You know that feeling when you're reviewing your billing and coding practices and wondering if you're leaving money on the table?
If you're a qualified healthcare professional with prescribing authority, you've probably had sessions where you’re doing both medication management and meaningful psychotherapy - all in one appointment. That’s exactly where CPT 90836 comes in. And honestly, it's one of the most misunderstood psychotherapy add-on codes in the billing toolkit.
Every day, providers across the country are delivering integrated behavioral health services that combine medical evaluation with individual therapy. But many psychiatrists, psychiatric nurse practitioners, and clinical nurse specialists either underuse code 90836 or run into documentation hurdles that block proper reimbursement. Whether you're treating depression, PTSD, anxiety, or another mental health condition, knowing how to use CPT 90836 correctly can significantly impact both your revenue and the quality of care you provide.
This guide breaks down everything you need to know about this important psychotherapy add-on code from documentation do’s and don’ts, to billing tips, real-world examples, and what you can expect in terms of reimbursement.
What Exactly Is CPT Code 90836?
Here's how the American Medical Association defines code 90836 in the official CPT codebook:
"Psychotherapy, 45 minutes with patient when performed with an evaluation and management service"
In simpler terms, 90836 is a psychotherapy add-on code that covers 38 to 52 minutes of individual therapy when it happens in the same session as a medical evaluation. It’s designed for prescribers typically psychiatrists, psychiatric NPs, or clinical nurse specialists, who are doing both medication management and therapy during the same visit.
It’s not a standalone code, and it doesn’t work with non-E/M services. So, you can’t just use it on its own, it must be paired with an E/M code like 99213, 99214, or 99205 depending on the complexity and patient status.
Think of it this way: Imagine you're treating a patient with PTSD. You start by checking in on their meds, maybe you adjust the dosage or monitor side effects for the first 15 minutes. Then, you shift gears into 45 minutes of trauma-focused therapy. That’s a textbook example of when 90836 CPT Code is appropriate.
Key characteristics of CPT 90836:
- Duration: 38-52 minutes of individual psychotherapy sessions
- Provider requirement: Prescribers only (psychiatrists, psychiatric NPs, CNSs)
- Session type: Must be paired with an appropriate E/M code
- New patients: 99203–99205
- Established patients: 99213–99215
- E/M coding rule: The E/M component must be billed based on medical decision-making, not time
- Documentation requirement: Separate, detailed notes for both the E/M and psychotherapy portions, including exact start and stop times
- Medical necessity: Documentation must support the need for both management services and psychotherapy services
Real-World Insurance Billing Example
Let's look at a concrete example to make this crystal clear for your practice:
Session Scenario:
- Total appointment time: 60 minutes
- Medical evaluation and medication management: 15 minutes (10:00-10:15 AM)
- Individual psychotherapy: 45 minutes (10:15-11:00 AM)
- Patient diagnosis: Recurrent depression with anxiety symptoms
Documentation Example for Progress Report:
"Rationale: The patient displays high number & complexity of problems with two chronic mental health conditions with exacerbation, low amount of data reviewed, and moderate risk for prescription management services. A total of 45 minutes of psychotherapy was provided during the session, addressing depression symptoms and treatment response."
Level of MDM: Moderate
CPT Codes Selected: 99214 + 90836
This clear documentation shows exactly how to justify both the evaluation and management code and the psychotherapy add on code for insurance billing purposes.
When Should Mental Health Providers Use CPT 90836?
Code 90836 documentation has specific guidelines as a psychotherapy add on code. To report both evaluation and management and psychotherapy services, the two medical services must be significant and separately identifiable.
Perfect scenarios for behavioral health providers:
- A 60-minute appointment where you spend 15 minutes on medical evaluation and medication management plus 45 minutes of individual psychotherapy
- Initial psychiatric diagnostic evaluation that extends into substantial therapy work
- Follow-up medication management that includes processing trauma or working through depression symptoms
- Sessions where you're providing both medical services and psychotherapy for mental health diagnosis
When NOT to use code 90836:
- You're providing only psychotherapy sessions (use standalone psychotherapy codes like 90834 or 90837)
- You're doing brief medication checks without substantial therapy
- You're a non-prescribing mental health provider like clinical social workers (this cpt code isn't intended for your practice)
- The psychotherapy component is less than 38 minutes (use cpt code 90833 instead)
- The psychotherapy component is 53+ minutes (use cpt code 90838 instead)
- You're providing group therapy or group psychotherapy (use different psychotherapy codes)
- You're using crisis codes for emergency situations
The Documentation That Actually Matters
Code 90836 documentation has specific guidelines as a psychotherapy add on code. One of the most common reasons for claim denials is the lack of clear differentiation between medical evaluation and psychotherapy services.
