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90833, 90836, 90838: Psychotherapy Add-On Codes to E/M

Last Updated: October 5, 2025

If a psychiatrist or PMHNP sees a patient for a medication check (E/M) AND provides formal psychotherapy during the same visit, they can bill both services using the psychiatric add-on codes.

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2026 Medicare National Fee (90833): Non-Facility (Office): $94.62 · Facility (Hospital): $72.48
✓ 2,054 Medicare-Approved ICD-10 Diagnoses on file for 90833:

How Add-On Therapy Works

First, you bill the primary E/M code based on Medical Decision Making (MDM), NOT time. (e.g., 99214 ↗ for managing high-risk psychiatric meds).

Then, you bill the add-on psychotherapy code based strictly on the time spent providing therapy:

  • +90833: 16-37 minutes of therapy.
  • +90836: 38-52 minutes of therapy.
  • +90838: 53+ minutes of therapy.

Documentation Requirements

The medical record MUST have two distinct sections: one documenting the medication management (the E/M), and one documenting the specific psychotherapeutic techniques used (e.g., CBT, DBT). You must also explicitly state the time spent on therapy separate from the time spent on med management.

NCCI Edits

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Because these are add-on codes, they NEVER require Modifier 51 or Modifier 59 when billed with the primary E/M code. However, they will instantly deny if billed by themselves without a primary E/M.

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