The 90837 CPT code is often understood to be the standard of a therapy session among providers. Generally speaking, it’s a code used to bill for an hour-long session of psychotherapy (i.e. talk therapy).
However, insurers have a tendency to flag 90837 more frequently than other codes. This can result in payment delays, requests for clinical documentation to support use of the 90837, and other confusion for what seems like a typical billing selection.
Why does 90837 get flagged more frequently?
- The 90837 code has a few hard requirements. Specifically, 90837 is for:
- Sessions of at least 53 minutes of therapeutic services
- Psychotherapy (talk therapy)
- Performed by a licensed mental health provider
- If a provider codes 90837, insurers typically look for the following supporting conditions:
- Did the nature of the treatment justify the length of the session?
- Was the treatment rendered medically necessary?
Regarding the length of a session, insurers might be wondering whether the provider could have offered the same quality of treatment in a shorter session, in which case, 90834 should be used instead.
→ Headway’s clinical templates help guide you through the items most important to insurers, making sure you provide the detail they’re looking for.
Regarding medical necessity, insurers want to verify the care you give is clinically appropriate and that there is no less costly, equally effective service available to meet treatment goals and improve the client’s symptoms as it relates to their diagnosis.
In other words, medical necessity is informed by the client’s diagnosis, impairments as a result of the diagnosis, and interventions used to decrease symptoms and improve functioning. Read more about medical necessity here.
→ Headway's clinical templates can help guide you through diagnosis, symptoms, and progress details to help you capture all the key information in minutes.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.