What does 90837 reimburse?
Reimbursement varies by payer. Approximate national medians: $130–180 per session for commercial payers, somewhat lower for Medicare. 90837 reimburses ~30–40% more than 90834 (45 min) but some payers require additional medical-necessity documentation to reduce inappropriate billing of longer sessions when a 45-minute session would have been clinically sufficient.
Why do some payers scrutinize 90837?
Several large commercial payers have flagged 90837 utilization patterns as audit-worthy because the higher reimbursement creates billing-incentive concerns. Payer policies may require: clear medical-necessity documentation for the longer session, treatment plan justification, signs of progress in the therapeutic relationship, or specific clinical complexity. Best practice: use 90837 when the session genuinely required 53+ minutes for therapeutic reasons, document why, and don't routinize it across all patients.
Can 90837 be billed alongside 96127?
Yes. 90837 is the primary service code; 96127 (brief assessment with scoring and documentation) is an add-on billed in addition to 90837. A typical 60-minute MBC session administering PHQ-9 + GAD-7 + AUDIT bills 90837 + 96127×3.
How much does CPT 90837 pay?
CPT 90837 pays $167.00 per session under the 2026 Medicare Physician Fee Schedule national non-facility average, up from $154.29 in 2025 per the CY 2026 Final Rule (an 8.24 percent increase). Commercial payer rates typically range from $130 to $180 per session and vary by contract. CPT 90837 reimburses about 47 percent more than 90834 (45 minutes), but several payers require additional medical-necessity documentation to justify the longer session. Locality adjustments via the Geographic Practice Cost Index (GPCI) apply. Verify your specific payer fee schedule.
Who can bill CPT 90837?
Licensed mental health clinicians bill CPT 90837, including licensed clinical social workers (LCSW, LICSW), licensed marriage and family therapists (LMFT), licensed professional counselors (LPC, LMHC), licensed psychologists (PhD, PsyD), psychiatrists, psychiatric nurse practitioners, and physician assistants. Each state defines scope of practice for trainees and pre-licensed clinicians. Most payers require independent licensure for direct CPT 90837 billing.
Is CPT 90837 billable for telehealth?
Yes, CPT 90837 is billable for telehealth sessions. Use place of service code 02 (telehealth, non-home) or 10 (telehealth, patient home), with modifier 95 for synchronous audio-video psychotherapy when required by the payer. Medicare and most commercial payers extended telehealth coverage for psychotherapy after the public health emergency. Some payers apply tighter scrutiny to 90837 telehealth claims; document medical necessity for the 53+ minute session length carefully.
How often can CPT 90837 be billed?
CPT 90837 can be billed once per session per patient per provider. Medicare's Medically Unlikely Edit (MUE) limit is 1 unit per date of service. Most payers cover weekly or biweekly 90837 sessions as medically necessary, but several large commercial payers (UHC, Anthem, Aetna among others) flag high-frequency 90837 utilization for audit when used routinely instead of 90834. Use 90837 when the session genuinely required 53 or more minutes for therapeutic reasons.