90837 vs 90834: time rules, audits and 2027 Long Island rates

Individual psychotherapy codes are picked by the time spent in psychotherapy with the patient. Under the CPT time rule, a session of 38 to 52 minutes is reported as 90834 and a session of 53 minutes or more as 90837. Under 16 minutes isn’t reported as psychotherapy. The note has to show the time, and that is the first thing an auditor checks. The interactive complexity add-on, 90785, has nothing to do with length: it’s for specific communication problems during the session.

The time ranges

The codes are named for 30, 45 and 60 minutes, but the ranges below are what decide the code. Medicare’s contractor for New York instructs providers to report the code closest to the actual time (Wellpoint Federal billing article A56937, revision effective April 1, 2026).

Sources: Wellpoint Federal A56937; First Coast billing article A57520, which also says not to report psychotherapy under 16 minutes.

A few rules that go with the table:

• Count psychotherapy time only. Time on a separate service, such as an E/M visit by a prescriber, doesn’t count toward the psychotherapy code. For 90833, 90836 and 90838, the psychotherapy time has to be documented separately from the E/M (First Coast A57520).
• Only some clinicians can bill the E/M combinations. Medicare pays psychotherapy with an E/M component only to physicians, physician assistants, nurse practitioners and clinical nurse specialists (Wellpoint Federal A56937).
• The service has to be psychotherapy. A visit that is mainly medication management or another service shouldn’t be billed as psychotherapy (same source).

What the note has to show for time

The New York MAC’s article requires the record to include the time element, meaning how long the face-to-face psychotherapy lasted (Wellpoint Federal A56937). Another MAC’s article says start and stop times or total time must be documented for 90832, 90834 and 90837 (First Coast A57520).

Either way, a 90837 note without a time is hard to defend. Start and stop times are the clearest form, because they also show the session didn’t overlap another patient’s. Commercial plans may have their own documentation rules, so check each plan’s behavioral health policy.

Example (for illustration only). A session runs from 2:00 to 2:55. That is 55 minutes, which falls in the 53-minute-or-more range for 90837. A session from 2:00 to 2:50 is 50 minutes, which is 90834, even though it feels like “the hour”.

90785: interactive complexity

90785 is an add-on for sessions where specific communication factors complicate the work. The LCD for New York lists the qualifying factors; at least one has to be present (Wellpoint Federal LCD L33632, Psychiatry and Psychology Services), paraphrased:

1. Maladaptive communication, such as high anxiety, high reactivity, repeated questions or disagreement.
2. Emotional or behavioral conditions that get in the way of carrying out the treatment plan.
3. A mandated reporting situation, such as suspected abuse or neglect.
4. Play equipment, devices, an interpreter or a translator needed because language expression is inadequate or the patient and clinician speak different languages.

90785 can be reported with the diagnostic evaluations (90791, 90792), individual psychotherapy (90832, 90834, 90837), psychotherapy with E/M (90833, 90836, 90838) and group psychotherapy (90853). The record has to describe the factor, the adaptations used in the session and why (Wellpoint Federal A56937). A long session alone never qualifies.

Why 90837 gets audited

90837 is the highest-paid individual psychotherapy code, so it is a natural target for reviews. The public record shows what reviewers look for:

• Medicare overall. In 2023 the HHS Office of Inspector General reported that Medicare improperly paid an estimated $580 million for psychotherapy services during the first year of the COVID-19 public health emergency, based on a sample of 216 enrollee days. Of those, 128 didn’t meet Medicare requirements. Missing documentation of psychotherapy time was one of the failures OIG cited (HHS OIG, A-09-21-03021).
• MAC reviews. MACs run targeted reviews of 90832, 90834 and 90837. First Coast’s results notice of September 1, 2026 lists the denial reasons: documentation that didn’t support medical necessity, didn’t support the time spent, or lacked measurable treatment goals (First Coast, TPE results for 90832, 90834, 90837).
• Long courses of therapy. The New York LCD says the length of a course of psychotherapy must be individual to the patient, that prolonged treatment may be subject to medical necessity review, and that the provider must document why it’s needed (Wellpoint Federal LCD L33632).

