90836 CPT Code: Time Rules, 2026 Rate and E/M Pairing

The 90836 CPT code is 38 to 52 minutes of psychotherapy delivered in the same visit as an evaluation and management (E/M) service. It is an add-on code, so it never goes on a claim by itself: it is billed with the E/M code for the medication visit.

In 2026 Medicare pays USD 103.21 for 90836 nationally at the non facility rate (USD 83.17 facility), on top of the E/M payment. The E/M level is picked on medical decision making. The minutes you count for 90836 cannot also count toward the E/M.

What is the 90836 CPT code?

CMS lists it as "Psytx w pt w e/m 45 min": psychotherapy with the patient, with an E/M service, 45 minutes. It belongs to a set of three add-on codes that differ only by time: 90833, 90836 and 90838.

The Medicare billing and coding article A57480 sets out the split. Psychotherapy without an E/M is billed as 90832, 90834 or 90837. Psychotherapy with an E/M is billed as the E/M code "plus a psychotherapy add-on code (90833; 90836; 90838)". In practice that means a prescriber who also does therapy in the same visit.

90836 at a glance

What is the time requirement for 90836?

38 to 52 minutes of psychotherapy. The Medicare article A57520 tells you to "choose the code closest to the actual time" and gives the ranges. The 45 in the descriptor is the midpoint of that range.

Only psychotherapy minutes count. A57520 says "the total time does not include the E/M time." The minutes do not have to be in one block either. The same article accepts that psychotherapy inside a combined visit "may not be continuous". It expects the start and stop times, or the total time, of the psychotherapy itself.

So a 60 minute visit with 15 minutes of medication management and 45 minutes of therapy is an E/M plus 90836. A 50 minute visit with 20 minutes of medication work and 30 of therapy is an E/M plus 90833.

How much does 90836 pay in 2026?

Medicare pays USD 103.21 nationally at the non facility rate and USD 83.17 at the facility rate. That is 3.09 and 2.49 relative value units times the 2026 conversion factor of 33.4009, from the CMS relative value file. Your Medicare contractor's local amount is what pays. Medicaid and commercial plans set their own rates.

The add-on is paid on top of the E/M. Here is the national non facility total for the visit with the established patient office codes:

National rates before locality adjustment. Billing 38 to 52 minutes of therapy as 90833 loses USD 21.71 at the national rate.

Which E/M codes can you bill with 90836?

A57520 lists the E/M ranges that pair with the add-ons: 99202 to 99255, 99304 to 99310 and 99341 to 99350. That covers office and outpatient visits, hospital and other inpatient settings, nursing facility visits, and home or residence visits.

Three rules decide the E/M side, all from A57480:

• "The type and level of E/M service is selected based on medical decision making."
• "Time may not be used as the basis of E/M code selection."
• Prolonged services cannot be added when 90833, 90836 or 90838 are on the claim.

The two services must also be separately identifiable in the note. A57520 says the documentation "should show that they are separately identifiable services". The contractor billing guide for L34616 adds that a separate diagnosis is not required for each one.

Who can bill 90836?

Only a clinician who can bill the E/M visit it attaches to. In a behavioral health group that is usually the psychiatrists and the psychiatric nurse practitioners, clinical nurse specialists or physician assistants, within their state license. The same clinician has to deliver both parts. A therapist who does not bill E/M codes uses 90834 for the same 38 to 52 minutes.

Check scope of practice and payer enrollment for each clinician type before you build templates around the code. Medicaid plans and commercial payers keep their own lists.

Can you add 90785 to 90836?

Yes. A57520 lists 90836 among the codes 90785 can be reported with. Use it when a communication factor made the psychotherapy harder to deliver. Examples: a caregiver whose behavior interfered, or a disclosure the clinician had to report. Because 90836 is time based, A57520 also expects the note to show the time spent on the interactive complexity.

Can 90836 be billed for telehealth?

Yes for Medicare. 90836 is on the CY 2026 Medicare telehealth list with the status "Maintain". The code does not change for video visits. The place of service code and any modifier the payer asks for mark the visit as telehealth. Our guide to place of service codes covers POS 02 and 10.

How do you document a 90836 visit?

Write the note so a reviewer can see two services and count the therapy minutes without guessing. A note that holds up records:

• The start and stop times, or the total time, of the psychotherapy alone.
• The E/M work: history, the medication decisions, and the medical decision making that sets the level.
• The psychotherapy: the method used, what was worked on, and the patient's response.
• How the session connects to the treatment plan, and the plan for the next visit.
• For 90785, the specific communication factor and the time it took.

Example: Medication management 15 min. Sertraline increased to 100 mg after side effect review; labs reviewed. Psychotherapy 42 min, 2:10 to 2:52 pm, CBT: worked on avoidance at work, patient completed an exposure plan for Monday's team meeting. MDM moderate (prescription drug management), billed 99214 + 90836. Goal 1 partly met. Return in 4 weeks.

Our guide to psychotherapy notes covers where therapy notes sit in the record and who can see them.

Why do 90836 claims get denied or downcoded?

The usual errors are below. Each row can be written as a pre-submission edit in the billing system:

For claims that do come back, see our guides to denial management and claim scrubbing. The psychiatric billing guide covers the wider E/M and psychotherapy picture.

Sources

• CMS Medicare Coverage Database, Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520)
• CMS Medicare Coverage Database, Billing and Coding: Psychiatry and Psychology Services (A57480)
• CMS 2026 physician fee schedule relative value file, January release
• CMS CY 2026 Medicare telehealth services list

Streamline Your Practice

A 90836 note has to separate two services and carry the therapy minutes. That is hard to write at the end of a full clinic day. mdhub drafts the note from the session for your clinician to review and sign. For the codes around 90836, see our pages on 90833, 90834, 90837 and 90785. Start a free trial, or book a demo if you run a clinic with 10 or more clinicians.

90836 CPT code FAQ