90833 CPT Code: The Complete Guide for Mental Health Providers

Picture this: You've just finished a productive session with a patient. You've discussed medication adjustments through an evaluation and management service and then seamlessly transitioned into 30 minutes of focused psychotherapy. Now comes the administrative part—coding the session correctly. If you're providing both medication management and psychotherapy services in the same visit, CPT code 90833 is likely your go-to code among the various CPT codes available, but are you using it correctly in your mental health billing process?

As healthcare professionals specializing in mental health treatment, we excel at helping our patients navigate complex emotions and behaviors through therapeutic interventions, yet the intricacies of medical billing and add-on codes can sometimes leave us feeling as confused as our clients might feel about their own challenges. This comprehensive guide will demystify everything you need to know about code 90833 to ensure appropriate reimbursement and financial stability for your practice.

What is CPT Code 90833?

CPT code 90833 represents "Psychotherapy, 30 minutes with patient when performed with an evaluation and management service." This is an add-on code that must be used in conjunction with an Evaluation and Management (E/M) service code as part of the broader framework of mental health services billing.

Key characteristics:

• It's specifically for 30 minutes of psychotherapy time during individual therapy
• It must be provided on the same day as an E/M service
• The same provider must perform both services
• The psychotherapy service must be significant and separately identifiable from the E/M service
• Time range: 16-37 minutes (per CPT timing rules)
• Medical necessity must be established for both the psychotherapy and E/M components

When to Use CPT Code 90833 vs. Other Psychotherapy Codes

Understanding when to use 90833 versus other similar codes is crucial for accurate billing in mental health treatment:

Understanding these other CPT codes helps ensure you're using the appropriate code for the services provided during therapy sessions.

The Correct Provider Scenario

90833 is most commonly used by psychiatrists, psychiatric nurse practitioners, physician assistants, and other healthcare professionals who can both:

1. Prescribe and manage medications (the medical evaluation component)
2. Provide psychotherapy services as part of comprehensive care

These providers may perform a psychiatric diagnostic evaluation and medical decision making related to medication management, followed by therapeutic interventions to address the patient's mental health concerns.

Psychologists and other mental health professionals who cannot perform medical services typically would not use this code but would instead use standalone codes for psychotherapy services.

How to Bill CPT Code 90833 Correctly

Step 1: Select the Appropriate E/M Code First

Choose the appropriate E/M code (such as 99213 or 99214) based on:

• The complexity of medical decision making
• The extent of history taken during the patient2 evaluation
• The extent of examination performed during the medical evaluation

Following proper documentation guidelines for the E/M service is essential before adding psychotherapy services to the billing process.

Step 2: Document Both Services Separately

Your documentation must clearly distinguish between:

• The elements justifying the E/M service (separate documentation)
• The psychotherapy service (techniques used, focus of therapy, patient's progress)
• Establish medical necessity for both components

Separate documentation helps demonstrate that these are separately identifiable services for billing purposes.

Step 3: Specify Time Spent on Psychotherapy

Explicitly document the time spent providing psychotherapy separate from the E/M service. This documentation of psychotherapy time is critical for justifying the use of code 90833.

Step 4: Bill Both Codes

Submit the claim with both the E/M code (appropriate E/M code) as the primary service and 90833 as the secondary, add-on code. This ensures proper reimbursement for both management services and mental health therapy provided.

Documentation Requirements for 90833

Strong documentation is your best defense against denied claims and is essential for proper billing. For CPT code 90833, be sure to include:

E/M Documentation:

• Chief complaint
• History (as appropriate for the E/M level)
• Mental status examination findings as part of the psychiatric diagnostic evaluation
• Assessment of current medications
• Medical decision making elements
• Diagnosis related to mental health treatment
• Treatment plan considerations

Psychotherapy Documentation:

• Specific start and end times for the psychotherapy portion (documentation of time spent)
• Therapeutic interventions employed during individual therapy
• Focus of therapy
• Patient's response to interventions
• Patient's progress toward treatment goals
• Plan for future therapy sessions

Documentation requirements for 90833 differ from those for family therapy, group therapy, or crisis intervention services, as these would use different CPT codes and require different documentation approaches.

Sample Documentation Template:

E/M Service (99214): 15-minute evaluation of patient's current medication regimen for depression. Patient reports continued low mood but improvement in sleep with current dose of sertraline. Side effects include mild morning nausea. Mental status exam reveals improved affect compared to last visit. Medical decision making indicates need to maintain current dose and reassess in one month.

