CPT Code 90836: Psychotherapy Add-On with E/M, 38-52 minutes
What is CPT 90836?
CPT 90836 is a psychotherapy add-on code for 45 minutes (38 to 52 minutes of psychotherapy) provided on the same day as an E/M service by the same clinician. It is the add-on counterpart of 90834 and is never billed alone. Psychotherapy minutes must be counted separately from the time spent on the E/M service.
Psychotherapy add-on for clinicians who provide an E/M service and 38 to 52 minutes of psychotherapy at the same visit. Typically billed by psychiatrists and psychiatric nurse practitioners who combine medication management with psychotherapy.
Time Requirements
38 to 52 minutes of psychotherapy (CPT lists 45 minutes), counted separately from E/M time.
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 plus a distinct block of psychotherapy lasting 38 to 52 minutes
- Combined medication management and psychotherapy visits by a psychiatric prescriber
- Any setting where an E/M code is billed the same day by the same clinician
When Not to Use
- Without an E/M code from the same clinician on the same claim
- Psychotherapy of 16 to 37 minutes: use 90833; 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 90834
What to Document for CPT 90836
- The E/M service and its medical decision making
- A separate psychotherapy section: intervention, client response, and progress
- Psychotherapy minutes (38 to 52), recorded separately from E/M work
- Link to treatment plan goals
Common Denial Reasons
- Billed without a qualifying E/M code
- Psychotherapy minutes missing, under 38, or blended with 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
Payer Notes
Payer rules vary. Modifier 25 is generally not required on the E/M because 90836 is an add-on code, but some payers ask for it. Some payers review frequent pairing of high-level E/M codes with longer psychotherapy add-ons, so keep both parts of the note distinct. A few payers deny psychotherapy add-ons billed with higher-level E/M codes such as 99214 or 99215, although CPT and CMS allow the pairing.
Related Codes
Frequently Asked Questions
What is the difference between 90834 and 90836?
Both cover 38 to 52 minutes of psychotherapy. 90834 is billed on its own, used by any eligible clinician, including prescribers when no E/M is billed that day. 90836 is an add-on billed only with a same-day E/M service by the same clinician.
Can 90836 be billed without an E/M code?
No. It is an add-on code and must appear on the same claim as a qualifying E/M code from the same clinician on the same date.
Does medication review time count toward the 38 minutes?
No. Medication review, history, and other E/M work are part of the E/M service. Only the separate psychotherapy minutes count toward 90836.
Which E/M codes pair with 90836?
Office or outpatient E/M codes such as 99212 to 99215 are common, and CPT also allows other E/M settings such as inpatient and nursing facility visits. The E/M must be significant and separately identifiable from the psychotherapy.
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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