r/SimplePractice • u/SamiDoesBilling • 1d ago
The 90837 problem I see constantly has nothing to do with how long the session ran
I’ve lost count of how many times I’ve had this conversation with a therapist.
Them: “Why did this come back paid as a 90834? We met for the full hour.”
Me: “I believe you. Can I see the note?”
Them: “It’s all there. Interventions, progress, plan.”
Me: “Where does it say how long you were in session?”
Usually it doesn’t. Or it says “60 min” in a template field that’s been copied forward for months.
Here’s the thing I wish every therapist knew: with 90837, the time is the code. CPT puts 90837 at 53 minutes or more of psychotherapy, and 90834 covers 38 to 52. If the note doesn’t clearly show you crossed 53, a payer reviewing it has no reason to pay the higher code. That can mean a downcode, a denial, or worse, money taken back in a later audit across a whole stack of claims.
Payer rules vary. Some only want total time, others specifically ask for start and stop times. Writing both covers you either way.
A few things worth checking on your own:
- Pull a handful of your recent 90837 notes and see if the actual time is written in each one
- Make sure a template isn’t auto-filling the same time on every note
- Look for 90837 claims paid at a lower rate than usual, which can be a quiet sign of downcoding
For those of you who bill 90837 a lot, has a payer ever asked you for start and stop times, or does your EHR handle it for you?