Most psychiatrists and psychiatric NPs do not lose revenue because they failed to provide care. They lose it because the psychotherapy portion of a visit is coded incorrectly. A common example is billing 90833 when the documented time actually supports the 90836 CPT code.
This guide explains what 90836 means, when to use it, how it differs from 90834, what documentation supports it and where billing errors happen. It is written for psychiatrists, psychiatric NPs and behavioral health billers using professional behavioral health billing services.
What Is CPT Code 90836?
CPT code 90836 is an add-on psychotherapy code for 38–52 minutes of psychotherapy provided during the same encounter as a separately reportable Evaluation and Management, or E/M, service.
In simple terms, the provider performs two services in one visit:
- E/M work, such as medication management
- Psychotherapy lasting 38–52 minutes
The 90836 CPT code description is commonly summarized as 45 minutes of psychotherapy performed with an E/M service. It is not a standalone code.
That means CPT code 90836 must be paired with an appropriate E/M code, such as 99213 or 99214, when the documentation supports that E/M level.
Psychotherapy time must be separate. Time spent on medication review, orders, or other E/M work should not be counted again as psychotherapy time.
90836 CPT Code vs 90834: The Most Important Distinction
90836 and 90834 generally cover the same psychotherapy time range: 38–52 minutes. The difference is whether a separately reportable E/M service is also performed.
Use 90834 when the encounter is psychotherapy only and no E/M service is billed.
Use 90836 when the same qualified clinician performs an E/M service plus 38–52 minutes of psychotherapy.
For example, a psychologist provides 45 minutes of psychotherapy without an E/M service. In that case, 90834 may be appropriate.
Now consider a psychiatrist who reviews medications, evaluates side effects, makes a treatment decision and also provides 42 minutes of psychotherapy. An appropriate E/M code plus 90836 may be supported.
Full CPT Code Comparison Table
| CPT Code | Psychotherapy Time | Type | Common Eligible Clinicians | Reimbursement |
| 90832 | 16–37 min | Standalone | Psychiatrists, psychologists, LCSWs, LPCs, LMFTs | Varies |
| 90833 | 16–37 min | Add-on to E/M | Psychiatrists, psychiatric NPs, PAs, other E/M-qualified clinicians | Varies |
| 90834 | 38–52 min | Standalone | Psychiatrists, psychologists, LCSWs, LPCs, LMFTs | Varies |
| 90836 | 38–52 min | Add-on to E/M | Psychiatrists, psychiatric NPs, PAs, other E/M-qualified clinicians | Approx. $80 Medicare planning estimate; verify current rate |
| 90837 | 53+ min | Standalone | Psychiatrists, psychologists, LCSWs, LPCs, LMFTs | Varies |
| 90838 | 53+ min | Add-on to E/M | Psychiatrists, psychiatric NPs, PAs, other E/M-qualified clinicians | Varies |
Actual reimbursement depends on the payer, geographic locality, place of service, modifiers, and provider contract.
Who Can Bill CPT Code 90836?
90836 is intended for clinicians who can report both psychotherapy and an E/M service.
Common examples include:
- Psychiatrists
- Psychiatric nurse practitioners
- Physician assistants in psychiatric settings, subject to scope and payer rules
- Other physicians or qualified health professionals allowed to bill the accompanying E/M service
This makes 90836 especially relevant to psychiatry billing services.
LCSWs, LPCs, LMFTs and most psychologists generally use standalone psychotherapy codes such as 90834 because they do not typically report office or outpatient E/M codes.
Provider eligibility can vary by state, scope of practice and payer. So those rules should always be verified before submitting a claim.
When to Use CPT Code 90836 Clinical Scenarios
Extended Psychiatric Follow-Up With Therapy
A psychiatrist evaluates depression symptoms, reviews medication effectiveness, adjusts the treatment plan and provides 40 minutes of CBT-based psychotherapy.
If both portions are separately supported, an E/M code plus 90836 may be appropriate.
Combined MAT and Counseling Visit
A qualified prescriber manages medication-assisted treatment and provides 45 minutes of psychotherapy focused on triggers, coping strategies, and relapse prevention.
Payer-specific coverage and billing requirements should still be checked.
Trauma Processing Alongside Medication Management
A psychiatric NP reviews medication response, side effects, and safety, then provides 38–52 minutes of structured psychotherapy addressing trauma-related symptoms.
Complex Co-Occurring Disorder Encounter
A patient experiencing anxiety and substance-use concerns receives medication management plus 50 minutes of psychotherapy addressing coping skills, motivation and behavioral change.
Remember that the diagnosis alone does not justify 90836. The medical record must show that psychotherapy was medically necessary and actually performed.
Documentation Requirements for 90836
Good documentation clearly separates the E/M service from the psychotherapy service.
E/M Documentation Requirements
The note should support the medical work performed, which may include:
- Current symptoms and relevant history
- Medication effectiveness
- Medication side effects
- Risk assessment when appropriate
- Medical decision-making
- Treatment changes
- Follow-up plan
When psychotherapy add-on codes are reported with office/outpatient E/M services, providers should also follow current CPT and payer rules regarding E/M level selection and medical decision-making.
Psychotherapy Documentation Requirements
Document:
- Psychotherapy start and stop times, or another payer-accepted method showing total psychotherapy time
- Therapeutic modality or intervention
- Problems addressed during therapy
- Patient response
- Progress toward treatment goals
Accurate CPT coding also depends on proper charge entry services in mental health billing, because this is where the E/M and psychotherapy codes enter the billing process.
Example of an Audit-Ready Session Note
E/M: Medication response and side effects reviewed. Risk assessed and treatment plan continued.
