90837 CPT code: psychotherapy 60 minutes
CPT code 90837 describes individual psychotherapy lasting about 60 minutes with the patient present. Insurers may deny it for medical necessity, frequency limits, or missing prior authorization for behavioral health. Compare the denial reason on your EOB to your plan’s mental health benefit before you appeal.
90837 is a timed psychotherapy code used by licensed mental health clinicians for a full session. Payers often apply visit limits or require precertification for intensive outpatient programs.
Code search and filter
Filter the reference table by code or keyword (FY2025+ CM where noted).
| Code | Description | When used | Billable / notes |
|---|---|---|---|
| 90837 | Psychotherapy, 60 minutes with patient | Individual therapy when documented face-to-face time is about 60 minutes. | Timed code; billable with correct time documentation. |
| 90834 | Psychotherapy, 45 minutes | Sessions of about 45 minutes. | Billable; do not upcode to 90837 without time support. |
Check my denial
Pick the closest denial type to see how to respond on this code page.
Not medically necessary or experimental for the diagnosed condition
Attach treatment plan, PHQ-9 or GAD-7 scores, and prior session notes showing progress or risk if stopping care.
Also try denial code lookup for exact CARC/RARC text from your EOB.
Common ICD-10 pairings
- F41.1 — Generalized anxiety disorder
- F32.1 — Major depressive disorder
Documentation checklist
- Operative or visit note for date of service
- Order/referral if required by plan
- Prior authorization number if applicable
- Proof of medical necessity addressing denial reason
- Correct CPT and ICD-10 pairing on claim
Top denial reasons and how to beat each one
Not medically necessary or experimental for the diagnosed condition
Attach treatment plan, PHQ-9 or GAD-7 scores, and prior session notes showing progress or risk if stopping care.
Frequency or visit cap exceeded for the benefit year
Attach treatment plan, PHQ-9 or GAD-7 scores, and prior session notes showing progress or risk if stopping care.
Out-of-network provider without authorized network exception
Attach treatment plan, PHQ-9 or GAD-7 scores, and prior session notes showing progress or risk if stopping care.
Sample appeal paragraph
I appeal the denial of CPT 90837 on [date of service]. The attached record shows [clinical indication]. The denial reason stated [reason] is not supported because [evidence]. Please reprocess this claim.
Step therapy and visit limits
Behavioral health visit limits and step therapy are plan-specific; federal parity rules may apply when medical/surgical benefits are covered differently.
Medicare LCD / coverage notes
Medicare covers outpatient mental health with cost sharing; documentation must support medical necessity and session time.
Related CPT codes
Typical use
Individual therapy sessions billed in 60-minute increments when documentation supports the time spent.
Cost and allowed amounts
Allowed amounts vary widely by plan, region, and contract. Use your EOB allowed amount, not the clinic’s chargemaster, to estimate patient responsibility.
How this CPT code appears on claims and EOBs
90837 is reported on professional or facility claims when documentation supports the service description. Payers compare the billed code to the medical record, authorization files, and plan benefit limits. When the allowed amount is zero or patient responsibility equals the full charge, read the remark and CARC codes before you pay the provider's full statement.
Step-by-step appeal workflow for a 90837 denial
First, request the written adverse benefit determination if you only received a verbal explanation. Second, match the denial reason — medical necessity, prior authorization, frequency limit, downcoding, or network — to the evidence you need. Third, draft a letter with the free appeal generator citing claim number, date of service, and 90837. Fourth, attach visit notes, imaging reports, or therapy logs that answer the payer's stated reason. Fifth, file through the portal or fax on your notice and keep confirmation. If the service is imaging or therapy, consider the MRI or medical necessity specialty tools for tailored language.
Documentation that supports medical necessity
For 90837 Psychotherapy 60 Minutes, insurers often expect diagnosis codes, duration of symptoms, prior treatments tried, and objective findings. Parity rules may apply when mental health services are denied more restrictively than medical services with similar complexity. Do not assume one paragraph from the patient overturns the denial — payer reviewers look for clinician documentation.
What to do after you file
Watch for additional information requests; missing them can uphold the denial without reviewing your clinical argument. If internal appeal fails, read your notice for external review rights (many ACA and fully insured plans) or Medicare/Medicaid levels if applicable. AppealFlow's Appeal Pack can organize exhibits, but it does not file on your behalf or provide legal advice.
How payers review professional and facility claims
After your clinician submits a claim, the payer runs edits for authorization, medical necessity, coding consistency, and benefit limits. The allowed amount on your Explanation of Benefits may be lower than the provider charge even when the service is covered. When payment is zero, identify whether the issue is clinical (CO-50), administrative (CO-16, CO-197), or patient cost-sharing (PR codes) before you choose an appeal strategy.
Regulatory context (not legal advice)
Many group health plans must provide written adverse benefit determinations and appeal rights under 29 CFR 2560.503-1. Many individual and small-group plans must provide internal and external appeal rights consistent with 45 CFR 147.136. Medicare and Medicaid use CMS and state fair-hearing processes instead. Your notice tells you which rules apply to your coverage.
Paid pack option
If you want a checklist, deadline worksheet, and exhibit list in one download, see the Appeal Pack on /pricing. AppealFlow prepares documents; you file them and review all facts before submission.