CPT Code 90837: The Definitive Guide to Reimbursement Rates & Documentation in 2026

If you're a therapist, LCSW, LPC, or LMFT billing for individual psychotherapy, CPT code 90837 is probably the code you use most. It's also one of the most scrutinized codes in behavioral health billing — and one of the most misunderstood.

This guide breaks down everything you need to know about 90837 in 2026: what it covers, what it pays, how to document it correctly, and how to protect yourself from audits and claim denials. No fluff, no vague generalizations — just the practical information you need to get paid accurately and stay compliant.

What Is CPT Code 90837?

CPT 90837 describes individual psychotherapy, 60 minutes. More precisely, it covers psychotherapy sessions lasting 53 minutes or more with a patient. It is the highest-value of the three standard individual psychotherapy codes and is used by licensed mental health professionals providing face-to-face (or telehealth) therapy.

Here's a quick breakdown of the three core individual psychotherapy codes:

| CPT Code | Session Length | Minimum Time | Typical Use | |----------|---------------|--------------|-------------| | 90832 | 30 minutes | 16–37 min | Brief check-ins, crisis support | | 90834 | 45 minutes | 38–52 min | Standard shorter sessions | | 90837 | 60 minutes | 53+ min | Standard full-length therapy |

Key rule: Time is the determining factor. You must document the start and end time of the session, and the face-to-face psychotherapy time must meet the threshold for the code billed. For 90837, that means at least 53 minutes of psychotherapy.

CPT 90837 Reimbursement Rates in 2026

Reimbursement for 90837 varies significantly depending on whether you're billing Medicare, Medicaid, or a commercial payer. Here's what you need to know.

Medicare Reimbursement (2026)

The Centers for Medicare & Medicaid Services (CMS) updates the Physician Fee Schedule (PFS) annually. Based on the 2026 PFS final rule, the national average Medicare reimbursement for CPT 90837 is approximately $112–$125, depending on geographic location (using the locality-adjusted conversion factor).

Medicare reimburses at 80% of the allowed amount — the patient is responsible for the remaining 20% coinsurance (or their Medigap plan covers it).

Key points for Medicare billing of 90837:

You must be enrolled as a Medicare provider (or be a qualified supervising provider)
Telehealth delivery is covered through at least the end of 2026 under extended flexibilities
Psychologists and licensed clinical social workers (LCSWs) can bill independently; LPCs and LMFTs may have limitations depending on state and payer policy

Medicaid Reimbursement (2026)

Medicaid rates are state-determined, so there's no single national rate. Rates typically range from $65–$105 for 90837, with significant variation:

California Medi-Cal: ~$87–$95
New York Medicaid: ~$95–$110
Texas Medicaid: ~$70–$85
Florida Medicaid: ~$72–$90

Always verify your state's current fee schedule directly through your state Medicaid portal or managed care organization (MCO) contract.

Commercial Payer Reimbursement (2026)

Commercial insurers typically reimburse above Medicare rates, but it varies widely by contract. Common ranges for 90837 with major commercial payers:

| Payer | Estimated 90837 Rate (2026) | |-------|-----------------------------| | Aetna | $130–$165 | | Anthem/BCBS | $125–$175 | | Cigna | $120–$160 | | UnitedHealthcare | $125–$170 | | Humana | $115–$155 | | Optum (UHC subsidiary) | $120–$165 |

Important: These are estimates based on typical contracted rates and publicly available data. Your actual contracted rate may differ. Always review your provider agreement or call provider relations to confirm your fee schedule.

Self-Pay / Out-of-Network Rates

For self-pay clients or out-of-network billing, therapists typically charge their full fee, which ranges from $100–$300+ per session depending on market, specialty, and provider type. Always provide a Good Faith Estimate (GFE) under the No Surprises Act for self-pay clients.

Documentation Requirements for CPT 90837

This is where therapists get into trouble. Inadequate documentation is the #1 reason 90837 claims are denied or recouped during audits. Here's exactly what your note needs to include.

