What Are 90833, 90836 and 90838?
These codes represent psychotherapy services performed with an evaluation and management service.
CMS identifies:
- 90833: Psychotherapy, 30 minutes with patient, when performed with an E/M service
- 90836: Psychotherapy, 45 minutes with patient, when performed with an E/M service
- 90838: Psychotherapy, 60 minutes with patient, when performed with an E/M service
CMS describes these as add-on codes used in conjunction with an appropriate E/M service.
These Are Add-On Codes
One of the most important points for billing teams:
90833, 90836 and 90838 are not stand-alone E/M codes.
They are used in addition to an appropriate E/M service when the requirements for both services are met.
Psychotherapy Time Matters
CMS contractor guidance describes psychotherapy as time-based and provides specific time ranges for these services.
The record should clearly support the psychotherapy component.
Documentation Should Support Both Components
When billing an E/M service together with psychotherapy, documentation should support:
The E/M service
and
The psychotherapy service
The psychotherapy portion should be separately identifiable and supported by the applicable requirements.
Who Can Bill These Codes?
CMS states that psychotherapy codes that include an E/M component are payable only to specified eligible practitioners, including physicians, PAs, NPs and CNSs under the cited Medicare guidance.
Commercial payer requirements can differ.
Common Problems
- Billing psychotherapy without a qualifying E/M service
- Insufficient psychotherapy-time documentation
- Incorrect E/M code
- Incorrect provider type
- Inadequate documentation
- Incorrect payer configuration
- Incorrect POS
- Authorization issues
Billing Workflow
Before submitting a combined E/M + psychotherapy claim, verify:
Provider eligibility
→ E/M documentation
→ Psychotherapy documentation
→ Psychotherapy time
→ Correct add-on code
→ Payer requirements
→ Claim submission
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