Psychotherapy (90833): 30 minutes (1:15pm-1:45pm) of cognitive-behavioral therapy focused on identifying and challenging negative thought patterns related to work stressors. Patient demonstrated improved ability to recognize catastrophic thinking and practiced reframing techniques. Homework assigned to continue thought logs. Patient expressed feeling "more hopeful" about managing work scenarios by session end. Medical necessity for combined approach established by patient's need for both medication management and skill-building.

Reimbursement Rates and Considerations

Appropriate reimbursement for 90833 varies significantly based on:

• Geographic location and fee schedules
• Insurance payer policies for mental health billing
• Provider credentials and specialty
• Contracted rates for psychiatric services

Understanding reimbursement rates is crucial for financial stability in your practice when providing both E/M and psychotherapy services.

Average Reimbursement Ranges:

• Medicare: Approximately $45-60
• Commercial insurance: $50-90
• Medicaid: $35-55

Reimbursement for code 90833 is in addition to the payment received for the appropriate E/M code, which helps compensate providers for delivering comprehensive mental health services.

Important Note: Always verify with specific payers, as reimbursement rates change annually and can vary by region and contract. Some payers have specific requirements for billing E/M and psychotherapy together.

Common Billing Errors to Avoid

Error 1: Incorrect Time Allocation

Incorrect: Counting the same minutes for both E/M and psychotherapy services Correct: Clearly separate the time spent on each component of health services

Error 2: Missing or Inadequate Documentation

Incorrect: "Provided medication management and therapy." Correct: Detailed documentation of both services with specific therapeutic interventions and documentation of psychotherapy time

Error 3: Using 90833 Without an E/M Service

Incorrect: Billing 90833 alone as you would with standalone codes Correct: Always pairing 90833 with an appropriate E/M code since it's one of the add-on codes

Error 4: Inappropriate Provider Usage

Incorrect: Using 90833 when provider cannot perform both medical services and psychotherapy Correct: Only healthcare professionals qualified to deliver both E/M and psychotherapy should use this code

Error 5: Confusing with Other Services

Incorrect: Using 90833 for family counseling or crisis psychotherapy Correct: Using appropriate codes for these other services (family therapy, crisis intervention) instead of 90833, which is specifically for individual therapy with E/M

Insurance Coverage and Authorization Requirements

Most insurance plans cover the 90833 code when medical necessity is established for both the medical evaluation and mental health therapy components, but there are important considerations:

• Some plans require pre-authorization for combined E/M and psychotherapy services
• Medicare Advantage plans often have specific documentation requirements for psychiatric services
• Some commercial payers may limit the frequency of combined services or have specific billing guidelines
• Insurance policies may differ in how they cover interactive complexity when added to these services

Best Practice: Verify coverage and requirements for mental health billing before the first session when possible to ensure appropriate reimbursement and minimize disruption to the billing process.

Automating 90833 Documentation with Supanote

For many providers, writing notes for combined E/M and psychotherapy services is one of the most time-consuming parts of the job. Especially when juggling multiple sessions a day, tracking separate start and end times, detailing techniques, and maintaining insurance-ready formatting can take a toll.

Supanote helps you streamline that process. It listens securely (with patient consent) during your session and automatically generates structured notes that distinguish between the E/M and psychotherapy components - making it easier to justify the use of CPT code 90833.

Supanote also comes with pre-built templates like SOAP, DAP, GIRP, and BIRP, so your documentation is always formatted to meet payer expectations.

If documenting combined sessions is slowing you down, this can be a simple way to keep your workflow efficient while staying audit-ready.

Learn more about how Supanote works!

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Frequently Asked Questions About CPT Code 90833

Q1: Can two different providers bill for the E/M and psychotherapy services?

A: No. The same provider must perform both services during the same encounter for 90833 to be appropriate. Other healthcare professionals in your practice would need to bill separately for any additional services they provide.

Q2: If I spend 40 minutes on psychotherapy after an E/M service, should I use 90833?

A: No. For 38-52 minutes of psychotherapy with an E/M service, you should use CPT code 90836 (45-minute add-on code). It's important to use the code that accurately reflects psychotherapy time for proper billing.

Q3: How should I document time for both services?

A: Document the specific start and end times for the psychotherapy portion separately from the E/M service. Proper documentation of time spent on each component is essential for using code 90833.

Q4: Can I use 90833 for every patient who receives both medication management and therapy?

A: Only if both services are medically necessary and the psychotherapy is significant enough to warrant separate reporting (16-37 minutes). Medical necessity must be established for both components.

