How to Document a 90837 53-Minute Therapy Session
Ahhhh, 90837.
The code that insurance has gaslighted everyone into thinking is actually an “extended session”.
😂
If you bill a 53-minute psychotherapy session, your documentation absolutely needs to support the service you provided.
But that does not mean:
53-minute session = 53-minute progress note.
Your note still has the exact same job.
Document the clinical need.
Document the skilled treatment.
Document the client's response.
Document progress.
Document the plan.
And document the time.
That's it.
What Is CPT Code 90837?
90837 is the CPT code used for an individual psychotherapy session of 60 minutes, with the CPT time rule allowing the code to be reported for sessions lasting 53 minutes or longer.
Which is why therapists commonly refer to it as the 53-minute therapy session.
If you're billing 90837, your documentation should support that the psychotherapy service actually occurred for the required amount of time.
And yes:
Put the fucking time in the note.
Document the Actual Session Time
This does not need to be complicated.
Depending on your documentation system and requirements, you may document:
Start time: 2:00 PM
End time: 2:55 PM
Or:
Psychotherapy time: 55 minutes
The important thing is that your documentation supports the service you're billing.
Please do not make an auditor perform advanced calculus using your appointment calendar, vibes, and the position of the sun to determine whether the session met the time requirement.
😂
Make it clear.
90837 Does Not Mean Your Note Needs to Be Longer
This is probably the biggest misconception I want to kill.
A longer therapy session does not automatically require a longer narrative.
You still need to document the clinically relevant information from the session.
If you can adequately establish:
Symptoms and functional impairment
Skilled intervention
Client response
Progress
Continued medical necessity
Plan
in a concise note?
Great.
The fact that you spent 53+ minutes providing psychotherapy does not mean you need three pages describing what the client talked about.
But Your Documentation Should Support a Skilled Psychotherapy Service
The other extreme isn't great either.
If you're billing a full psychotherapy session and your entire note says:
Client discussed stress. Therapist provided support. Client was receptive. Continue therapy.
I would like us to try again. 😂
Give me the clinical story.
For example:
Client reports continued anxiety and excessive worry resulting in difficulty concentrating and completing occupational responsibilities. Therapist utilized cognitive restructuring to support the client in identifying and challenging catastrophic thoughts contributing to anxiety and avoidance. Client identified two cognitive distortions and developed alternative thoughts with therapist support. Client demonstrates partial progress toward reducing anxiety-related impairment but continues to experience clinically significant symptoms affecting occupational functioning. Continue weekly psychotherapy focused on increasing independent implementation of CBT skills.
That tells me substantially more.
And we still didn't write a novel.
Don't Add Random Detail Just to "Justify" the Longer Session
I see therapists get nervous about 90837 and start adding shit.
More client quotes.
More history.
More details about what happened during the week.
More description of the client's relationships.
More everything.
But none of that necessarily explains why a skilled psychotherapy service was provided.
Your note should demonstrate clinical complexity and treatment, not simply contain a higher word count.
If additional information is clinically relevant, document it.
If you're adding it because the note looks suspiciously short to you?
That's not a particularly compelling reason to permanently put it in the client's medical record.
Your Intervention Documentation Matters
If you're billing psychotherapy, I want to know what psychotherapy you provided.
Instead of:
Therapist provided supportive therapy.
Tell me:
Therapist utilized cognitive restructuring to address catastrophic thinking contributing to anxiety.
Or:
Therapist utilized DBT emotion-regulation strategies to support the client in identifying vulnerability factors contributing to increased emotional reactivity.
Or:
Therapist utilized ACT cognitive defusion to support the client in changing their relationship with distressing thoughts contributing to avoidance.
You provided skilled clinical treatment.
Document the fucking treatment.
Document Why Treatment Is Still Necessary
The client can absolutely be improving while continuing to require 90837 psychotherapy.
Maybe symptoms have decreased but remain clinically significant.
Maybe functioning has improved but impairment remains.
Maybe the client understands the skills but still requires substantial therapist support to implement them.
Maybe you're actively addressing complex or persistent symptoms.
Your note might say:
Client demonstrates continued improvement in anxiety symptoms but continues to experience clinically significant avoidance affecting occupational functioning and requires ongoing psychotherapy to support further symptom reduction and independent skill implementation.
Progress.
Remaining need.
Treatment.
Beautiful.
Does Every 90837 Note Need to Explain Why You Used 90837 Instead of 90834?
This is where I don't want you inventing unnecessary documentation requirements.
Your record should accurately support the service provided, including the required time and the clinical work performed.
If a specific payer, employer, state program, or organizational policy requires additional justification for longer psychotherapy sessions, obviously follow that requirement.
But don't start adding a giant paragraph titled:
WHY I DESERVE 90837 TODAY
to every progress note because somebody on Facebook told you insurance requires it. 😂
Know the requirements that actually apply to your practice and your payer contracts.
90837 Documentation Still Needs to Be Individualized
You can absolutely use a template.
You know I love a fucking template.
But your note should still reflect:
This client.
This session.
This clinical presentation.
These interventions.
This response.
You don't need entirely original prose every week.
But you also don't want 37 notes that are identical except for the date.
Templates should make accurate documentation faster.
They're not supposed to turn your clinical record into Mad Libs.
A Simple 90837 Progress Note Structure
If you're staring at your EHR after your last client of the day wondering what the hell insurance actually needs from you, think:
TIME: How long was the psychotherapy service?
PRESENTATION: What symptoms and functional impairment were clinically relevant?
INTERVENTION: What skilled psychotherapy did I provide?
RESPONSE: How did the client respond?
PROGRESS: How are they progressing toward the treatment goal?
MEDICAL NECESSITY: What clinically significant symptoms or impairment remain?
PLAN: What happens next?
That's your note.
The 90837 does not magically require you to document the client's entire life story.
Example of a Concise 90837 Progress Note
Here's what that could look like:
Psychotherapy time: 55 minutes. Client reports continued anxiety characterized by excessive worry and difficulty concentrating, resulting in impairment in occupational functioning. Therapist utilized CBT cognitive restructuring and Socratic questioning to support the client in identifying and challenging catastrophic thoughts related to occupational performance. Client successfully identified cognitive distortions and developed alternative thoughts with therapist support. Client demonstrates continued progress toward reducing anxiety-related impairment but continues to experience clinically significant worry affecting occupational functioning. Continued weekly psychotherapy remains indicated to support further symptom reduction and independent implementation of CBT skills.
That's it.
We have the time.
Clinical presentation.
Functional impairment.
Intervention.
Response.
Progress.
Continued need.
Plan.
No transcript.
No novella.
No description of what their fucking coworker Karen said at lunch.
90837 Is a Billing Code, Not a Creative Writing Assignment
Ultimately, documenting 90837 isn't fundamentally different from everything else we've been talking about.
Your documentation should accurately support the service you're billing.
Document the time.
Document the clinical need.
Document the skilled psychotherapy.
Document what happened as a result.
Document what happens next.
Then sign the fucking note and go home.
Want Me to Just Give You the Progress Note Template?
Obviously. 😂
My Documentation Templates for Compliance include a customizable individual therapy progress note template designed to help you document session time, clinical presentation, functional impairment, skilled interventions, client response, progress, continued medical necessity, and the ongoing treatment plan without writing a fucking novel.
The bundle also includes diagnosis-based treatment plan goals, modality-based objectives and interventions, client strengths, medical justification language, safety documentation, and diagnostic justification.