Not every medical visit is simple. Sometimes multiple services are provided in the same session. This makes billing very complex, and oftentimes, claims end up in denials.
Mental health professionals frequently perform psychotherapy and evaluation & management (E/M) in a single session. Yet, many don’t know how to file claims for it properly. That’s why our billing experts have created this guide.
We will discuss CPT code 90833, which is commonly used in these situations. We will provide all the details on how to bill this code. So, let’s start.
CPT Code 90833 – Description
CPT code 90833 is officially defined as:
“Psychotherapy with a patient, with evaluation and management (E/M), 30 min”
Let’s break this down in more detail.
Code 90833 is an add-on psychotherapy code used for a 30-minute session. However, the definition is misleading and prompts many billers to make the same error. What error? Although the definition mentions 30 minutes, CPT code 90833 can be used for psychotherapy sessions lasting between 16 and 37 minutes. An essential point to note here is that the 16-37-minute time limit does not include the time for evaluation and management or other activities performed during the session.
Additionally, since this is an add-on service code. Therefore, it cannot be used independently. 90833 must always be used in conjunction with an E/M code, given that the same healthcare provider rendered both the services in the same session. However, the E/M and the psychotherapy must be significant and separately identifiable.
It is also important to note that 90833 is mostly used by psychiatrists or other medical professionals who have a prescribing authority, such as nurse practitioners or physicians. Health professionals such as licensed clinical social workers (LCSWs) and licensed professional counselors (LPCs) usually do not use this code because they don’t have the authority to prescribe.
Scenarios Where CPT Code 90833 is Applicable
To better understand the practical use of CPT code 90833, let’s look at a couple of real-world scenarios in which this code can be used.
Adjusting Medication and Providing Therapy
Suppose a patient visits his psychiatrist. He has a major depressive disorder, which requires proper medication and therapy from time to time. During the appointment, the psychiatrist spends the first 15 minutes on evaluation and management of the previous treatment. He assesses the patient’s response to the antidepressants, their side effects, and adjusts the dose accordingly.
After this, the psychiatrist performs psychotherapy for cognitive behavior. This takes an additional 25 minutes. The therapy aims to help the patient cope with any negative thoughts and gradually erase them. In this scenario, the psychiatrist has performed both E/M and psychotherapy, so CPT code 90833 can be used here to bill the therapy part.
Combined Telehealth Sessions
Let’s now explore a scenario in which the session is conducted virtually. During a 45-minute virtual appointment, a psychiatrist spends 15 minutes on medication management activities, such as reviewing symptoms, discussing medication adherence, and evaluating treatment response.
After this, he spends 30 minutes in psychotherapy focusing on stress reduction techniques and relationship counseling. In this scenario, the physician can bill the E/M service with an appropriate code and the psychotherapy with CPT code 90833 as an add-on service.
Applicable Modifiers for CPT Code 90833
The following modifiers are most commonly appended to the CPT code 90833 to explain the circumstances under which the psychotherapy was performed:
| Modifier | Description | Usage Scenario |
|---|---|---|
| 25 | Significant, separately identifiable E/M service | Applied to the E/M code to indicate psychotherapy was a distinct, separate service. |
| 93 | Synchronous real-time audio | It is used when the psychotherapy session is conducted virtually, with only audio. |
| 95 | Synchronous telemedicine service | Used for real-time audio/video telehealth encounters. |
| GT | Interactive audio/video telecommunication | Alternative telehealth modifier accepted by some payers. |
CPT Code 90833 – Billing & Reimbursement Guidelines
Add-on services can be challenging to bill. But you can bill them successfully if you follow the basic guidelines. Don’t know how to justify the use of CPT code 90833? Just keep in mind the following details to get your claims right:
Provide Comprehensive Documentation
Documentation is the most essential part of insurance claims. It helps justify the medical necessity of the service and avoid claim denials. You should always back your claims with comprehensive documentation for both E/M services and psychotherapy sessions. For 90833 claims, you should:
- Provide records verifying that the E/M and psychotherapy are significantly separate services.
- Maintain separate documentation sections for each service type.
- Ensure precise recording of start and end times.
- Mention the patient’s identification information on every page.
Pair with Valid ICD-10 Diagnosis Codes
Providing a valid ICD-10 diagnosis code is essential to justify the medical necessity of the treatment. The following are some valid diagnosis codes that can be used with CPT code 90833:
- F01.B11: Vascular dementia, moderate, with agitation
- F03.A4: Unspecified dementia, mild, with anxiety
- F05: Delirium due to a known physiological condition
- F06.1: Catatonic disorder due to a known physiological condition
- F07.81: Postconcussional syndrome
- F10.10: Alcohol abuse, uncomplicated
- F10.11: Alcohol abuse, in remission
You can check the complete list of valid diagnosis codes in CMS’s guide on Psychiatric Diagnostic Evaluation and Psychotherapy Services.
Check the Medicare Reimbursement Rates
Medicare currently pays around $72.78 nationally for CPT code 90833 in non-facility settings and $64.37 in facility settings, according to the 2025 Physician Fee Schedule.
However, this amount is the national average, and the actual payment varies for each MAC locality. You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
Let’s revisit all that we learned in this guide. CPT code 90833 is an add-on service code used for 30-minute psychotherapy sessions. The code must always be paired with a primary E/M service code. For proper reimbursement, you must provide comprehensive documentation and append the appropriate modifiers.
We have attempted to simplify this code to the best of our ability. However, if you are not confident about taking up the billing responsibility, you can always get professional help. Many companies, like MediBillMD, offer specialized mental health billing services.
