90837 CPT Code: 2026 Rate, 53-Minute Rule and Billing Limits

The 90837 CPT code covers individual psychotherapy sessions lasting 53 minutes or longer. It is one of three time-based individual psychotherapy codes, and the only one with no upper time limit. In 2026 Medicare pays USD 167.00 nationally in the office and USD 135.27 in a facility, before your locality adjustment.

The official CPT descriptor reads "Psychotherapy, 60 minutes with patient," while the billable time range starts at 53 minutes. Both facts matter: the descriptor names the typical session, the range decides the claim.

The code applies to licensed therapists, psychologists, and psychiatrists delivering psychotherapy face to face or by telehealth. Scope-of-practice rules and payer credentialing determine who can bill it in a given state and under a given contract.

This guide covers the time ranges and how 90837 differs from 90834. It also covers add-on codes, 2026 rates, billing limits, what payers check and a documentation checklist.

Key takeaways

• 90837 needs 53 minutes or more of documented psychotherapy time. At 52 minutes the claim is 90834.
• 2026 Medicare pays USD 167.00 nationally in the office and USD 135.27 in a facility, about USD 53 more than 90834.
• Medicare allows up to 2 units per patient per day, each with its own documented start and end time.
• When a prescriber also bills an E/M visit, the psychotherapy goes on the claim as the add-on 90838.

CPT 90837 at a Glance

The 90837 CPT Code Time Range

90837 requires a documented session length of 53 minutes or more. The three individual psychotherapy codes divide time into non-overlapping ranges, with no flexibility at the boundaries.

These published ranges come from the CPT time rule for psychotherapy services. The APA Services summary of psychotherapy codes and the AMA entry for CPT code 90837 are the sources to check. Compare them with your current CPT manual before you change how your practice bills.

What Counts Toward the Time

Psychotherapy time is the time spent with the patient in the therapeutic encounter. Documentation written after the patient leaves is not session time, and adding it to reach 53 minutes is the error payers look for hardest.

90837 vs 90834: How to Choose

Choose between 90837 and 90834 on documented time alone. Session intensity and clinical complexity do not change the code. A difficult 45-minute session is still 90834. A routine 55-minute session is still 90837.

The gap between the two codes is one minute, which is where billing errors concentrate. Payers reimburse 90837 at a higher rate than 90834; the differential varies by payer and contracted rate, and it compounds across a full caseload.

Two practical consequences follow. A practice that rounds down when unsure leaves revenue uncollected. A practice that rounds up without recorded times carries claims it cannot defend. Both come from the same gap: nobody recorded the session length while it was happening.

The Four Mistakes That Move a Claim to the Wrong Code

• Billing a 53 to 59 minute session as 90834. The time qualifies for 90837. Rounding down to be safe gives up about USD 53 per session at the Medicare national rate.
• Billing a 50 minute session as 90837. The common 50 minute therapy hour falls in the 90834 range.
• Billing from the appointment length. A 60 minute calendar slot often holds less than 53 minutes of psychotherapy once check-in and wrap-up come out. Bill the time in the note.
• Counting documentation time. Notes written after the patient leaves do not count toward the 53 minutes.

Add-On Codes and Modifiers That Travel With 90837

90837 is a standalone psychotherapy code, but two situations change what appears on the claim.

• Psychotherapy with medication management. When a prescriber delivers both in one encounter, the claim carries an evaluation and management code plus a psychotherapy add-on code (90833, 90836 or 90838). The E/M component must be separately documented and medically necessary. Our guide to psychiatric billing walks through how the E/M and psychotherapy components interact.
• Telehealth. Sessions delivered by video are generally reported with the telehealth modifier and the place-of-service code your payer requires. Modifier and place-of-service rules differ between Medicare and commercial plans and have changed several times. Confirm the current requirement with each payer every year.

Family therapy and crisis psychotherapy have their own codes: 90846 or 90847 for family sessions, and 90839 for crisis psychotherapy. The session note sits in the medical record, apart from psychotherapy notes.

What 90837 Pays in 2026

The CMS 2026 relative value file, January release, sets 90837 at 5.00 total RVUs non facility and 4.05 facility. At the 2026 conversion factor of 33.4009 that is USD 167.00 and USD 135.27 nationally.

Source: CMS PPRRVU2026_Jan_nonQPP, conversion factor 33.4009.

Your Medicare amount is the national figure adjusted for your locality, which the CMS Physician Fee Schedule lookup shows. Facility settings, and Medicare telehealth billed with place of service 02, pay the facility amount. Commercial rates are set by your contract, so the number that matters for your practice is the one in your fee schedule.

