Psytx w pt w e/m 30 min
CPT 90833 represents a 30-minute psychotherapy session combined with a medical evaluation and management (E/M) service during the same visit. This code allows mental health providers to bill for both talking therapy and medical assessment when both are medically necessary.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always append modifier 25 to the E/M code, never to 90833 itself, and document the medical necessity for both services separately in the encounter note
Impact: Proper modifier placement prevents automatic denial; improper use causes 100% payment loss on both services ($150-250 total revenue at risk)
Document exact time spent on psychotherapy separate from E/M service time, as 90833 requires minimum 30 minutes of psychotherapy beyond the E/M component
Impact: Insufficient time documentation is the #1 audit vulnerability; inadequate documentation can result in full recoupment of $72.78 per encounter plus penalties
Bill 90833 only with E/M codes 99202-99215, 99221-99223, 99231-99233, 99238-99239, 99241-99245, 99251-99255, 99304-99310, or 99315-99316; verify payer-specific pairing rules
Impact: Pairing with non-approved codes results in automatic rejection; using correct base code ensures clean claims processing and 15-20% faster payment
Use place of service code 11 (office) for non-facility rate of $72.78 versus POS 22 (hospital outpatient) for facility rate of $64.37
Impact: Incorrect POS code costs $8.41 per encounter (11.6% revenue reduction); verify actual service location to maximize appropriate reimbursement
For patients requiring longer psychotherapy, consider 90836 (45 min) or 90838 (60 min) with E/M for higher reimbursement when time thresholds are met
Impact: Upgrading to appropriate time-based code when justified can increase reimbursement by $30-60 per session while maintaining compliance
Verify commercial payer requires separate authorization for psychotherapy add-on codes versus E/M-only authorization before providing service
Impact: Lack of prior authorization causes 25-40% of commercial denials; pre-service verification prevents $72.78 write-offs and patient balance disputes
Common denials
Missing or improper modifier 25 on the E/M code, causing payer to bundle psychotherapy into E/M service
How to appeal: Submit corrected claim with modifier 25 appended to E/M code and include documentation showing distinct E/M service. Reference CPT guidelines that 90833 is an add-on code requiring separate psychotherapy and medical components. Most payers allow corrected claims within 1 year of service date.
Insufficient documentation of separate psychotherapy time or lack of distinct psychotherapy note versus E/M documentation
How to appeal: Provide detailed encounter documentation showing time-stamped psychotherapy interventions, therapeutic techniques used, and progress toward treatment goals separate from medical decision-making elements. Include treatment plan showing medical necessity for both components. Consider peer-to-peer review for high-value appeals.
Medical necessity not established for both psychotherapy and E/M service on same date, particularly when diagnosis codes don't support dual service
How to appeal: Submit clinical notes demonstrating distinct medical and psychiatric needs addressed in single visit. Include diagnosis codes supporting both mental health condition (psychotherapy) and medical condition requiring E/M assessment. Cite efficiency and integrated care model benefits preventing separate visits.
Claim denied as duplicate or bundled when billed with certain procedure codes or when psychotherapy frequency exceeds payer policy limits
How to appeal: Review payer's bundling edits and frequency limitations in policy manual. If services are distinct and medically necessary, submit appeal with treatment plan justifying visit frequency, clinical progress notes, and CPT/CMS guidelines supporting separate payment for add-on psychotherapy codes. Request specific policy language if denial reason is unclear.
Frequently asked questions
What is CPT code 90833 used for?
CPT 90833 is an add-on code for 30 minutes of psychotherapy provided during the same visit as an evaluation and management (E/M) service. It's used when a provider delivers both psychotherapy and medical assessment/medication management in a single encounter, commonly by psychiatrists managing both mental health therapy and psychiatric medications.
How much does Medicare pay for CPT 90833 in 2025?
Medicare pays $72.78 for CPT 90833 in non-facility settings and $64.37 in facility settings based on the 2025 national average rates. Actual reimbursement varies by geographic locality due to practice expense and malpractice adjustments. The code has 2.25 total RVUs (1.64 work RVU, 0.55 non-facility PE RVU, 0.06 MP RVU).
Can CPT 90833 be billed alone or does it require another code?
CPT 90833 cannot be billed alone; it is an add-on code that must be billed with a primary E/M service code such as 99213, 99214, or other qualifying E/M codes. The E/M code should have modifier 25 appended to indicate a separately identifiable service, and both the psychotherapy and medical components must be medically necessary and documented.
What is the difference between 90833 and 90832?
CPT 90832 is a standalone psychotherapy code for 30 minutes of therapy without a medical E/M service, while 90833 is an add-on code for 30 minutes of psychotherapy provided during the same visit as a separately billable E/M service. Use 90832 for therapy-only visits and 90833 when combining psychotherapy with medication management or medical assessment in one encounter.
Do I need modifier 25 when billing 90833 with an E/M code?
Yes, modifier 25 must be appended to the E/M code (not to 90833) to indicate that the evaluation and management service is significant, separately identifiable, and above and beyond the psychotherapy service. Without modifier 25, most payers will deny or bundle the services together, resulting in payment for only one service instead of both.
How do I document CPT 90833 to avoid audits?
Document the total time spent on psychotherapy (minimum 30 minutes), specific therapeutic interventions used, patient response, and progress toward goals separately from the E/M documentation. The E/M portion should include history, examination, and medical decision-making for medical issues or medication management. Clearly distinguish why both services were medically necessary on the same date and include start/stop times or duration.
Can psychologists bill CPT 90833?
Typically no, because psychologists without prescribing authority cannot perform the medical E/M service component required for 90833. This code is primarily used by psychiatrists, psychiatric nurse practitioners, and other providers who can legally provide both psychotherapy and medical evaluation/medication management. Psychologists should use standalone psychotherapy codes like 90832, 90834, or 90837 instead.