CPT Code 90833: Psychotherapy Add-On with E/M, 16-37 minutes
What is CPT 90833?
CPT 90833 is a psychotherapy add-on code for 30 minutes (16 to 37 minutes of psychotherapy) provided on the same day as an E/M service by the same clinician. It is never billed alone. Psychiatrists, psychiatric nurse practitioners, and other clinicians who bill E/M use it; therapists who do not bill E/M use 90832.
Psychotherapy add-on for clinicians who provide an evaluation and management (E/M) service and psychotherapy at the same visit, such as a medication management visit followed by a block of psychotherapy. The E/M must be significant and separately identifiable, and psychotherapy time cannot include time spent on the E/M.
Time Requirements
16 to 37 minutes of psychotherapy (CPT lists 30 minutes), counted separately from E/M time. Under 16 minutes of psychotherapy is not reported.
Modifiers
| Code | Description |
|---|---|
| 95 | Synchronous audio-video telehealth. Many payers also require a telehealth place of service code (02 or 10). |
| 93 | Synchronous audio-only service, where the payer allows audio-only care. |
When to Use
- An E/M visit (for example medication management) plus a distinct block of psychotherapy lasting 16 to 37 minutes
- Psychotherapy delivered by a psychiatrist or psychiatric nurse practitioner after the medication review
- Outpatient, inpatient, or other settings where an E/M code is billed the same day
When Not to Use
- Without an E/M code from the same clinician on the same claim
- Psychotherapy of 38 to 52 minutes: use 90836; 53 minutes or more: use 90838
- With 90791 or 90792 on the same day
- With crisis psychotherapy codes 90839 or 90840
- By clinicians who do not bill E/M: use 90832
What to Document for CPT 90833
- The E/M service: history, examination if relevant, and medical decision making such as medication changes
- A separate psychotherapy section with the intervention and the client response
- Psychotherapy minutes, recorded separately from E/M work
- How the psychotherapy relates to treatment plan goals
Common Denial Reasons
- Billed without a qualifying E/M code
- Psychotherapy time not documented, or not separated from E/M time
- E/M service not significant and separately identifiable
- Billed by a clinician type the payer does not allow to bill E/M
- Billed on the same day as 90791 or 90792
Payer Notes
Payer rules vary. Medicare and many commercial payers recognize psychotherapy add-on codes with E/M. Modifier 25 is generally not required on the E/M because 90833 is an add-on code, but some payers ask for it. If the E/M level is chosen by time, psychotherapy minutes must be left out of that time.
Related Codes
Frequently Asked Questions
Can a therapist bill 90833?
Only clinicians who can also bill an E/M service. 90833 must be paired with a same-day E/M code by the same clinician, so it is used by physicians, psychiatric nurse practitioners, physician assistants, and others whose license and payer enrollment allow E/M billing. Therapists and psychologists use 90832.
What is the difference between 90832 and 90833?
Both cover 16 to 37 minutes of psychotherapy. 90832 is billed on its own. 90833 is an add-on that is billed only together with a same-day E/M service by the same clinician.
Does 90833 need modifier 25 on the E/M code?
Generally no, because 90833 is an add-on code designed to be billed with E/M. Some payers still ask for modifier 25 on the E/M, so check each payer policy.
How do I count psychotherapy time during an E/M visit?
Track psychotherapy minutes separately. Time spent on medication review, history, and other E/M work does not count toward the 16 to 37 minutes. If the E/M level is chosen by time, psychotherapy minutes are excluded from it.
Can I bill 90785 with 90833?
Yes, when an interactive complexity factor applies and is documented. CPT allows 90785 with the psychotherapy add-on codes that are billed with E/M.
Sources: American Medical Association (AMA), CPT Professional codebook: code descriptors, psychotherapy time rules, and add-on code guidance. Centers for Medicare & Medicaid Services (CMS): Medicare Physician Fee Schedule and National Correct Coding Initiative (NCCI) policy.
Payer rules vary. Confirm coverage, time, modifier, and documentation rules with each payer before billing. This page is general education, not billing or legal advice.
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