Add-On Codes: CPT 90833, 90836 and 90838
What CMS.gov says these add-on codes are, when they go with an E/M visit, and how to document the psychotherapy time. Checked against CMS.gov on 9/29/26.
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Psychotherapy Add-On Codes at a glance
This page covers psychotherapy add-on codes for mental health billing: what the codes cover, how payers apply them, and what to document. Psychotherapists and psychiatrists both use these codes, so the sections below call out differences where they matter. Payer rules vary, so confirm current requirements with the payer before you bill.
The psychotherapy add-on codes are billed only with an E/M visit, never alone. The psychotherapy add-on codes are 90833 for 16 to 37 minutes, 90836 for 38 to 52 minutes, and 90838 for 53 minutes or more. Document the E/M work and the psychotherapy add-on codes time separately, so each part of the visit stands on its own.
What CMS.gov says these codes are
Quotes are copied from CMS.gov pages. Each quote names its source. Contractor articles are written by Medicare Administrative Contractors (MACs), the companies that process Medicare claims for a region, and apply to their own region.
Code list entry
“Psychotherapy with patient”
“Interactive complexity”
What the service is
“Psychotherapy with medical evaluation and management services are reported with codes for E/M services plus a psychotherapy add-on code (90833; 90836; 90838).”
“For psychotherapy services performed with an E/M service (CPT codes 90833, 90836, and 90838), it is recognized that the psychotherapy time may not be continuous in a combined psychotherapy with an E/M service.”
“Interactive Complexity (90785) is an add-on code specific for psychiatric services and refers to communication difficulties during the psychiatric procedure.”
Time range and documentation
Every timed code needs the date of service and the start and end time of the service.
| Code | Service | Time range | Document |
|---|---|---|---|
| +90833 | Psychotherapy add-on, reported with an E/M serviceRange quoted with 90832 in contractor article A57520. Psychotherapy time need not be continuous. | 16–37 minutes | Date of service + start and end time Documentation rules |
| +90836 | Psychotherapy add-on, reported with an E/M serviceRange quoted with 90834 in contractor article A57520. | 38–52 minutes | Date of service + start and end time Documentation rules |
| +90838 | Psychotherapy add-on, reported with an E/M serviceRange quoted with 90837 in contractor article A57520. | 53 minutes or more | Date of service + start and end time Documentation rules |
| +90785 | Interactive complexity (add-on)Do not bill if the patient cannot communicate by any means. Not billed with crisis codes 90839/+90840. | No time - not a timed code | Date of service + what was adapted and why Documentation rules |
How often and with what?
- Add-ons are never billed alone. They go with an E/M service on the same date.
Source: CMS Coverage Database, Article A57480 (WPS, rev. 1/1/2026) - Interactive complexity (+90785) is not billed if the patient cannot communicate by any means.
Source: CMS Coverage Database, Article A57520 (First Coast, rev. 1/1/2025) - Crisis codes 90839/+90840 are not billed with 90785–90899 or 90832, 90833, 90834, 90836, 90837, 90838.
Source: CMS, Psychotherapy for Crisis (page modified 02/25/2026)
These are Medicare rules. Private payers and state Medicaid programs set their own; ask each payer. Full list: frequency and documentation rules.
Psychotherapists and psychiatrists
Psychiatrists and other prescribers
This is your combined visit: an E/M for medication management plus the add-on for the psychotherapy that was done in the same visit. The E/M and the psychotherapy must be significant and separately identifiable.
Psychotherapists
These codes need an E/M service, so they apply only if you bill E/M visits. Otherwise use 90832, 90834 or 90837.
Frequently asked questions
What is a psychotherapy add-on code?
A psychotherapy add-on code is reported together with an E/M code when the practitioner provides both a medical visit and psychotherapy. Contractor article A57480 says psychotherapy with E/M services is reported with an E/M code plus a psychotherapy add-on code: 90833, 90836 or 90838.
How do I choose between 90833, 90836 and 90838?
Choose by the psychotherapy minutes only: 16–37, 38–52 or 53 or more. The E/M level is chosen separately. Document the psychotherapy start and stop times or total time apart from the E/M.
Does the psychotherapy time have to be continuous?
No. Contractor article A57520 recognizes that the psychotherapy time may not be continuous in a combined psychotherapy with an E/M service.
When can I add interactive complexity (+90785)?
When communication difficulties affect the session, and it is not billed if the patient cannot communicate by any means. Record what was adapted and why. Contractor article A57065 asks that the record show the adaptations used and the rationale.
More CPT code guides
CMS.gov sources
- CMS Coverage Database, Article A57480 (WPS, rev. 1/1/2026)
- CMS Coverage Database, Article A57520 (First Coast, rev. 1/1/2025)
- CMS, Medicare & Mental Health Coverage (MLN1986542, March 2026)
- CMS, Psychotherapy for Crisis (page modified 02/25/2026)
Current as of last search (9/29/26). Reconfirm before publishing. For quick reference only: verify against the current AMA CPT manual and each payer's policy before billing. Operational billing guidance, not legal advice.
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