Key takeaways
- The add-on psychotherapy codes 90833, 90836 and 90838 are reported with an E/M visit. The psychotherapy time picks the code: 16 to 37, 38 to 52, or 53 minutes and more.
- The standalone codes 90832, 90834 and 90837 use the same time ranges but are billed without an E/M.
- Psychotherapy time has to be documented on its own, separate from the E/M work, or the add-on is not supported.
- Interactive complexity, 90785, is an add-on to the psychotherapy code. Report it only when the documented factors apply.
What the psychotherapy add-on codes are
When a psychiatrist or other prescriber sees a patient for medication management and also provides psychotherapy in the same visit, the visit is billed as an E/M code plus a psychotherapy add-on code. The add-on does not replace the E/M. It reports the extra psychotherapy time on top of it.
A therapist who provides psychotherapy alone does not use the add-ons. They bill the standalone psychotherapy code that matches the session length.
The codes and time ranges
| Psychotherapy time | With an E/M visit (add-on) | Psychotherapy alone |
|---|---|---|
| 16 to 37 minutes | 90833 | 90832 |
| 38 to 52 minutes | 90836 | 90834 |
| 53 minutes or more | 90838 | 90837 |
Psychotherapy for a crisis is separate: 90839 covers the first 30 to 74 minutes and 90840 each additional 30 minutes.
How to pick the code: count psychotherapy time only
The add-on code is chosen by the minutes of psychotherapy, not the length of the whole visit. Time spent on the E/M work, such as reviewing symptoms and adjusting medication, counts toward the E/M and not toward the psychotherapy. A 45-minute visit that includes 20 minutes of psychotherapy supports the 16 to 37 minute add-on, 90833, not 90836.
Record the psychotherapy minutes in the note, with the start and stop time or the total, so the code can be defended on review.
What the note needs
- The E/M elements that support the visit level.
- A separately identifiable psychotherapy section with the minutes spent.
- The type of psychotherapy and the patient response, so it does not read as medication counseling.
- For 90785, the specific interactive complexity factor that applied, such as a third party who needed to be involved.
Common psychotherapy billing mistakes
- Billing an add-on without an E/M the same day.
- Choosing 90836 or 90838 from the total visit time instead of the psychotherapy time.
- Billing a standalone code such as 90837 together with an E/M.
- Rounding up minutes that fall below the range.
- Reporting 90785 without a documented factor.
- Not checking payer rules, because some payers limit add-ons by provider type or place of service.
Sources
Time ranges, add-on pairing with E/M, 90785 and 90839: Washington State Health Care Authority, psychotherapy code selection. Confirm time rules in the current CPT manual and with each payer.
Psychotherapy add-on codes FAQ
What are the psychotherapy add-on codes?
The add-on codes 90833, 90836 and 90838 report psychotherapy provided in the same visit as an E/M service. They are billed with the E/M code, and the psychotherapy time picks the add-on.
What are the time ranges for 90833, 90836 and 90838?
90833 is 16 to 37 minutes of psychotherapy, 90836 is 38 to 52 minutes, and 90838 is 53 minutes or more.
Do the E/M minutes count toward the psychotherapy time?
No. Time spent on the E/M work counts toward the E/M. Only the minutes of psychotherapy count toward the add-on code.
What is the difference between 90833 and 90832?
They cover the same 16 to 37 minute range. 90833 is an add-on reported with an E/M visit, and 90832 is a standalone psychotherapy code billed without an E/M.
Can interactive complexity 90785 be billed with psychotherapy?
Yes. 90785 is an add-on to psychotherapy codes, including an E/M plus a psychotherapy add-on, when the documented interactive complexity factors apply.