time. Many EHR systems include start and stop time fields; use them. If yours does not, add the information to your note template.
The minimum documentation needed to support a 90837 claim: date and location of service, start time and stop time or total face-to-face time, CPT code and clinical rationale, and the treating clinician’s signature. The time documentation is what separates a defensible 90837 from a compliance risk.
The 53-Minute Threshold
The most common point of confusion: 90837 requires 53 minutes or more. A session that runs 50, 51, or 52 minutes falls into 90834 territory. A session that runs exactly 53 minutes qualifies for 90837.
Some payers define their own minimum, typically 53 to 60 minutes. A small number have required documentation of at least 55 minutes. Always check your payer contracts, but 53 minutes is the AMA standard.
In practice: a 45-minute appointment where the session runs 42 minutes is 90834. A 45-minute appointment where the session runs 55 minutes is 90837. A 60-minute appointment where the session runs 58 minutes is 90837. A 60-minute appointment where the session runs 50 minutes is 90834. The scheduled appointment length does not determine the code. The documented face-to-face time does.
The Revenue Difference
The reimbursement gap between 90834 and 90837 varies by payer and geography, but Medicare reimburses 90837 at roughly 25 to 30 percent more than 90834 per session. For a practice seeing 20 patients per week, consistently billing the correct code for actual session time, rather than defaulting to 90834 for all sessions, can represent meaningful annual revenue.
The goal is not to bill 90837 more often. The goal is to document accurately so that sessions that genuinely qualify for 90837 are billed as such, and sessions that do not, are not.
A Note on E/M Add-On Codes
For psychiatrists and other practitioners who provide evaluation and management services in the same session as psychotherapy, the add-on code 90833 is used alongside an E/M code to capture the psychotherapy component. When 90833 is billed with an E/M, the time for each component must be documented separately. This is a common audit target, if you bill E/M plus psychotherapy add-ons, make sure your note templates support the separate time documentation.
Common Mistakes to Avoid
Defaulting to 90837 for all sessions without tracking actual time creates audit exposure. Defaulting to 90834 for all sessions, even when most run 55 or more minutes, leaves money on the table. Not including start and stop times or total face-to-face time in the note means the claim is indefensible if reviewed. Counting note-writing time or records review as face-to-face time is not permitted. And rounding a 50-minute session up to 90837 falls outside the code’s time range.
The Bottom Line
The 90837 vs. 90834 decision is not complicated. It is determined entirely by documented face-to-face time. Practices that track this accurately bill the right code every time and have the documentation to support it if a payer asks.
Candor Health Intel covers CPT code updates, documentation requirements, and payer-specific billing alerts every Tuesday in plain English. The full CPT Code Reference with all 14 behavioral health codes is available inside the member portal. See a free sample issue at candorhealthintel.com.