90837 — Individual Psychotherapy, 53+ minutes
Extended individual psychotherapy for sessions lasting 53 minutes or longer. This code is appropriate for complex clinical presentations, trauma processing, EMDR sessions, or any therapy that requires extended time. Some payers scrutinize this code more closely.
Time Requirements
53 minutes or more face-to-face. Some payers define this as 53-60 minutes; sessions over 60 minutes should still use this code (there is no higher time-based therapy code).
Modifiers
| Code | Description |
|---|---|
| 95 | Synchronous telemedicine service. |
| HO | Master's level clinician (some Medicaid plans). |
When to Use
- Extended therapy sessions lasting 53 minutes or more
- Complex trauma processing (EMDR, CPT, PE)
- Sessions requiring additional time for crisis stabilization within therapy
- Initial sessions that combine assessment and therapy beyond 53 minutes
When Not to Use
- Sessions under 53 minutes — use 90834 or 90832
- Sessions where the extended time is primarily non-therapeutic (paperwork, scheduling)
- Family therapy — use 90846 or 90847
- When medical necessity for extended time cannot be documented
Common Denial Reasons
- Routine use without documented medical necessity for extended sessions
- Session time documented as under 53 minutes
- Payer determines 90834 is sufficient for the diagnosis/presentation
- Excessive frequency of 90837 compared to peer norms triggers audit
- Prior authorization required but not obtained
Payer Notes
Some payers require prior authorization or have utilization review triggers for frequent 90837 billing. Document medical necessity clearly: why the extended time was clinically required. Some Medicaid programs cap reimbursement at 90834 rates regardless.
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