Psytx w pt w e/m 45 min
CPT 90836 covers a 45-minute psychotherapy session combined with medical evaluation and management (E/M) services for a patient with mental health needs. This add-on code allows mental health providers to bill for both talk therapy and medical assessment in the same visit.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document the E/M component separately from psychotherapy notes - use a SOAP format for medical evaluation (vitals, medication review, side effects, physical assessment) distinct from therapy content
Impact: Prevents denials and audit recoupment; 30-40% of claims denied due to insufficient E/M documentation
Bill 90836 instead of 90834 when medication management, physical health assessment, or medical decision-making occurs - this increases reimbursement by $19-22 per session
Impact: Revenue increase of approximately $22.68 per session compared to 90834 (non-facility rate difference)
Time must be clearly documented and at least 38 minutes (typical CPT time rules apply: 45 min code requires 38+ minutes actual time)
Impact: Underdocumented time accounts for 25% of downcoding to 90833; could result in $40-50 revenue loss per encounter
For patients on psychotropic medications, document specific medication review including dosage, adherence, efficacy assessment, and side effect monitoring to justify E/M component
Impact: Strengthens medical necessity; reduces audit risk and supports the additional $30-40 in reimbursement over psychotherapy-only codes
Verify patient is established and diagnosis supports combined therapy/E/M before using 90836; initial diagnostic evaluations should use 90792 instead
Impact: Prevents denials for inappropriate code selection; 90792 pays $195.71 vs $92.51, so using wrong code costs $103.20
For telehealth visits, ensure platform meets HIPAA requirements and document patient location, consent for telehealth, and that full psychotherapy and E/M components were delivered virtually
Impact: Maintains full reimbursement eligibility; non-compliant telehealth documentation can result in 100% claim denial
Common denials
Insufficient documentation of E/M component separate from psychotherapy
How to appeal: Submit appeal with clearly delineated medical evaluation section showing vitals, medication review, physical assessment, and medical decision-making separate from therapy notes. Include statement explaining why both services were medically necessary during same encounter.
Time documentation missing or below threshold for 45-minute code
How to appeal: Provide corrected claim with exact time documentation (start/stop times or total minutes). If time was legitimately 38+ minutes, submit amended documentation. If time was less, accept downcoding to 90833 (38 minutes) rather than continue appeal.
Billed by non-qualifying provider (psychologist, LCSW, or other non-prescriber)
How to appeal: If provider has prescriptive authority or is MD/DO/NP/PA, submit credentials verification. If provider cannot provide E/M services, rebill with appropriate psychotherapy-only code (90834) and accept adjustment.
Medical necessity not established for combined E/M and psychotherapy
How to appeal: Submit clinical notes demonstrating active medication management, monitoring of physical symptoms related to psychiatric condition, or medical complications requiring physician-level assessment. Include treatment plan showing ongoing need for integrated care.
Frequently asked questions
What is the difference between CPT 90836 and 90834?
CPT 90836 includes both psychotherapy and evaluation/management (E/M) services in a 45-minute session, while 90834 is psychotherapy only for 45 minutes. Use 90836 when providing medical management such as medication monitoring, assessment of physical symptoms, or other physician-level medical decision-making alongside therapy. 90836 reimburses approximately $23 more than 90834 but requires documentation of both components.
How much does Medicare pay for CPT 90836 in 2025?
Medicare pays $92.51 for CPT 90836 in non-facility settings and $81.84 in facility settings based on the 2025 national average payment rates. Actual payment may vary slightly based on geographic locality adjustments.
Can psychologists bill CPT code 90836?
No, psychologists cannot bill CPT 90836 because they cannot provide evaluation and management (E/M) services, which are physician-level services. Only physicians (MD/DO), nurse practitioners, clinical nurse specialists, and physician assistants with prescriptive authority can bill 90836. Psychologists should use psychotherapy-only codes like 90834.
How many minutes are required for CPT 90836?
CPT 90836 requires a minimum of 38 minutes of face-to-face psychotherapy with E/M services. The code descriptor indicates 45 minutes, but following standard CPT time rules, you need at least the midpoint between this code and the next lower time increment (38 minutes minimum).
What documentation is required for billing CPT 90836?
Documentation must include total time spent, psychotherapy techniques and interventions, a separate E/M component with medical evaluation (such as medication review, side effects assessment, vital signs, physical examination elements), medical decision-making, psychiatric and medical diagnoses, and treatment plan. The E/M portion must be clearly distinct from psychotherapy process notes.
Can I bill 90836 for telehealth services?
Yes, CPT 90836 can be billed for telehealth services using modifier 95. Medicare and most payers have continued coverage for psychiatric services via telehealth. Ensure your platform is HIPAA-compliant, document the patient's location and consent for telehealth, and maintain the same time and documentation standards as in-person visits.
What is the RVU value for CPT 90836?
CPT 90836 has a total RVU of 2.86 for 2025, consisting of 2.08 work RVU, 0.70 non-facility practice expense RVU (0.37 facility), and 0.08 malpractice RVU. This converts to the Medicare payment rates of $92.51 non-facility and $81.84 facility when multiplied by the 2025 conversion factor of 32.3465.