Your progress report documentation must include:
Session Details (Critical Requirements):
- Patient name and date of birth on every page
- Exact start and stop times for each service performed
- Date and place of service
- Total session duration
- Mental health diagnosis being treated
For the evaluation and management component:
- Current medications and dosages
- Side effects or concerns
- Medication adherence assessment
- Any medication adjustments made
- Mental status relevant to medication management
- Medical necessity for management services
For the code 90836 psychotherapy component:
- Specific therapeutic interventions used during treatment
- Issues addressed during individual psychotherapy portion
- Patient response to therapeutic techniques
- Progress made toward treatment plan goals
- Treatment plan adjustments
- Documentation of medical necessity for psychotherapy services
Interactive Complexity Considerations: If your session involves interactive complexity (such as using play equipment with children or managing difficult family dynamics), you may also need to document the interactive complexity code (90785) as an additional add-on. This is necessarily documented separately but can be used in conjunction with code 90836.
Pro tip: Use phrases like "Medical evaluation portion: 10:00-10:15 AM" and "Psychotherapy portion: 10:15-11:00 AM" to clearly delineate services.
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Reimbursement Rates: What to Expect
Let's talk numbers for your practice. Medicare reimbursement rates for CPT 90836 typically range between $88.09 and $102.50, though this varies by geographic location and your Medicare Administrative Contractor. Additionally, private insurance carriers may offer different reimbursement rates for mental health services.
Factors affecting your reimbursement:
- Geographic location (urban vs. rural practice areas)
- Provider credentials and behavioral health specialization
- Insurance carrier policies for mental health providers
- Network vs. out-of-network status
- Local market rates for psychotherapy services
Remember, you're billing TWO services here—the evaluation and management code AND the 90836 psychotherapy add on code—so your total reimbursement should reflect both medical services provided during the session.
Common Billing and Coding Mistakes (And How to Avoid Them)
After reviewing hundreds of insurance billing audits, here are the mistakes I see repeatedly among mental health providers:
Mistake #1: Billing Code 90836 Without an Appropriate E/M Code Since this is a psychotherapy add on code, it must always be accompanied by evaluation and management services. Your claim will be rejected faster than you can say "medication management."
Mistake #2: Combined Documentation Failing to separate documentation: Combining psychotherapy notes with medical evaluation documentation can lead to claim denials. Keep them distinct—auditors need to see clear evidence of both services performed.
Mistake #3: Incorrect Time Documentation
Not documenting time properly: Omitting start and stop times may result in payment rejections or audits. Be specific about when each service component began and ended.
Mistake #4: Telehealth Modifier Confusion If the session is conducted via telehealth, ensure that the appropriate telehealth modifiers (e.g., GT or 95) are used for both the evaluation and management and psychotherapy services provided. Don't let a missing modifier cost you reimbursement.
Mistake #5: Wrong Provider Type Remember that code 90836 is intended for qualified health care professionals with prescribing authority. Clinical social workers and other non-prescribing mental health providers should use standalone psychotherapy codes instead.
Telehealth Considerations for Mental Health Services
The pandemic changed everything about how we deliver behavioral health care, and insurance billing followed suit. CPT 90836 can be billed for in-office or virtual psychotherapy sessions. Just ensure you're using the correct Place of Service codes and telehealth modifiers when applicable.
For telehealth sessions using code 90836:
- Use modifier GT or 95 as required by your payers for both services provided
- Document that both evaluation and management and psychotherapy components were delivered via telehealth
- Maintain the same documentation standards as in-person visits for your progress report
- Verify telehealth coverage with each insurance carrier for mental health services
- Note in documentation that the patient was present and engaged throughout both portions of the session
Best Practices for Success in Your Practice
Pre-Session Planning:
- Block appropriate time slots (typically 60-75 minutes total for both services)
- Review patient's medication history and treatment plan before the session
- Plan your therapeutic approach and intended psychotherapy services in advance
- Verify insurance coverage for both evaluation and management and psychotherapy add on codes
During the Session:
- Document start and end times: Medicare and private insurers require mental health providers to document the exact duration of both medical evaluation and psychotherapy sessions. The start and stop times must be distinct from those of management services visits.
- Keep a timer visible to track each service component
- Take brief notes during session to support later progress documentation
- Ensure medical necessity is apparent for both services performed
Post-Session Documentation:
- Complete notes immediately while details are fresh for your progress report
- Use templates that clearly separate evaluation and management and psychotherapy components
- Consider AI documentation tools to streamline the process while ensuring compliance for billing and coding
- Document treatment response and progress toward goals
Insurance Verification:
- Always check the patient's insurance coverage to confirm that CPT 90836 is covered under their plan for behavioral health services. This helps avoid unexpected claim rejections.
