CPT 90838Mental Health

Psytx w pt w e/m 60 min

CPT 90838 covers a 60-minute psychotherapy session combined with evaluation and management of a medical condition, typically used when a mental health provider also addresses physical symptoms or medication management during the same visit.

Showing rates for

National Average

Base Medicare rate

$122.92

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

2.74

PE RVU (NF)

0.93

MP RVU

0.13

Total RVU

3.8

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

NCCI bundling edits

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Billing tips

Always bill 90838 as an add-on to a primary E/M code (never standalone); verify the primary E/M code is from the approved list (99202-99215, 99221-99233, etc.)
Impact: Billing standalone results in automatic denial; proper pairing ensures full $122.92 non-facility payment
Document the exact time spent on psychotherapy separately from the E/M component, specifying start/stop times for the 60-minute psychotherapy portion
Impact: Time documentation is the primary audit target; incomplete time records lead to downcoding from $122.92 to $83.74 (90836) or denial of add-on payment entirely
Ensure documentation clearly demonstrates medical necessity for both psychotherapy AND medical E/M components in the same session
Impact: Lack of dual necessity justification accounts for 40% of denials; proper documentation of why both services were essential on same day prevents $122.92 recoupment
Bill the appropriate facility vs. non-facility rate based on place of service; hospital inpatient/outpatient settings use facility rate ($109.33)
Impact: Incorrect POS coding creates $13.59 payment differential and potential audit exposure; verify POS 11 for office, 21/22 for hospital
For commercial payers, verify whether 90833, 90836, or 90838 time thresholds apply; some require minimum 52 minutes for 60-minute codes
Impact: Payer-specific time requirements vary; billing 90838 for 45-minute session may result in denial and requirement to rebill 90836, losing potential reimbursement difference
When billing with observation or inpatient E/M codes (99217-99239), confirm payer allows 90838 add-on; some restrict psychotherapy add-ons to outpatient E/M only

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Frequently asked questions

What is CPT code 90838 used for?

CPT 90838 is used for psychotherapy with evaluation and management services lasting approximately 60 minutes. It's an add-on code billed alongside a primary E/M visit when a provider performs both medical management and psychotherapy during the same session, such as adjusting psychiatric medications while providing therapeutic counseling.

How much does Medicare pay for CPT 90838 in 2025?

Medicare pays $122.92 for CPT 90838 in non-facility settings and $109.33 in facility settings based on the 2025 national average rates. Actual payment may vary by geographic locality due to practice expense and malpractice adjustments.

Can CPT 90838 be billed alone without an E/M code?

No, CPT 90838 is an add-on code and cannot be billed standalone. It must always be billed with an appropriate primary E/M code such as 99212-99215 for outpatient visits, 99221-99233 for initial hospital care, or other approved E/M services from the CPT-specified list.

What is the difference between 90833, 90836, and 90838?

The difference is the duration of psychotherapy provided with E/M services: 90833 is for 30 minutes, 90836 is for 45 minutes, and 90838 is for 60 minutes. All three are add-on codes requiring a separate E/M service, with 90838 having the highest reimbursement at $122.92 due to the longer time requirement.

Who can bill CPT code 90838?

CPT 90838 can be billed by physicians (MD/DO) and qualified non-physician practitioners (nurse practitioners, physician assistants, clinical nurse specialists) who have the authority to perform both medical evaluation/management and psychotherapy within their scope of practice. Psychologists and social workers cannot bill this code as it requires medical E/M capability.

How do you document time for CPT 90838?

Document the start and stop times specifically for the psychotherapy portion of the visit, which should total approximately 60 minutes (minimum 53 minutes per CPT midpoint rule). Separately document the E/M component with appropriate history, exam, and medical decision making. Both components should be clearly distinguished in the medical record.

Can 90838 be billed via telemedicine?

Yes, CPT 90838 can be billed for telemedicine services when provided via real-time interactive audio and video. Append modifier 95 to indicate the service was performed via telehealth. The 2025 Medicare payment rate remains the same as in-person services when billed with appropriate telehealth modifiers and place of service codes.