Psychotherapy Services

Psychotherapy is the treatment of mental illness and behavioral disturbances in which a physician or other qualified health care professional establishes professional contact with a patient through therapeutic communication and techniques, attempts to alleviate emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personality growth and development.

Effective December 31, 2027, an in-person, non-telehealth visit within six months prior to the first mental health telehealth service is required. After the first mental health telehealth service in the home, an in-person, non-telehealth service is required within 12 months of each mental health telehealth service. If a beneficiary began receiving mental health services on or before December 31, 2027, then they would not be required to have an in-person visit within six months; rather, they will be considered established and will instead be required to have at least one in-person visit every 12 months.

Psychotherapy times are for face-to-face services with the patient and may include informant(s). The patient must be present for all or some of the service. The psychotherapy service CPT® codes 90832–90838 include ongoing assessment and adjustment of psychotherapeutic interventions and may include involvement of informants in the treatment process.

In calendar year 2016, Medicare Part B allowed approximately $1.2 billion for psychotherapy services, including individual and group therapy. A prior Office of the Inspector General (OIG) review found that Medicare allowed $185 million in inappropriate outpatient mental health services, including psychotherapy services. The review found that psychotherapy services were particularly problematic, noting that almost half of the psychotherapy services reviewed were inappropriate.

Specifically, Medicare paid for services that were not covered, inadequately documented, or medically unnecessary. The OIG plans to review Part B payments for psychotherapy services to determine whether they were allowable in accordance with Medicare documentation requirements.

When a beneficiary receives an Evaluation and Management (E/M) service with a psychotherapeutic service on the same day, by the same provider, both services are payable if they are significant and separately identifiable and billed using the correct codes.

An add-on code is eligible for payment only if reported with an appropriate primary service performed on the same date of service. Time spent for the E/M service is separate from the time spent providing psychotherapy and time spent providing psychotherapy cannot be used to meet criteria for the E/M service.

Because time is indicated in the code descriptor for the psychotherapy CPT® codes, it is important for providers to clearly document in the patient’s medical record the time spent providing the psychotherapy service rather than entering one time period including the E/M service.

Coding guidelines for Psychotherapy include the following:

• CPT® code 90832: 30 minutes with the patient
• CPT® code +90833: Psychotherapy, 30 minutes with the patient when performed with an E/M service (list separately in addition to the code for primary procedure)
• CPT® code 90834: Psychotherapy, 45 minutes with the patient
• CPT® code +90836: Psychotherapy, 45 minutes with the patient when performed with an E/M service (list separately in addition to the code for primary procedure)
• CPT® code 90837: Psychotherapy, 60 minutes with the patient
• CPT® code +90838: Psychotherapy, 60 minutes with the patient when performed with an E/M service (list separately in addition to the code for primary procedure)

(+) represents an add-on code

For psychotherapy services provided without an E/M service (CPT® Codes 90832, 90834 and 90837), the correct code depends on the time spent with the beneficiary.

In general, providers should select the code that most closely matches the actual time spent performing psychotherapy. CPT® provides flexibility by identifying time ranges that may be associated with each of the three codes:

• CPT® code 90832 (or + 90833): 16 to 37 minutes
• CPT® code 90834 (or + 90836): 38 to 52 minutes
• CPT® code 90837 (or + 90838): 53 minutes or longer

Note: Do not bill psychotherapy codes for sessions lasting less than 16 minutes.

The correct E/M code selection must be based on the elements of the history, exam, and medical decision making required by the complexity/intensity of the patient’s condition.

The psychotherapy code is chosen on the basis of the time spent providing psychotherapy.

Psychotherapy for Crisis was added for Medicare payment in 2024. These services use an urgent assessment and history of a crisis state, a mental status exam, and a disposition (or what happens next for the patient) to help reduce the patient’s mental health crisis.

• CPT® code 90839: Psychotherapy for crisis; first 60 minutes
• CPT® code 90840: Each additional 30 minutes (list separately in addition to the code for the primary service)

Educational Resources

• Medicare Part B Payments for Psychotherapy Services
• MLN Booklet: Medicare & Mental Health Coverage (PDF)
• Psychotherapy for Crisis
• Telehealth