Psychotherapy: 10:10 a.m.–10:52 a.m. CBT and supportive interventions used to address anxiety and work-related stress. Patients identified triggers, practiced reframing techniques and participated actively.
A good audit note does more than say, “45 minutes spent with the patient.”
Auditors want to see that the required psychotherapy time occurred and that real therapeutic work was provided separately from medication management.
Billing and Reimbursement Rates for 90836
For planning purposes, an approximate 2026 Medicare national reimbursement estimate for 90836 is around $80, while an E/M service combined with 90836 may produce total reimbursement of roughly $210 per encounter in some situations.
These numbers should not be treated as guaranteed payment. Medicare reimbursement varies by geographic locality, setting and annual fee schedule changes. Commercial insurers use their own contracted rates.
90834 is paid as a standalone psychotherapy service. By contrast, 90836 is added to an eligible E/M service, so total reimbursement reflects both parts of the encounter.
The revenue difference can become significant over time.
Suppose a payer reimburses $25 more for 90836 than 90833, and a practice incorrectly reports 90833 for 10 visits each week that actually meet 90836 requirements.
That equals:
$25 × 10 visits × 52 weeks = $13,000 per year
That is $13,000 in potential gross reimbursement difference simply from correct code selection, assuming the documentation genuinely supports 90836.
Correct coding is also an important part of effective mental health revenue cycle management.
Medicaid rates can vary considerably by state, managed-care plan, provider type and place of service.
Modifiers Used With CPT Code 90836
Modifier 95: Often used to identify synchronous telehealth services when required by the payer.
Modifier 52: Do not automatically use modifier 52 because psychotherapy falls below the 90836 time range. If psychotherapy is shorter, 90833 may be the proper code. Modifier 52 use is payer-specific.
Modifier 25: Generally should not be added simply because 90836 is reported with an E/M service. 90836 is already designed as an add-on to E/M.
Modifier 59: Generally should not be used merely to separate 90836 from its required E/M service.
For telehealth claims:
- POS 10 generally means telehealth was provided while the patient was at home.
- POS 02 generally means telehealth was provided while the patient was somewhere other than home.
Always follow the payer’s current telehealth billing instructions.
Payer-Specific Rules for 90836
Medicare
Medicare claims should support medical necessity, provider eligibility, the accompanying E/M service, psychotherapy time, and applicable telehealth requirements.
Medicaid
Medicaid policies vary by state. Check eligible provider types, allowed code combinations, authorization requirements, reimbursement, and telehealth rules.
Aetna Behavioral Health
Aetna requirements may differ between plans. Verify behavioral health benefits, provider network status, code-pairing rules, and authorization requirements.
UnitedHealthcare
Confirm the patient’s specific plan, behavioral health coverage, coding edits, network rules, and telehealth requirements.
Cigna
Check benefits, provider eligibility, authorization rules, and claim requirements for psychotherapy performed with an E/M service.
Some plans may require authorization for certain behavioral health services or extended treatment. Effective prior authorization management can help reduce avoidable delays.
Practices struggling with this process may also review when to outsource prior authorization services.
Because payer policies change, always verify the patient’s current benefits, authorization status, provider contract, telehealth rules, and code-pairing requirements before submitting 90836.
Common Billing Errors and Audit Risks
Common 90836 billing problems include:
- Upcoding 90833 to 90836 without at least 38 minutes of psychotherapy
- Documenting the total appointment length instead of psychotherapy time
- Billing 90836 repeatedly without clear medical necessity
- Missing separate E/M documentation
- Improperly counting the same time toward both E/M and psychotherapy
- Using the wrong E/M level
- Having one provider bill E/M while another attempts to append 90836 to that service
These mistakes can lead to claim denials, payer recoupments, or audit exposure.
A professional mental health billing audit can help identify coding and documentation patterns before they become larger compliance problems. So in order to provide best mental health billing services, every billing company should follow these CPT Codes.
For claims that have already been rejected, mental health denial management can help determine whether the problem involves coding, documentation, eligibility, authorization, or payer policy.
Frequently Asked Questions
Can 90836 Be Billed Without an E/M Code?
No. 90836 is an add-on code and must be reported with an appropriate E/M service.
What Is the Difference Between 90836 and 90834?
90834 is standalone psychotherapy. 90836 represents psychotherapy performed with a separately reportable E/M service.
Can LCSWs and LPCs Bill 90836?
Generally, no. LCSWs and LPCs typically do not report the office/outpatient E/M codes required with 90836, so standalone psychotherapy codes are normally used.
What Is the 2026 Reimbursement Rate for 90836?
An approximate Medicare planning estimate is around $80 for 90836, but actual payment varies by locality, place of service, payer, and annual fee schedule changes. Always verify the current rate before relying on a reimbursement figure.
Can 90836 Be Used for Telehealth?
Yes, when the patient’s payer covers 90836 through telehealth and all applicable technology, modifier, place-of-service, provider, and documentation rules are satisfied.
How Do I Document 90836 Correctly?
Document the E/M work separately, support 38–52 minutes of psychotherapy, identify the therapeutic intervention, describe what was addressed, and record the patient’s response.
Conclusion Get 90836 Billing Right
The 90836 CPT code represents 38–52 minutes of psychotherapy provided with a separately billable E/M service.
Correct billing requires the right provider, supported psychotherapy time, clear separation between E/M and therapy documentation, medical necessity, and compliance with payer-specific requirements.
Small coding differences can create large revenue gaps when they occur across hundreds of encounters. Mental health billing specialists understand these details and can help practices reduce avoidable denials while collecting reimbursement for services that are properly documented and medically necessary.
Get a Free Billing Audit to find out whether your practice is correctly coding, documenting, and submitting psychotherapy-with-E/M services.