The Non-Negotiables

Every 90837 session note must contain:

Date of service — specific date, not just a month
Start and end time — required to substantiate the 53+ minute threshold
Patient name and identifier — name, DOB, or MRN
Place of service — office (11), telehealth (02 or 10), home, etc.
Provider name and credentials — with signature or electronic attestation
Clinical content — presenting concerns, symptoms, interventions used
Mental status or clinical observations — brief assessment of functioning
Treatment plan alignment — how the session relates to documented treatment goals
Plan / next steps — follow-up, homework, next appointment

What "Good" Looks Like vs. What Gets You Audited

Audit-triggering note (avoid this):

"Client discussed anxiety. Therapist provided supportive therapy. Client will return next week."

This note lacks time documentation, specific interventions, clinical observations, and treatment plan linkage. If an auditor pulls this, it's a recoupment risk.

Compliant note (aim for this):

"Session time: 10:00–11:05 AM (65 minutes). Client presented with elevated anxiety related to workplace conflict. CBT techniques applied, including cognitive restructuring around catastrophizing. Client demonstrated partial insight into thought patterns. Mental status: alert, cooperative, mood anxious but improving. Consistent with Goal 2 of treatment plan (reduce anxiety symptoms). Plan: Client will complete thought record worksheet before next session (11/15/2026)."

This note documents time, intervention type, clinical observations, treatment plan alignment, and a clear plan. That's what survives an audit.

Modifiers That Affect 90837 Billing

Modifiers change how a claim is processed. Here are the most relevant ones for 90837:

| Modifier | When to Use | |----------|-------------| | GT | Telehealth services (some payers) | | 95 | Synchronous telehealth (more commonly required now) | | GQ | Asynchronous telehealth (store-and-forward) | | HO | Master's-level therapist (required by some Medicaid plans) | | U1–U9 | State-specific Medicaid modifiers (check your state) | | 52 | Reduced services (use with caution — rarely appropriate for 90837) |

For telehealth in 2026, most commercial payers and Medicare now require modifier 95 rather than GT. Confirm your payer's current requirements before billing.

Common Billing Mistakes with 90837 (And How to Avoid Them)

1. Billing 90837 When You Didn't Hit 53 Minutes

If your session was 48 minutes, bill 90834. Upcoding — billing a higher-level code than the time supports — is fraud. Document actual time and bill accordingly.

2. Forgetting to Document Time

Without start/end time in the note, you can't prove the session met the 53-minute threshold. This is the single most common audit finding.

3. Using 90837 with Add-On Codes Incorrectly

90837 can be billed with add-on codes like:

90785 — Interactive complexity (add-on, not a standalone)
90833 — E/M with psychotherapy (for prescribers only)

Do not bill 90837 + 90833 together — these serve different purposes. 90833 is added to an E/M code for prescribers doing therapy during a medication management visit.

4. Ignoring Payer-Specific Session Limits

Some payers limit the number of 90837 sessions per year (e.g., 20–30 sessions). Know your payer's utilization management policies and request prior authorization when required.

5. Telehealth Place of Service Errors

Medicare now requires POS 02 (telehealth other than patient's home) or POS 10 (telehealth patient's home) depending on where the patient is located. Getting this wrong triggers denials.

90837 vs. 90834 vs. 90832: When to Bill Which

Many therapists default to 90837 for all sessions out of habit — or worse, because it pays more. This is a compliance risk. Bill based on documented time, not habit.

| If Your Session Was... | Bill This Code | |------------------------|----------------| | 16–37 minutes | 90832 | | 38–52 minutes | 90834 | | 53 minutes or more | 90837 | | Less than 16 minutes | Do not bill psychotherapy |

A healthy billing pattern shows a mix of codes that reflects your actual clinical practice. If 100% of your claims are 90837, that's a statistical outlier that can trigger payer audits.

Telehealth & CPT 90837 in 2026

Telehealth parity has expanded significantly, and in 2026, most major payers continue to reimburse 90837 at the same rate as in-person when delivered via synchronous video. Key 2026 telehealth rules for 90837:

Medicare: Telehealth flexibilities extended through 2026 (and likely beyond under current legislation); audio-only may be covered with appropriate documentation of patient limitations
Most commercial payers: Require synchronous video (not audio-only) for full reimbursement parity
State parity laws: Over 40 states have telehealth parity laws requiring equal reimbursement — verify your state's current law
Audio-only: Some payers cover with modifier FQ (audio-only) but at reduced rates

Audit Defense: Protecting Your 90837 Claims

Insurers conduct post-payment audits — and 90837 is a high-volume, high-value code that gets targeted. Here's how to protect yourself:

Document every session completely — not just the clinical content, but the time, setting, and interventions
Maintain a consistent note format — variation in documentation patterns raises flags
Conduct internal audits — review 10–15 random charts per quarter for completeness
Respond to ADR (Additional Documentation Requests) promptly — typically within 30–45 days
Use an AI documentation platform — tools like Mozu Health flag documentation gaps before you submit claims, dramatically reducing audit risk

Frequently Asked Questions About CPT 90837

Q1: Can an LPC or LMFT bill Medicare for CPT 90837?

