CPT 90833 is an add-on code for psychotherapy, 30 minutes with the patient, performed on the same day as an evaluation and management (E/M) service by the same provider. It exists for prescribers — psychiatrists, psychiatric nurse practitioners, and physician assistants — who deliver both medical management and psychotherapy in a single encounter. Under CPT time rules, 90833 covers psychotherapy time of 16 to 37 minutes; 90836 (45 minutes, 38–52) and 90838 (60 minutes, 53+) are the longer add-ons in the same family.
Report 90833 alongside an office/outpatient E/M code (such as 99212–99215) when the provider performs a medically necessary E/M service and a distinct psychotherapy service of at least 16 minutes in the same visit. The two services must be separately identifiable: the E/M portion addresses diagnosis, medication, and medical decision making, while the psychotherapy portion is a defined therapeutic intervention with its own time. Because psychotherapy is time-based, the note must state psychotherapy time explicitly, and that time must exclude the E/M work.
Do not report 90833 without a same-day E/M by the same provider — standalone psychotherapy is 90832 (30 minutes). Do not select the E/M level based on total time when billing a psychotherapy add-on: CPT requires the E/M to be chosen on medical decision making in that scenario, because the same minutes cannot count toward both services. Do not report it when the "therapy" was supportive conversation inherent to medication management rather than a defined psychotherapeutic intervention. Non-prescribing therapists who cannot bill E/M services have no use for this code. And if psychotherapy time was under 16 minutes, no psychotherapy add-on is reportable at all.
The note needs two clearly separable components: the E/M documentation (history, exam as relevant, and medical decision making supporting the level billed) and a psychotherapy section recording the time spent in psychotherapy, the modality or therapeutic technique used, the themes addressed, and the patient’s response. A single blended narrative with one total visit time is the most common documentation failure — auditors look for a stated psychotherapy time of 16–37 minutes that is distinct from the E/M work.
No. When psychotherapy add-on codes are billed with an E/M service, the E/M level must be selected based on medical decision making. Time spent on psychotherapy is carved out for the add-on code and cannot also justify the E/M level.
Sixteen minutes. CPT time conventions assign 16–37 minutes of psychotherapy to 90833; 38 minutes or more moves the encounter to 90836, and under 16 minutes means no psychotherapy add-on may be reported.
Providers who are credentialed to bill E/M services and perform psychotherapy — typically psychiatrists, psychiatric mental health nurse practitioners, and physician assistants. Psychologists, LCSWs, and counselors bill standalone psychotherapy codes instead because they cannot report E/M.
Many payers require modifier 25 on the E/M line to signal a significant, separately identifiable E/M performed the same day, though some instruct otherwise. Follow each payer’s published guidance, and make sure the documentation supports two distinct services either way.
Coding questions like this one are where revenue leaks start. See how Medtransic supports mental health practices with certified billing and denial management: Mental Health Billing Services.