Commercial behavioral health plans also run their own reviews. We didn’t find a current, public notice from a commercial payer about a 90837 audit program to cite here. If you get a records request or an outlier letter, the letter itself is the source to work from: it names the codes, the dates and what the plan wants to see.

What holds up in a review: a time on every note, a treatment plan with goals, progress notes that tie the session to the plan, and a mix of session lengths that reflects what actually happened.

Telehealth in 2027

Medicare. For 2027, CMS implemented section 6209(c) of the Consolidated Appropriations Act, 2026, which says the in-person visit requirement for mental health services furnished by telehealth doesn’t apply to services through December 31, 2027 (CMS CY2027 PFS final rule fact sheet). Watch for what Congress does before that date.

Place of service and modifiers. Medicare and commercial plans don’t all use the same place of service codes or telehealth modifiers for video and audio-only sessions. Set these per payer from each payer’s current telehealth policy rather than from a single rule.

New York commercial plans. New York Insurance Law §3217-h requires insurers it regulates to reimburse covered services delivered by telehealth on the same basis and at the same rate as in person. The current text with that payment parity rule is marked effective until April 1, 2028 (NY Insurance Law §3217-h, revision of May 2026). It doesn’t apply to self-funded employer plans, which follow federal law and their own plan terms.

2027 Medicare rates: Long Island vs the rest of New York

Medicare pays more on Long Island than upstate because of geographic cost adjustments. Nassau and Suffolk are in Medicare locality 02, “NYC Suburbs/Long Island”, which also includes the Bronx, Brooklyn, Staten Island, Rockland and Westchester. Counties outside New York’s four downstate localities fall in locality 99, “Rest of New York” (CMS 2026 locality key, RVU26A file).

Office (non-facility) amounts, as of November 2026:

How these were calculated: relative value units times the locality’s geographic indices, times the conversion factor for clinicians not in an advanced alternative payment model ($33.4009 for 2026, $32.63 for 2027). 2026 figures use CMS’s January 2026 RVU file. 2027 figures use the CY2027 final rule’s Addendum B and Addendum E (CMS RVU26A; CMS CY2027 final rule addenda; CMS fact sheet). The 2027 work index for “Rest of New York” is 0.991, because the 1.0 floor applied in earlier years isn’t reflected for 2027 (Addendum E note). These are our calculations, before patient cost sharing, sequestration or any other adjustment. Once CMS loads 2027 into its Physician Fee Schedule Look-Up Tool, that tool is the official figure.

The headline: even with the lower 2027 conversion factor, the relative values for 90834 and 90837 went up, so their Medicare amounts rise about 9–10% on Long Island. Commercial plans set their own rates. If a contract is tied to Medicare rates, check how it handles the 2027 change.

A checklist for therapy claims

1. Every note has a start and stop time or a total psychotherapy time.
2. The code matches the time range, not the scheduled slot.
3. With an E/M visit, psychotherapy time is documented apart from the E/M.
4. 90785 only with a named qualifying factor and the adaptations used.
5. Telehealth place of service and modifier set per payer.
6. Treatment plan current, and progress notes tie back to it.

Sources

• Wellpoint Federal (New York MAC), Billing and Coding: Psychiatry and Psychology Services, A56937
• Wellpoint Federal, LCD L33632: Psychiatry and Psychology Services
• First Coast, Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services, A57520
• HHS OIG, Medicare improperly paid providers for some psychotherapy services (A-09-21-03021, May 2023)
• First Coast, Targeted probe and educate round results: psychotherapy services (September 2026)
• CMS, CY2027 Physician Fee Schedule final rule fact sheet
• CMS, CY2027 Physician Fee Schedule final rule (CMS-1848-F) and addenda
• CMS, PFS relative value file RVU26A
• NY Insurance Law §3217-h, telehealth delivery of services

General information, not advice on a specific claim, contract or legal question. Rules and rates change; check the linked sources for the current version. CPT® is a registered trademark of the American Medical Association. Code descriptions here are paraphrased.