As of 2026, LPCs and LMFTs are not recognized Medicare providers for independent billing purposes. This is a longstanding gap in Medicare coverage. LCSWs and psychologists can bill Medicare independently. LPCs and LMFTs must bill through a qualifying supervising provider or work within a FQHC/RHC setting where different rules apply. Advocacy efforts to change this are ongoing.

Q2: Can I bill 90837 for a 50-minute session?

No. A 50-minute session does not meet the 53-minute minimum for 90837. You should bill 90834 (45-minute code, 38–52 minutes). Many therapists schedule "50-minute hours" — if that's your practice, 90834 is your correct code unless you consistently extend sessions past 52 minutes.

Q3: What's the difference between 90837 and 90853?

90837 is individual psychotherapy (one patient, one therapist). 90853 is group psychotherapy (multiple patients in a group setting). Never bill 90837 for a group session — that's upcoding and a serious compliance violation.

Q4: Can I bill 90837 and a psychiatric evaluation (90791) on the same day?

Generally, no. Payers typically bundle the initial psychiatric evaluation with any psychotherapy on the same day. If you do provide therapy after an intake evaluation, some payers allow it with an appended modifier, but you should check your specific payer's policy before doing so.

Q5: How do I handle a session that goes over 60 minutes?

If your session exceeds 60 minutes, you still bill 90837 — there is no "90-minute psychotherapy" code in the standard CPT set for individual therapy. Document the actual time (e.g., 75 minutes) and bill 90837. Some exceptional circumstances may allow billing of multiple codes with appropriate documentation, but this is rare and payer-specific.

Q6: Does my 90837 note need to include a DSM-5 diagnosis?

Yes. Every claim requires an ICD-10 diagnosis code that supports medical necessity. Your note should reference the diagnosis and demonstrate that the services provided are clinically appropriate for that condition. A diagnosis of F41.1 (GAD) with no anxiety-related content in the note is a documentation mismatch that auditors catch.

Q7: What happens if I get audited and my 90837 notes are incomplete?

The payer can demand recoupment of all paid claims in the audit sample — and potentially extrapolate that finding across your entire billing history. This can result in thousands of dollars owed back, and in severe cases, exclusion from the payer network. Complete documentation is your best defense.

The Bottom Line on CPT 90837 in 2026

CPT 90837 remains the backbone of outpatient psychotherapy billing. Reimbursement rates range from roughly $87 to $175+ depending on payer, geography, and contract terms. But getting paid accurately — and staying protected — requires precise documentation, correct code selection, and awareness of payer-specific rules.

The therapists and practices that consistently get paid correctly aren't doing anything magical. They document completely, they know their payer rules, and they audit their own work before problems arise.

Stop Leaving Money on the Table — and Stop Worrying About Audits

Mozu Health is the AI-powered clinical documentation platform built specifically for behavioral health providers. Whether you're a solo therapist or a growing group practice, Mozu Health helps you:

Generate complete, compliant session notes in minutes — not hours
Auto-flag documentation gaps before you submit claims (no more missing time stamps or treatment plan linkages)
Stay audit-ready with structured notes that satisfy payer requirements for 90837, 90834, 90791, and more
Reduce billing errors with built-in CPT and ICD-10 guidance
Stay HIPAA-compliant with enterprise-grade security and encrypted storage

Your documentation shouldn't be a liability. With Mozu Health, it becomes your strongest asset.

👉 Try Mozu Health free at mozuhealth.com — and see how much time and stress you save starting with your very next session.

Disclaimer: Reimbursement rates cited in this article are estimates based on publicly available fee schedules and industry data as of early 2026. Actual reimbursement varies by payer, geographic location, provider type, and contracted rates. Always verify rates directly with your payers and consult a qualified healthcare billing professional for guidance specific to your practice.

CPT Code 90837: Definitive Guide to 2026 Reimbursement