90833 Billing Errors: 5 Fixes for Psychiatric Add-On Codes
90833 billing errors happen when a psychiatric practice bills a psychotherapy add-on code with an evaluation and management (E/M) visit. The add-on codes are 90833, 90836 and 90838. They only work alongside an E/M code, and payers check the time and the notes. Here are five common mistakes and how to fix them.
What the add-on codes are
Codes 90833, 90836 and 90838 report psychotherapy performed on the same day as an E/M service, such as 99213 or 99214. The code describes the time spent in psychotherapy: 90833 for 16 to 37 minutes, 90836 for 38 to 52 minutes and 90838 for 53 minutes or more. See our guide to psychotherapy add-on codes for the full table.
5 best fixes for 90833 billing errors
1. Never bill the add-on alone
An add-on code must be reported with an E/M service. A claim with 90833 and no E/M will deny.
2. Keep the times separate
Time spent on the E/M work does not count toward psychotherapy time. Record the psychotherapy minutes separately in the note.
3. Match the time to the right code
Use the psychotherapy minutes, not the visit total, to pick between 90833, 90836 and 90838.
4. Pick the E/M level by medical decision making
When you report an add-on, the E/M level should reflect the medical work. Do not raise it because the visit was long.
5. Document both services
The note should show a significant, separately identifiable E/M service and a psychotherapy service. A CMS billing article describes both as needing to be separately identifiable and says prolonged services are not reported with these add-on codes. See the CMS billing and coding article for psychiatry and psychology services.
Private payers vs Medicare vs Medicaid
Private payers
Edits differ. Some payers have extra rules for the E/M level or for modifier use. Check each payer’s policy.
Medicare
Medicare contractors publish their own billing articles, and some are still in draft. Confirm the current version before you rely on it. See Medicare behavioral health billing.
Medicaid
State Medicaid agencies and managed care plans set their own rules, and they vary by state. Use the state billing guides.
Where to go next
Prescribers also need to watch documentation and credentialing. Read documentation requirements, psychiatrist credentialing and billing service for a solo psychiatrist. If you are choosing support, see psychiatry billing services.
Most 90833 billing errors come from a gap between the note and the claim. A short template that records E/M work and psychotherapy minutes separately prevents many 90833 billing errors. Ask your EHR or billing service to flag any add-on code that appears without an E/M, and review denials by code every month.
For related code definitions, see psychotherapy codes and the CPT and E/M code guide.
Key takeaways
Always pair the add-on with an E/M, track psychotherapy minutes on their own, pick the E/M by medical decision making and document both services. Clean up 90833 billing errors early, because the same pattern repeats on every claim.
Frequently asked questions
Can I bill 90833 without an E/M code?
No. It is an add-on code and needs a qualifying E/M service on the same day.
How many minutes do I need for 90833?
Psychotherapy time of 16 to 37 minutes. Longer sessions use 90836 or 90838.
Does the E/M time count toward the psychotherapy time?
No. Record the two services separately.
Which source should I follow for payer rules?
Follow the payer’s own policy. CMS and Medicare contractor articles apply to Medicare.
Where MCM South Medical Billing Service Works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.
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