Q5: What diagnoses support the use of 90833?

A: Any mental health diagnosis that justifies both medication management and psychotherapy services can support 90833, provided medical necessity is documented during the psychiatric diagnostic evaluation.

Q6: Can I use 90833 if I only discuss medications briefly and focus mainly on therapy?

A: No. The E/M service must be significant enough to warrant its own code and involve substantial medical decision making. If therapy is the primary focus, consider using a standalone therapy code like 90832 instead.

Q7: How many units of 90833 can I bill in one day for the same patient?

A: Only one unit per day is appropriate, as it represents a specific time-based service in mental health treatment.

Q8: What modifiers might be needed with 90833?

A: Common modifiers might include:

• 25 (significant, separately identifiable E/M service) on the E/M code
• 59 (distinct procedural service) in certain circumstances
• 95 (telehealth) when providing services via telehealth

Q9: Can I use 90833 for family therapy or when family members are present?

A: No, 90833 is specifically for individual therapy with the patient. For family counseling or when working with family members, use appropriate family therapy codes instead.

Q10: How does 90833 differ from crisis intervention codes?

A: Crisis psychotherapy involves immediate intervention for patients in acute distress and uses different CPT codes. Code 90833 is for planned psychotherapy sessions that occur alongside E/M services.

Practical Billing Case Studies

Case Study 1: Psychiatrist in Private Practice

Dr. Rodriguez sees a patient with major depressive disorder. She spends 20 minutes evaluating medication effectiveness and side effects during the medical evaluation, then conducts 30 minutes of cognitive behavioral therapy as part of the patient's ongoing mental health treatment.

Correct Coding: 99214-25 + 90833 Documentation Note: Dr. Rodriguez documents both the E/M service and psychotherapy services separately, with clear medical decision making notes regarding medication adjustments and separately identifiable documentation of the therapeutic interventions provided.

Case Study 2: Psychiatric Nurse Practitioner in Community Mental Health

A psychiatric NP sees a patient with schizophrenia who is experiencing increased paranoia. The NP spends 25 minutes on a comprehensive medication review and adjustment during the patient evaluation, followed by 25 minutes of supportive psychotherapy focused on reality testing.

Correct Coding: 99214-25 + 90833 Documentation Note: The NP clearly documents the time spent on each service and establishes medical necessity for both the E/M and psychotherapy components in the treatment plan.

Case Study 3: Physician Assistant in Integrated Care Setting

A PA working under physician supervision sees a patient with anxiety and insomnia. The PA spends 15 minutes reviewing medication efficacy and adjusting dosages, then provides 30 minutes of guided relaxation techniques and cognitive restructuring as part of the comprehensive care approach.

Correct Coding: 99213-25 + 90833 Documentation Note: The PA documents both services separately and clearly notes that the same provider performed both the E/M service and psychotherapy during the same encounter.

Resources for Mental Health Providers

Official Coding References:

• American Medical Association CPT® Professional Edition - Essential for understanding all CPT codes related to psychiatric services
• National Correct Coding Initiative (NCCI) Policy Manual - Clarifies appropriate code combinations for E/M and psychotherapy

Professional Organizations:

• American Psychiatric Association Coding Resources - Specific guidance on psychiatric billing
• American Psychological Association Practice Organization - Resources for mental health billing across disciplines
• National Association of Social Workers - Resources for clinical social workers providing mental health therapy

Billing Software and Services:

• Electronic Health Records with integrated billing capabilities for mental health billing
• Specialized mental health billing services with expertise in psychiatric coding
• Practice management systems with built-in documentation templates for E/M and psychotherapy services provided

Conclusion: Mastering 90833 for Practice Success

Understanding and correctly applying CPT code 90833 is essential for healthcare professionals who routinely combine medication management with psychotherapy services. By adhering to proper documentation guidelines and billing practices, you can ensure appropriate reimbursement while minimizing the risk of audits and claim denials during the billing process.

Remember the key points:

• 90833 is always an add-on code to an appropriate E/M code
• Documentation must clearly separate the two services as separately identifiable
• Psychotherapy time must be explicitly documented
• The same provider must perform both the E/M service and psychotherapy
• Medical necessity must be established for both components
• Proper documentation supports the billing process and ensures financial stability

By mastering these billing nuances for psychiatric services and mental health billing, you can focus more energy on what matters most—providing high-quality mental health treatment and comprehensive care to your patients while maintaining the financial health of your practice.

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