How Many Times Can 90837 Be Billed?

Medicare allows up to 2 units of 90837 per patient per day, under the CMS practitioner MUE table, effective October 1, 2026. Each unit is a separate session with its own documented start and end time. One long session is one unit. 90837 has no upper limit, and the prolonged-service add-ons were deleted in 2023. An 80 minute session is one 90837. Our psychiatric billing guide covers extended and crisis sessions.

What Commercial Plans Do Differently

Commercial and Medicaid plans set their own limits, and three patterns come up across billing guides.

• Prior authorization. It is most common with large commercial plans and Medicare Advantage plans. Some ask for it on 90837 and skip it on 90834. UnitedHealthcare is the plan billing guides name most often.
• Claim review. Reviewers check the same three things: a session of 53 minutes or more, medical necessity for the longer session, and that it was individual psychotherapy.
• Silent downcoding. Some payers pay a 90837 claim at the 90834 rate without a denial. It only shows up in the remittance, so compare paid amounts on 90837 lines against your contract each month.

Check the plan policy before the first extended session. Visit caps and prior authorization rules sit in each plan's behavioral health policy.

The useful exercise is the differential. Pull your contracted rate for 90837 and for 90834 and take the difference. Multiply it by the sessions per month that run past 53 minutes. That figure is what accurate time capture is worth to your practice.

Why Payers Pull 90837 Claims for Review

90837 draws more review attention than the codes next to it, and the reason is statistical. Payers benchmark billing patterns across providers. A clinician billing 90837 for most sessions stands out against peers who mostly bill 90834. That gap alone can prompt a chart review.

Two documentation failures sink most 90837 claims: missing start and end times, and medical necessity language too vague for an extended session. Neither involves fraud. Both involve notes that cannot survive review.

What Reviewers Look For

A payer reviewing a 90837 claim is confirming two things: that the session lasted at least 53 minutes, and that the length was clinically appropriate. Reviewers look for a documented start time, a documented end time, and necessity language tied to the patient's presentation.

Note format matters as much as note content. A structured note with a visible time field is easier to defend than a narrative that buries duration mid-paragraph.

A Denial and an Audit Are Not the Same Problem

A denial affects one claim, and you rework it. An audit affects a set of claims across a date range and holds payment while the review runs. Staff hours go to reviewing old documentation. The cost of responding often exceeds the value of the claims under review. Handling this well upstream is what good denial management looks like, and it is cheaper than handling it downstream.

Documentation Checklist for a 90837 Session

Six elements make a 90837 claim defensible. Work through them before the note is signed.

1. Start time, recorded as a clock time. Not a duration written from memory.
2. End time, recorded as a clock time. The two together establish the 53-minute threshold on their own.
3. Total psychotherapy time, excluding documentation completed after the patient left.
4. Medical necessity for an extended session, tied to what the patient presented with that day. A standing phrase reused across notes will not hold up.
5. The therapeutic content of the session, including modality and the interventions delivered.
6. Telehealth details where they apply, including modality and the modifier and place-of-service code the payer expects.

If your notes carry those six consistently, a high 90837 rate is a defensible billing pattern. If they do not, billing a lower code does not fix it, because under-billing is its own loss.

Where the Coding Decision Should Live

Most guidance on 90837 asks clinicians to watch the clock, which puts a billing task inside the clinical hour. The alternative is to capture the inputs automatically, so the code follows from recorded data.

That is what Emma, the mdhub AI Clinical Assistant, is built for: clinical documentation and CPT coding. A quality and compliance layer checks notes against payer expectations. Clinics using mdhub save 2+ hours per clinician per day and see up to 50% lower operational costs. Part of that comes from not reworking claims that went out wrong.

Running this across several clinicians or locations? See our guide to behavioral health software and how mdhub works for group practices.

Emma drafts, the clinician reviews and signs. The AI does the assembly and the arithmetic; the clinical judgment stays with the person who was in the room. On the claim side, Eric handles submission, payments, and denials, so a coding problem gets caught before it becomes a rejection.

To see how this fits together, read how we approach behavioral health billing and what mental health billing software actually does. For the documentation side, our SOAP note example shows the structure these time fields live in.

Capture the Time, Then Bill the Code

Accurate 90837 billing comes down to whether session time was captured while it was still a fact. Emma handles the documentation and the coding so that answer is yes by default. Your clinicians review the note and sign it. To see it inside a live practice, book a demo with the mdhub team.