Standard individual psychotherapy is billed based on strictly defined time increments. If you are a therapist or a doctor providing therapy without medical evaluation and management on that day, you use the standalone therapy codes.
The Time Thresholds
Unlike the PT 8-minute rule, psychotherapy has its own specific time brackets:
- 90832 (30 Minutes): Must be at least 16 minutes. (Range: 16-37 mins)
- 90834 (45 Minutes): Must be at least 38 minutes. (Range: 38-52 mins)
- 90837 (60 Minutes): Must be at least 53 minutes. (Range: 53+ mins)
Medical Necessity & The 90837 Audit Trap
CPT 90837 (60 minutes) is heavily audited by Medicare and commercial payers because it pays the most. Routine billing of 90837 for every patient, every week, will trigger a Targeted Medical Review. Ensure your documentation proves the patient's acuity required a full hour of intense therapy.
NCCI Edits
These codes cannot be billed with crisis codes (90839) or group therapy (90853) on the same day without explicitly documented distinct sessions and Modifier 59.