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What is CPT 90836?

The CPT 90836 code is part of the Current Procedural Terminology (CPT) codes used for billing mental health services. Specifically, 90836 is defined as:

CPT 90836: “Psychotherapy, 45 minutes with patient when performed with an evaluation and management service.”

This code is considered a time-based psychotherapy code, typically billed when psychotherapy lasts between 38 and 52 minutes with a patient. It is intended for use in conjunction with other services, such as psychiatric evaluation or medication management, and cannot be billed as a standalone service.

In contrast:

• 90834 – psychotherapy, 38–52 minutes (without E/M)
• 90837 – psychotherapy, 53+ minutes
• 90832 – psychotherapy, 16–37 minutes

Knowing the differences between these codes is essential to prevent claim denials and ensure accurate reimbursement.

When to Use CPT 90836

CPT 90836 should be used when the following criteria are met:

• Psychotherapy Duration: The session lasts approximately 45 minutes, or between 38–52 minutes.
• Combined Service: The psychotherapy is performed alongside an evaluation and management (E/M) service, such as medication management or psychiatric evaluation.
• Documented Medical Necessity: The provider documents the session thoroughly to justify the need for psychotherapy alongside another service.
• Not Standalone: It should not replace 90834 or 90837 when psychotherapy is provided as a standalone session.

Example Scenario

A psychiatrist sees a patient for medication management (CPT 99214) and provides psychotherapy during the same visit. If psychotherapy lasts about 45 minutes, CPT 90836 is billed in addition to the evaluation and management service. Proper documentation must indicate both the psychotherapy content and the time spent.

Coverage for CPT 90836

Coverage for CPT 90836 varies depending on insurance type, payer policy, and state regulations. Understanding coverage rules is crucial for avoiding claim denials.

Medicare Coverage

• Medicare recognizes CPT 90836 when billed with an evaluation and management code.
• Psychotherapy must be medically necessary and documented.
• Medicare may deny payment if the psychotherapy component is unclear or not properly timed.

Private Insurance Coverage

• Most commercial insurers cover CPT 90836 when billed with E/M services.
• Some insurers require preauthorization or may cap the number of psychotherapy sessions per year.
• Reimbursement rates vary depending on the insurance contract.

Medicaid Coverage

• Medicaid coverage for CPT 90836 is state-dependent.
• Many states follow Medicare rules for psychotherapy codes.
• Proper documentation is critical to meet Medicaid requirements.

Key Consideration

Always check payer-specific policies before billing CPT 90836, as rules can differ even between plans from the same insurer.

CPT 90836 Reimbursement

Reimbursement for CPT 90836 is influenced by:

• Relative Value Units (RVUs): CPT codes are assigned RVUs that determine Medicare reimbursement.
• Time-based Billing: Since 90836 is time-based, accurate time documentation is essential.
• Combination with E/M Services: Reimbursement depends on proper billing alongside the evaluation and management code. Some payers apply modifier 25 to indicate a significant, separately identifiable psychotherapy service.

Typical Reimbursement Rates

Medicare reimbursement for CPT 90836 ranges roughly $55–$70 (in addition to the E/M code), but rates vary by location. Commercial insurers may pay higher, especially for in-network providers.

Documentation Tips for CPT 90836

Accurate documentation is essential for claim approval, audits, and compliance. Here are best practices:

1. Document Start and End Time

• Record exact start and end times of psychotherapy.
• Indicate total face-to-face psychotherapy time.

Example: “Patient seen from 2:00 PM to 2:45 PM. Psychotherapy duration: 45 minutes.”

2. Describe Psychotherapy Interventions

• Cognitive Behavioral Therapy (CBT)
• Psychoeducation
• Stress Management Techniques
• Problem-Solving Therapy

3. Tie Psychotherapy to Medical Necessity

Document the patient’s diagnosis and specific clinical rationale for psychotherapy.

Example: “Patient with generalized anxiety disorder. Psychotherapy aimed to reduce anxiety symptoms and improve coping strategies.”

4. Combine with Evaluation and Management Notes

• Include E/M service documentation separately.
• Demonstrate that psychotherapy was additional to the E/M service.

Example: “Medication management discussed. Psychotherapy session added for anxiety symptom management.”

5. Record Patient Response

• Note the patient’s engagement and progress.

Example: “Patient actively engaged, reported decreased anxiety, completed homework assignments.”

6. Use Modifiers Correctly

Use modifier 25 when billing psychotherapy with E/M codes to indicate a distinct, separately identifiable service.

7. Avoid Common Documentation Errors

• Do not bill 90836 if psychotherapy is less than 38 minutes.
• Avoid using 90836 as a standalone code.
• Ensure both psychotherapy and E/M notes are clearly separated in the chart.

Common Mistakes with CPT 90836

Many claims for CPT 90836 are denied due to billing errors. Common mistakes include:

• Incorrect Timing: Billing 90836 for sessions under 38 minutes.
• Standalone Billing: Using 90836 without an E/M code.
• Poor Documentation: Not specifying psychotherapy type, duration, or patient response.
• Missing Modifier 25: Not indicating a distinct service when combined with E/M.
• Insurance Policy Ignorance: Failing to check payer-specific coverage rules.

Avoiding these mistakes is key to maximizing reimbursement and avoiding audits.

How to Properly Bill CPT 90836

Step 1: Verify Patient Eligibility

• Check insurance coverage.
• Confirm psychotherapy is medically necessary.

Step 2: Select the Right E/M Code

Choose the correct evaluation and management code (e.g., 99213, 99214) for the visit.

Step 3: Document Psychotherapy Separately

• Include a detailed note for the 90836 session.
• Record duration, interventions, patient response, and medical necessity.

Step 4: Apply Modifier 25

Add modifier 25 to the E/M code if required. This ensures the payer recognizes psychotherapy as a separate service.

Step 5: Submit Claim

• Ensure accurate CPT codes, modifier usage, and documentation.
• Double-check payer-specific rules before submitting.

Tips for Maximizing Compliance and Reimbursement

• Track Time Accurately: Use timers or session logs to track psychotherapy duration.
• Separate Notes: Maintain distinct E/M and psychotherapy documentation.
• Audit Your Records: Conduct internal audits to ensure coding accuracy.
• Stay Updated: Keep abreast of CPT changes and payer policies.
• Train Staff: Educate billing and clinical staff on proper 90836 usage.

Key Differences Between 90834, 90836, and 90837

CPT Code	Duration	Standalone	With E/M Service
90834	38–52 min	Yes	No
90836	38–52 min	No	Yes
90837	53+ min	Yes	No

90834 – for psychotherapy without E/M service.
90836 – psychotherapy provided with E/M service.
90837 – extended psychotherapy sessions exceeding 52 minutes.

Understanding this distinction is critical for accurate billing and reimbursement.

Real-World Example

A psychiatrist sees a patient for a follow-up medication management visit (99214). During the same session, the psychiatrist provides psychotherapy focused on coping skills, lasting 45 minutes. Documentation should reflect:

• Start and end times.
• Interventions used (e.g., CBT, psychoeducation).
• Patient response.
• E/M service is separate from psychotherapy.
• Modifier 25 on the E/M code.

This ensures both the evaluation and management code and the psychotherapy code (90836) are reimbursed correctly.