CPT® Code 90833

Add-On Code

Last Updated: January 2026 | Verified for 2026 AMA, CPT & CMS Guidelines

Quick Reference: CPT 90833

• Definition: Psychotherapy, 30 minutes with patient and/or family member when performed with an E/M service.
• Time Rule: Requires 16 to 37 minutes of distinct psychotherapy time.
• Provider Scope: Only for prescribers (MD, DO, NP, PA) who can bill E/M codes. Psychologists/LCSWs use standalone codes (90832).
• Billing Structure: Must be billed with a primary code (e.g., 99213 or 99214).
• Modifier 25: Often required by commercial payers on the E/M code; typically not required by Medicare. CPT 90833 is a critical add-on code for psychiatric prescribers, allowing for the billing of ~30 minutes of psychotherapy provided during the same encounter as a medical evaluation and management (E/M) service. It acknowledges the dual nature of psychiatric visits: medical management (medications, side effects) and therapeutic intervention (counseling, psychoeducation) .

1. What is CPT 90833?

CPT 90833 is exclusively an add-on code. It cannot be billed alone. It allows a provider to capture the time and effort of psychotherapy delivered alongside a medical visit (e.g., 99213, 99214, 99204) .

Eligible Providers: Only clinicians credentialed to perform E/M services may bill this code. This includes Psychiatrists (MD/DO), Nurse Practitioners (NP), and Physician Assistants (PA).

Ineligible Providers: Clinical Psychologists (PhD/PsyD) and Social Workers (LCSW) cannot bill 90833 because they cannot bill the prerequisite E/M code. They must use standalone therapy codes (90832, 90834) .

2. When and How to Bill CPT 90833

To validly bill 90833, the provider must perform two distinct services in the same session:

• Service 1: Medical Management (E/M). This includes history updates, medication reconciliation, ordering labs, and medical decision making (MDM).
• Service 2: Psychotherapy (90833). This involves therapeutic interventions (CBT, supportive therapy, insight-oriented therapy) to modify behavior or cognitions.
• Separation of Time: Time spent on the E/M (e.g., asking about side effects) cannot be counted toward the 16-minute minimum for psychotherapy. The times must be distinct .
• Same Provider: Both the E/M and the therapy must be performed by the same provider. You cannot bill 90833 if an MD does the meds and an LCSW does the therapy; that requires separate standalone codes .

3. Documentation Requirements & Time Thresholds

The 16-Minute Rule

CPT guidelines use a “midpoint rule.” While 90833 is described as 30 minutes, it can be billed for any session lasting between 16 and 37 minutes .

Critical Note: If the therapy portion is 15 minutes or less, do not bill 90833. You may only bill the E/M code. The therapy in this case is considered incidental .

Structuring the Note for Audits

To survive a recoupment audit, your documentation should be visually separated into two distinct sections. Auditors look for “distinct and separately identifiable” services .

Section 1: Medical/E/M Note

Assessment: “Depression stable on Sertraline 100mg. No new side effects. Sleep improved.”

Plan: “Continue current dose. Refill sent.”

Code Selection: 99214 (based on Medical Decision Making).

Section 2: Psychotherapy Note

Time: “25 minutes spent on psychotherapy.” (Must be explicit)

Intervention: “Utilized Cognitive Behavioral Therapy (CBT) to identify cognitive distortions regarding workplace performance. Patient practiced reframing negative thoughts.”

Code Selection: +90833.

Common Audit Failure: CMS audits frequently cite “Time not documented” as a reason for denial. You must write the exact number of minutes spent on therapy .

4. Medicare Guidelines (2026 Rates)

• Reimbursement: In 2026, the national average allowed amount for 90833 is approximately $81.50 . This is slightly less than the standalone code (90832) because the “practice expense” is already paid via the primary E/M code.
• Coverage: Medicare covers 90833 when medically necessary. There is no hard frequency limit, but excessive use (e.g., billing it at every single medication check without clinical justification) may trigger a Targeted Probe and Educate (TPE) review .
• Telehealth: Medicare continues to allow 90833 via telehealth in 2026. Use the appropriate Place of Service (02/10) and Modifier (95) as per current PFS rules .

5. Commercial Payer Nuances & Modifier 25

Commercial Payer Alert: Unlike Medicare, private payers (Blue Cross, Cigna, UHC) often strictly enforce the use of Modifier 25 on the E/M code. Omitting it frequently results in automatic denial of the E/M service as “bundled” .

• Billing Example: 99213-25 (Primary) + 90833 (Add-on).
• Rates: Commercial rates vary widely, generally aligning with or slightly exceeding Medicare rates depending on the specific contract .
• Authorization: Some managed care plans require prior authorization for psychotherapy codes, even when done as add-ons .

6. Common Denial Reasons & Solutions

• Missing Primary Code: Billing 90833 alone will result in immediate rejection. It must be paired with an E/M.
• Provider Type Error: Psychologists (PhD/PsyD) billing 90833 will be denied. They must use 90832 .
• Time Not Met: Documentation showing “10 minutes of counseling” does not qualify for 90833. It is unbillable .
• Duplicate Logic: Billing 90832 AND 90833 on the same day is incorrect. It’s one or the other (Standalone vs. Add-on) .

7. Comparison: 90833 vs. Other Codes