CPT 90836Mental Health

Psytx w pt w e/m 45 min

CPT 90836 represents a 45-minute psychotherapy session combined with evaluation and management of a patient's medical condition. This is used when a mental health provider addresses both psychological concerns and physical health issues during the same visit.

Showing rates for

National Average

Base Medicare rate

$92.51

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.08

PE RVU (NF)

0.7

MP RVU

0.08

Total RVU

2.86

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Always bill 90836 as an add-on to a separate E/M code (99202-99215); never bill 90836 alone
Impact: Billing without a primary E/M code will result in 100% claim denial as 90836 is an add-on code only
Document the exact psychotherapy time (must be 45+ minutes) separately from the E/M service time
Impact: Inadequate time documentation is the #1 audit trigger; could result in $92.51 recoupment per claim plus penalties
Clearly differentiate the psychotherapy component from the medical E/M component in your documentation
Impact: Failure to show distinct services may trigger downcoding to E/M-only or psychotherapy-only codes, losing 30-40% of potential reimbursement
Use 90836 instead of standalone 90834 when you are also managing medical conditions requiring E/M work
Impact: Proper code selection can increase reimbursement by $60-80 per visit compared to billing psychotherapy alone
For non-facility settings, ensure proper place of service code (11) to receive the higher non-facility rate of $92.51 vs $81.84
Impact: Incorrect POS coding costs $10.67 per claim (11.5% reimbursement reduction)
Verify that your state Medicaid program recognizes 90836 for your credential type, as some states restrict to MD/DO only
Impact: NPs and PAs may face denials in restrictive states; requires credential verification and possible prior authorization

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Frequently asked questions

What is the difference between CPT 90836 and 90834?

CPT 90836 is used when you provide 45 minutes of psychotherapy along with a separate E/M service during the same visit, while 90834 is for 45-minute psychotherapy only without medical evaluation and management. 90836 requires billing with an E/M code (99202-99215) and is appropriate when managing both psychiatric and medical conditions.

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 rates. This is an add-on payment to the separate E/M service code, so total reimbursement includes both the E/M payment and the 90836 payment.

Can a nurse practitioner bill CPT 90836?

Yes, psychiatric nurse practitioners and family nurse practitioners can bill CPT 90836 if they are credentialed to provide both E/M services and psychotherapy in their state. They must have the clinical training and scope of practice authority to manage both medical and psychiatric conditions independently or under appropriate supervision.

What E/M codes can be billed with 90836?

CPT 90836 can be billed with outpatient E/M codes 99202-99205 (new patient) or 99211-99215 (established patient). It cannot be billed with inpatient codes, emergency department codes, or other E/M services outside the office/outpatient setting.

How do I document 45 minutes for CPT 90836?

Document the start and stop time of the psychotherapy portion of the visit, ensuring at least 45 minutes were spent in therapeutic interventions. This is separate from E/M time. Best practice is to note total encounter time, time spent in psychotherapy, and time spent in medical evaluation/management to clearly show both components.

Can CPT 90836 be used for telehealth visits?

Yes, CPT 90836 can be billed for telehealth services when provided via real-time audio-video technology. Append modifier 95 to indicate the service was provided via telehealth, and ensure you meet all telehealth requirements including patient location, technology standards, and state licensure in the patient's location.

What is the RVU value for CPT 90836?

CPT 90836 has a total RVU of 2.86 for 2025, consisting of 2.08 work RVUs, 0.7 non-facility practice expense RVUs (0.37 facility), and 0.08 malpractice RVUs. Using the 2025 conversion factor of 32.3465, this calculates to the Medicare rates of $92.51 non-facility and $81.84 facility.