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Understanding the distinction between CPT codes 90834 and 90837 is critical for behavioral health providers. These two psychotherapy codes represent different session durations, but the billing differences go beyond time alone. Incorrect use can lead to denials, downcoding, audit risk, and lost revenue. For practices focused on financial stability, mastering the nuances between these codes is essential.

Mental health billing services frequently identify coding inconsistencies between 90834 and 90837 as a common source of reimbursement issues. Billing services for mental health must ensure that documentation, medical necessity, and payer policies align with the code selected. A small misstep can significantly impact revenue cycle performance.

This guide explains the billing differences between 90834 and 90837, why they matter, and how practices can avoid costly mistakes.

What Is CPT Code 90834

CPT code 90834 represents individual psychotherapy lasting approximately 45 minutes. According to CPT guidelines, this code is typically used for sessions lasting between 38 and 52 minutes.

Key characteristics include:

• Face to face psychotherapy
  
  

• Individual patient session
  
  

• Time based service
  
  

• Requires documented start and stop times or total session duration
  
  

Reimbursement for 90834 is lower than for longer sessions, reflecting the shorter duration of therapy.

What Is CPT Code 90837

CPT code 90837 represents individual psychotherapy lasting approximately 60 minutes. It is used for sessions that typically last 53 minutes or longer.

Key characteristics include:

• Face to face psychotherapy
  
  

• Individual patient session
  
  

• Time based service
  
  

• Requires clear documentation of session length
  
  

Because it reflects a longer session, 90837 reimburses at a higher rate compared to 90834.

Primary Billing Difference: Session Duration

The most obvious distinction between 90834 and 90837 is time. However, documentation must clearly support the duration billed.

Mental health billing services often find that providers underestimate the importance of recording precise session times. Payers may request documentation during audits to verify whether the session length justified billing 90837 instead of 90834.

If documentation lacks a clear duration statement, payers may downcode the claim or deny it altogether.

Reimbursement Variations

Reimbursement for 90837 is significantly higher than for 90834. This creates financial incentives but also increases payer scrutiny.

Some insurance carriers impose restrictions on 90837 usage due to higher reimbursement rates. Common payer policies include:

• Requiring additional medical necessity documentation
  
  

• Limiting the frequency of 90837 sessions
  
  

• Requesting prior authorization for extended sessions
  
  

• Flagging providers who frequently bill 90837
  
  

Billing services for mental health must monitor payer specific rules to prevent unnecessary denials.

Medical Necessity Requirements

Billing 90837 often requires stronger documentation of medical necessity compared to 90834. Providers must justify why a longer session was clinically required.

Documentation should include:

• Severity of symptoms
  
  

• Crisis intervention needs
  
  

• Complex trauma processing
  
  

• Detailed treatment planning
  
  

• Risk assessment activities
  
  

Mental health billing services emphasize the importance of connecting session length to clinical complexity. Without this justification, payers may argue that a 45 minute session would have been sufficient.

Audit Risk and Scrutiny

Because 90837 reimburses at a higher rate, it is more likely to attract audit attention. Providers who bill 90837 at unusually high frequencies compared to peers may face additional review.

Billing services for mental health track utilization patterns to ensure they fall within reasonable benchmarks. Monitoring helps practices identify potential red flags before payers initiate audits.

Clear documentation and consistent coding rationale reduce compliance risk.

Telehealth Considerations

Both 90834 and 90837 can be billed via telehealth when permitted by payer policy. However, documentation must still reflect:

• Session duration
  
  

• Modality of service
  
  

• Patient location
  
  

• Provider location
  
  

Mental health billing services must verify payer specific telehealth requirements to prevent denials. Telehealth regulations may differ between commercial insurers and government programs.

Common Coding Mistakes

Several common errors occur when billing 90834 and 90837:

• Billing 90837 for sessions shorter than 53 minutes
  
  

• Failing to document session time
  
  

• Using 90834 when session length qualifies for 90837
  
  

• Not verifying payer authorization requirements
  
  

• Copying documentation across sessions without updating clinical details
  
  

Billing services for mental health implement coding audits to identify these issues before claim submission.

Impact on Revenue Cycle Performance

Consistent misuse of 90834 and 90837 affects key performance indicators such as:

• Denial rate
  
  

• Net collection rate
  
  

• Days in accounts receivable
  
  

• Audit exposure
  
  

Incorrect downcoding reduces revenue, while unsupported upcoding increases compliance risk. Balanced and accurate billing supports sustainable financial performance.

Mental health billing services analyze claims data to ensure correct code utilization aligned with documentation and payer guidelines.

Best Practices for Accurate Billing

To ensure proper use of 90834 and 90837, practices should implement the following strategies:

1. Document session start and end times clearly.
   
   

2. Connect session length to clinical complexity.
   
   

3. Review payer specific policies for extended sessions.
   
   

4. Conduct periodic internal coding audits.
   
   

5. Monitor frequency of 90837 utilization compared to benchmarks.
   
   

Billing services for mental health often provide regular reporting and education to help providers maintain compliance and maximize reimbursement.

Financial Planning Considerations

Understanding the reimbursement difference between 90834 and 90837 also impacts practice revenue projections. Scheduling patterns and session lengths directly influence income.

For example, a provider scheduling primarily 60 minute sessions may generate higher revenue per visit but see fewer patients per day. Conversely, 45 minute sessions may increase patient volume but reduce reimbursement per session.

Mental health billing services can assist practices in analyzing utilization patterns to align scheduling strategies with financial goals.

Final Thoughts

The difference between 90834 and 90837 extends far beyond a 15 minute time gap. Proper coding requires precise documentation, clear medical necessity, and awareness of payer policies. Missteps can lead to denials, underpayments, and audit exposure.

Mental health billing services play a crucial role in ensuring accurate claim submission and compliance. Billing services for mental health provide expertise in monitoring utilization trends, verifying documentation standards, and navigating payer specific requirements.

By understanding the billing distinctions between 90834 and 90837, mental health practices can protect revenue, reduce risk, and maintain a strong revenue cycle. Accurate coding is not just a technical task. It is a strategic component of long term financial success.