Coding · July 11, 2026 · 6 min read

CPT 90833, 90836 & 90838: Billing Psychotherapy with Med Management

When a psychiatrist or psychiatric NP does real psychotherapy in the same visit as medication management, two services happened — and both are billable. The add-on codes 90833, 90836, and 90838 exist for exactly this, and they're among the most under-billed codes in psychiatry. They're also among the most misdocumented. Here's how to get both the revenue and the compliance right.

How the add-on codes work

The add-ons attach to an E/M visit (99202–99215). The E/M code covers the medical work — evaluation, medication decisions — and the add-on covers psychotherapy time delivered in the same encounter. They're prescriber codes: psychiatrists, psychiatric NPs, and PAs who bill E/M. Therapists billing standalone psychotherapy use 90832/90834/90837 instead.

The two-clock rule

The single most important compliance concept: psychotherapy time must be separate from E/M time. The minutes spent on medication review, history, and medical decision-making belong to the E/M service; only distinct, additional psychotherapy minutes count toward the add-on threshold. A 30-minute visit that was mostly med management cannot support a 90833 — there wasn't 16 minutes of separate psychotherapy in it. Auditors call this "unbundling time," and it's the primary risk with these codes.

Documentation requirements

• Two distinct services in the note — the E/M elements (history, exam, medical decision-making) and a separately identifiable psychotherapy section.
• Psychotherapy time documented separately from total visit time.
• Psychotherapy content — modality, interventions, response — not just "supportive counseling provided."
• E/M level chosen on its own merits — note that when billing psychotherapy add-ons, the E/M level must be selected on medical decision-making, not total time.

Why these codes are under-billed

Many prescribers deliver 20 minutes of genuine therapy inside a 30-minute med check and bill only the E/M — leaving the add-on (often a meaningful percentage of the visit's value) on the table, visit after visit. The fix isn't billing more aggressively; it's documenting the psychotherapy that's already happening so the code is supportable. For the E/M side of the equation, see psychiatry E/M coding and our psychiatry billing page.

Common denials

• Add-on without a primary E/M code on the claim — automatic rejection.
• Time that doesn't add up — psychotherapy minutes plus plausible E/M work exceeding the appointment length.
• Identical add-ons every visit — the same pattern-scrutiny that follows 90837.
• Payer-specific rules — a few plans restrict which E/M levels can pair with which add-ons.

Full code list: behavioral health CPT reference.

This guide is for general reference only. CPT codes, HCPCS codes, and payer rules change, always verify against current coding guidance and your specific payer policies. CPT is a registered trademark of the American Medical Association.