90833, 90836, 90838: Psychotherapy Add-On Codes With E/M

90833, 90836 and 90838 are the psychotherapy add-on codes: a prescriber who provides an E/M visit and psychotherapy in the same encounter bills the E/M code plus one add-on, chosen by psychotherapy minutes (16–37, 38–52 or 53 or more). They're never billed alone, and only clinicians who can bill E/M visits can use them, so they belong to psychiatrists, psychiatric nurse practitioners, clinical nurse specialists and physician assistants.

The add-on codes by psychotherapy time

The ranges match the standalone codes. First Coast lists "16-37 minutes for CPT codes 90832 and 90833, 38-52 minutes for CPT codes 90834 and 90836, and 53 or more minutes for CPT codes 90837 and 90838" (A57520).

How E/M plus psychotherapy works

WPS (A57480) and First Coast (A57520) agree on the rules:

1. Two separate services. The E/M and the psychotherapy must each be significant and separately identifiable. A separate diagnosis isn't required.
2. E/M level by medical decision making. "Time may not be used as the basis of E/M code selection" when an add-on is reported (WPS).
3. Psychotherapy minutes stand alone. "Time spent on the activities of the E/M service is not included" in psychotherapy time (WPS). First Coast adds that the psychotherapy minutes don't have to be continuous.
4. No prolonged services. "Prolonged services may not be reported when psychotherapy services billed with an E/M service" (First Coast).

Example. A psychiatric NP sees an established patient for 45 minutes: 15 minutes adjusting medication and reviewing side effects, 30 minutes of psychotherapy. The E/M is chosen by the complexity of the medication decision, for example 99214, and the 30 minutes of therapy is 90833. Billing 90836 would count E/M minutes as therapy.

Who can bill 90833, 90836 and 90838

Only a practitioner who bills the same-day E/M can bill the add-on, which in Medicare means:

• Can bill: physicians (psychiatrists and others), nurse practitioners, clinical nurse specialists and physician assistants, within state scope.
• Can't bill: clinical psychologists, clinical social workers, marriage and family therapists and mental health counselors. CMS says they "cannot independently bill Medicare for E/M visits" (89 FR 97929), so they report the standalone psychotherapy codes.

NPs, CNSs and PAs are paid 85% of the fee schedule amount for both the E/M and the add-on when they bill under their own NPI. See Medicare reimbursement by provider type.

Add-on rates vs standalone psychotherapy

Each add-on is valued below the standalone code for the same minutes, but it's paid on top of the E/M, which carries its own share of the encounter's work. The visit as a whole is the E/M plus the add-on:

Practices that see commercial patients use these numbers too. Many commercial contracts are written as a percentage of Medicare, so the E/M and add-on amounts for your ZIP are the starting point for checking an offer in the contract check.

Interactive complexity with an add-on

90785 can be added to an E/M plus psychotherapy add-on when a specific communication factor complicated the visit and the note says what it was and how long it took. WPS bars 90785 with an E/M visit when no psychotherapy is billed, and with crisis psychotherapy (A57480).

Telehealth

Office E/M visits and the three add-ons are on the Medicare Telehealth Services List (MLN1986542). For a patient at home, bill POS 10, paid at the office rate, and modifier 93 if the visit was audio-only. Behavioral health telehealth has permanent rules that don't expire with the broader flexibilities at the end of 2027; see telehealth rules for therapy.

Common add-on code denials

• Add-on without an E/M. The claim needs the E/M line from the same practitioner on the same date.
• Add-on billed by a therapist. A psychologist, LCSW, LMFT or LPC billing 90833 will deny; they bill 90832.
• E/M level chosen by total time. With an add-on, the E/M level must come from medical decision making.
• Add-on with crisis codes. Crisis psychotherapy 90839 may not be reported with 90832–90838 (WPS A57480).
• Prolonged service added. Not allowed with psychotherapy add-ons (First Coast A57520).

Keep reading

• Mental health billing: the full behavioral health code set, payment and telehealth.
• 90791 vs 90792: the prescriber's intake evaluation before E/M follow-ups.
• 90834 vs 90837: the same time lines for standalone psychotherapy.
• Psychotherapy CPT codes: every therapy code in one guide.

Sources: First Coast Billing and Coding Article A57520 (revision effective Jan 1, 2025); WPS Billing and Coding Article A57480 (revision effective Jan 1, 2026); CY 2025 PFS final rule, 89 FR 97929; CMS MLN1986542, Medicare & Mental Health Coverage (March 2026); CMS Telehealth FAQ (updated Feb 26, 2026); 42 CFR 414.52, 414.56. Verified October 7, 2026.