Psychotherapy billing: 90832, 90834 and 90837 time rules

Individual psychotherapy is billed by time. Your documented session length decides between 90832, 90834 and 90837, and the documentation behind that number decides whether the claim holds up in an audit. This guide covers the time ranges, the add-on and related codes, Medicare telehealth basics as of early 2026, and the errors an OIG audit found.

The time ranges for 90832, 90834 and 90837

These ranges come from the AMA's CPT manual. HHS OIG reproduced them in a 2023 audit report, and APA Services publishes the same ranges for psychologists.^[5][2] APA Services' 2020 FAQ and the OIG report both say psychotherapy under 16 minutes should not be billed.^[1][5]

APA Services describes the CPT "Time Rule" as choosing the code closest to the actual time of the session.^[2] An older American Psychiatric Association primer explains the midpoint: "A unit of time is attained when the mid-point is passed."^[4] Under that logic a 35-minute session is still 90832, while 38 minutes reaches 90834. Because the primer dates from the 2013 CPT era, confirm the current wording in your CPT manual.

What counts toward session time

APA Services says psychotherapy time is face-to-face time with the patient. Time may also include informants, but the patient must be present for all or a majority of the service. Time spent arranging services, providing reports or communicating with other health care professionals is not counted.^[1]

When psychotherapy is billed on the same day as an E/M service, the time spent on the E/M work does not count toward psychotherapy time.^[5] OIG also lists the add-on psychotherapy codes 90833, 90836 and 90838 in the same time bands as 90832, 90834 and 90837.^[5]

Interactive complexity add-on 90785

90785 is an add-on code, so it is always reported with a primary service and never on its own. APA Services lists the qualifying situations as managing maladaptive communication, caregiver emotions or behaviors that interfere with the caregiver's ability to understand or help carry out the treatment plan, a sentinel event with mandated reporting, and the use of play equipment or other devices to communicate with a patient who lacks expressive or receptive language skills. At least one must be present and documented in the patient record.^[3]

It can be reported with a diagnostic evaluation (90791, 90792) or a psychotherapy treatment session (90832, 90833, 90834, 90836, 90837, 90838 or 90853). It cannot be used with family psychotherapy (90846, 90847), crisis psychotherapy (90839, 90840), psychological testing codes or adaptive behavior codes. APA Services also says not to report it for translation or interpretation services.^[3]

Family and crisis psychotherapy

APA Services' 2023 page lists 90846 and 90847 at 26 or more minutes. For crisis psychotherapy it lists 90839 for the first 60 minutes and 90840 for each additional 30 minutes.^[2] Its 2020 FAQ gave the practical thresholds: at least 30 minutes to use 90839, and 75 minutes or more to use 90839 plus 90840.^[1]

One Medicare contractor's policy says the crisis codes are reported by themselves and may not be reported with 90791, 90792, 90832 to 90838 or 90785 to 90899.^[8] Contractors differ, so check the policy for your jurisdiction.

Medicare telehealth basics (as of February 2026)

CMS's Telehealth FAQ, updated February 26, 2026, sets out the current rules.^[7] It was still the newest FAQ on CMS's telehealth page when we checked on September 25, 2026. Rules change, so re-check before you rely on any of this.

• Home is allowed for behavioral health. The Consolidated Appropriations Act, 2021 permanently removed geographic and place-of-service restrictions for behavioral health telehealth, and two-way audio-only technology is permitted for it. The FAQ adds a condition from January 1, 2028: the practitioner must be technically capable of audio-video, and the patient must be unable or unwilling to use it.^[7]
• Place of service. Use POS 02 for telehealth provided other than in the patient's home and POS 10 for telehealth provided in the patient's home. Medicare pays home telehealth at the non-facility rate.^[7]
• In-person visit requirement. The requirement takes effect after December 31, 2027: an in-person visit within 6 months before the first mental health telehealth service, and an in-person visit within 12 months of each mental health telehealth service after that, with limited exceptions. CMS says it does not believe the 6-month requirement applies to patients who began receiving mental health services in their homes before January 1, 2028. Those patients follow the 12-month cycle.^[7]

Modifier rules differ by payer. Our guide to Medicare telehealth billing rules for 2026 and 2027 covers what CMS says about POS 02, POS 10, GT and 95.

What auditors find: the 2023 OIG report

HHS OIG audited Medicare Part B psychotherapy payments from March 2020 through February 2021. Medicare paid about $1 billion for psychotherapy in that period, and OIG estimated that $580 million of it was improper: $348 million for telehealth services and $232 million for non-telehealth services.^[5]

In the sample, providers met Medicare requirements on 84 of 216 enrollee days and did not on 128. OIG did not review 4 sampled days because they were already part of other OIG reviews, and treated them as non-errors.^[5] These are sample-based estimates from the first year of the pandemic, but the error patterns are useful today.

• No documented time. On 60 of the 216 sampled days, providers did not document the time spent on psychotherapy. On 54 of those days the note had no start and stop time or total time, and on 6 an E/M service was also billed and the note showed total encounter time but not the psychotherapy portion.^[5]
• Wrong service count or code. On 16 sampled days, providers billed the wrong number of services or the wrong CPT code. On 12 they billed more than one psychotherapy service in a day when the record showed one.^[5]
• Undercoding too. In one example a provider billed 90834 for 45 minutes when the record showed 55 minutes. OIG said 90837 was correct and the provider should have been paid $98 instead of $67.^[5]

These findings do not account for all 128 deficient days, so read the full report for the rest.^[5]

An earlier OIG audit of one medical group (2019) estimated at least $2.6 million in unallowable Medicare payments for psychotherapy, mostly for services that were not provided or had no documented time.^[6]

A documentation checklist

OIG found that CMS has not set national documentation requirements for psychotherapy, and requirements vary among Medicare contractors.^[5] These elements appear in the contractor policies OIG summarized and in the audit's findings.^[5] Check the policy for your own contractor and payers before you rely on the list.

• Start and stop times, or total psychotherapy time
• The interventions used, such as behavior modification or supportive interaction
• A summary of the session, the patient's capacity to participate and, in some policies, the patient's reaction and any change in symptoms
• An expectation of improvement or maintenance of functioning
• A periodic summary of goals, progress toward goals and an updated treatment plan
• The provider's signature, and a claim that correctly shows telehealth or in-person delivery. OIG counted missing signatures and claims that did not identify the delivery method as guidance findings, not payment errors.^[5]

Where you keep the time matters too. HIPAA's definition of psychotherapy notes excludes medication prescription and monitoring, session start and stop times, the modalities and frequencies of treatment, clinical test results, and summaries of diagnosis, functional status, treatment plan, symptoms, prognosis and progress to date.^[9] Because those items are excluded from the definition, ask your compliance advisor where your practice should record them so billing staff can use them to support a claim.

Have your psychotherapy billing reviewed

Time-based codes, add-on rules and payer-specific documentation make psychotherapy easy to bill wrong in either direction. See how we approach mental health and behavioral health billing, including insurance verification and denial management, or request a free billing audit.