- Verify whether prior authorization is required for psychotherapy add on codes
- Understand any session limits or frequency restrictions for mental health services
- Confirm coverage for your specific provider type and credentials
The Bottom Line for Mental Health Providers
CPT 90836 represents a significant opportunity for qualified health care professionals with prescribing authority to be fairly compensated for the comprehensive behavioral health care we provide.
The key is understanding that this isn't just about billing and coding more—it's about accurately reflecting the dual nature of psychiatric care that combines medical evaluation with individual psychotherapy intervention.
When used correctly, code 90836 allows you to:
- Provide comprehensive mental health services in single appointments
- Reduce scheduling burden for patients seeking both medication management and therapy
- Receive appropriate compensation for complex psychiatric services
- Maintain clear documentation that supports medical necessity for both services
- Optimize your practice efficiency while delivering quality behavioral health care
The investment in mastering this psychotherapy add on code—proper documentation, time tracking, and insurance billing procedures—pays dividends in both clinical outcomes and practice revenue for mental health providers.
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Frequently Asked Questions
Q: Can clinical social workers or non-prescribing mental health providers use CPT 90836?
A: No. CPT 90836 is specifically intended for qualified health care professionals with prescribing authority who can perform both medication management (evaluation and management services) and psychotherapy in the same session. Clinical social workers, LPCs, and psychologists without prescribing privileges should use standalone psychotherapy codes for their individual psychotherapy sessions.
Q: What's the minimum time requirement for the psychotherapy component of code 90836?
A: The psychotherapy portion must be at least 38 minutes to qualify for code 90836. If your psychotherapy component is shorter, you'd use cpt code 90833 (30-minute psychotherapy add on code) instead. For example, if you spend 20 minutes on evaluation and only 25 minutes on therapy, you cannot use 90836.
Q: Can I bill code 90836 with telehealth for mental health services?
A: Yes, as long as you use appropriate telehealth modifiers and your payers cover telehealth services for behavioral health. Document that both evaluation and management and psychotherapy components were delivered virtually and maintain the same documentation standards for your progress report.
Q: How often can I bill CPT 90836 for the same patient?
A: There's no specific frequency limit necessarily, but medical necessity must be documented for each session. Some insurers may question frequent use of this psychotherapy add on code, so ensure your progress notes support the need for combined medical services and individual psychotherapy.
Q: What evaluation and management codes work best with code 90836?
A: Commonly paired EM codes include 99213, 99214, and 99215 for existing patients, and 99203, 99204, 99205 for new patient visits. The specific evaluation and management code depends on the complexity of the medical evaluation component performed during the session.
Q: Do I need prior authorization for CPT 90836?
A: This varies by insurance carrier. Most don't require authorization for the psychotherapy add on code itself, but some may have restrictions on frequency or require authorization for certain evaluation and management codes. Always verify with each payer for mental health services coverage.
Q: Can I use the interactive complexity code with CPT 90836?
A: Yes, you can use the interactive complexity code (90785) as an additional add-on when your session involves communication factors that complicate treatment delivery, such as using play equipment with children or managing difficult family dynamics. This requires separate documentation of the complicating factors.
Q: What happens if my psychotherapy sessions run longer than 52 minutes?
A: If your individual psychotherapy component exceeds 52 minutes, use cpt code 90838 (60-minute psychotherapy add on code) instead of code 90836. Don't use multiple psychotherapy add on codes to account for longer sessions—choose the appropriate single code based on actual time.
Q: How do I handle sessions where the medical evaluation takes longer than expected?
A: Document the actual time spent on each service component in your progress report. If medical evaluation becomes extensive, you might need to use a higher-level evaluation and management code, but the psychotherapy time determines which psychotherapy add on code to use for insurance billing.
Q: Should I use code 90836 for initial psychiatric diagnostic evaluations?
A: You can, but ensure the session includes substantial individual psychotherapy beyond the diagnostic evaluation. For primarily diagnostic sessions, consider using cpt code 90791 or 90792 instead, possibly with psychotherapy add on codes if appropriate based on the treatment provided.
Q: Can I bill code 90836 for group psychotherapy or group therapy sessions?
A: No, code 90836 is specifically for individual psychotherapy sessions. Group therapy and group psychotherapy have different cpt codes (such as 90853). The patient must be present for the majority of the psychotherapy service for code 90836 to be appropriate.
Q: What mental health diagnosis codes work with CPT 90836?
A: Code 90836 can be used with any mental health diagnosis that supports the medical necessity for both evaluation and management services and individual psychotherapy. Common examples include depression, post traumatic stress disorder, anxiety disorders, and other behavioral health conditions. The key is documenting how both services address the patient's mental health diagnosis and treatment plan.
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