Add-On Codes 90833 and 90836: The Revenue Most Psychiatrists Miss

Psychiatric practices often provide both medication management and psychotherapy during the same patient visit. When these services are properly performed and documented, the practice may be able to report an E/M service together with a psychotherapy add-on code. Two commonly used codes in this situation are 90833 and 90836.

The challenge is that these codes are sometimes misunderstood. They are not standalone psychotherapy codes, and they should not be added to an E/M code simply because therapy was discussed during a visit. For practices providing Psychotherapy Medical Billing Services, knowing when these codes apply can help prevent missed revenue, incorrect claims, and avoidable denials. CMS explains that 90833, 90836, and 90838 are psychotherapy add-on codes reported with an appropriate E/M service.

What Are Add-On Codes?

An add-on code is a CPT code that is reported in addition to a primary service. It is not normally billed by itself. For psychiatric billing, 90833, 90836, and 90838 are used with an appropriate evaluation and management service when psychotherapy is also provided.

This is different from codes such as 90832, 90834, and 90837, which describe psychotherapy without an E/M service. CMS separates these two groups in its billing guidance.

What Is CPT 90833?

CPT 90833 describes psychotherapy performed with an evaluation and management service. It represents the shorter psychotherapy time range in the add-on code family.

In Medicare guidance, 90833 is associated with psychotherapy of approximately 16–37 minutes, based on the applicable time range. It must be reported with an appropriate E/M service rather than as a standalone code.

For example, when the documentation supports both an E/M service and psychotherapy, a claim might include an appropriate E/M code plus 90833. The exact E/M code should be selected according to the applicable E/M coding rules and the service actually performed.

What Is CPT 90836?

CPT 90836 is also an add-on code for psychotherapy performed with an E/M service, but it represents a longer psychotherapy time range than 90833.

CMS guidance identifies approximately 38–52 minutes as the applicable psychotherapy time range for 90836. Like 90833, it cannot simply be reported by itself. It needs an appropriate primary E/M service.

The difference between 90833 and 90836 is therefore mainly the psychotherapy time range, along with the requirement that the service be properly documented and performed.

90833 vs. 90836: What Is the Difference?

The easiest way to understand the two codes is to look at the psychotherapy time.

CMS lists 90833, 90836, and 90838 as psychotherapy codes reported with an E/M service.

The important point is that the provider should not select the code simply because it may result in higher reimbursement. The code must match the actual psychotherapy service and documentation.

Why Psychiatrists May Miss This Revenue

One common problem is that a provider performs psychotherapy during an E/M visit but the claim only reports the E/M service. When the requirements for an add-on psychotherapy code are actually met, failing to report the psychotherapy portion may mean the practice is not fully reporting the services provided.

However, this does not mean every psychiatric visit should include 90833 or 90836. The psychotherapy must actually be performed, and the E/M and psychotherapy services must meet the applicable requirements.

CMS states that when both services are reported, the E/M service and psychotherapy must be significant and separately identifiable.

Common Examples of E/M + Psychotherapy Billing

Psychiatric practices often see combinations such as:

• 99213 + 90833
• 99214 + 90833
• 99214 + 90836
• 99215 + 90838

These combinations are examples of how an E/M service can be reported with a psychotherapy add-on code when the actual services and documentation support both services.

The E/M code should not be selected based only on the psychotherapy time. CMS guidance states that the E/M level is selected using the applicable E/M rules, while time spent on psychotherapy is not included in the time used to select the E/M code when these services are reported together.

Why Documentation Is So Important

Documentation is one of the most important parts of billing 90833 and 90836. The medical record needs to support the psychotherapy service as well as the separately identifiable E/M service.

A note should accurately reflect what happened during the encounter. It should not simply contain a statement that "therapy was provided" without enough information to support the service.

The provider should also make sure the documentation supports the medical necessity of the services. Good documentation gives the billing team a stronger foundation when submitting the claim or responding to a payer request.

Do You Need Modifier 25?

This is an area that often causes confusion. When psychotherapy is reported with an E/M service, the psychotherapy codes 90833, 90836, and 90838 are add-on codes. The E/M service and psychotherapy must be significant and separately identifiable under the applicable rules.

Whether modifier 25 is required on the E/M code can depend on the payer's coding rules and the specific claim circumstances. Billing teams should not automatically add modifier 25 to every E/M + psychotherapy combination without checking the applicable payer guidance.

For Medicare, the documentation must support both services, and CMS specifically states that the two services must be significant and separately identifiable.

90833 and 90836 Are Not Standalone Codes

One of the most important rules to remember is that 90833 and 90836 are add-on codes.

For example, submitting 90833 by itself would not follow the basic structure of the code. The code is designed to be reported in addition to an appropriate E/M service.

CMS specifically describes 90833, 90836, and 90838 as add-on codes used with E/M services.

This is why a claim containing an add-on code without its required primary service may receive a rejection or denial.

90833 vs. 90834

Another common mistake is confusing 90833 with 90834.

Both involve psychotherapy, but 90833 is psychotherapy performed with an E/M service, while 90834 represents psychotherapy without an E/M service.

CMS lists 90834 among psychotherapy codes without medical E/M and 90836 among psychotherapy codes performed with E/M.

The same basic distinction applies between 90837 and 90838: 90838 is the psychotherapy-with-E/M add-on code, while 90837 represents psychotherapy without E/M.

Can 90833 or 90836 Be Used With 90791 or 90792?

This is another area where billing teams need to be careful. 90791 and 90792 are psychiatric diagnostic evaluation codes, while 90833 and 90836 are psychotherapy add-on codes used with E/M services.

CMS guidance distinguishes the diagnostic psychiatric evaluation codes from E/M services and psychotherapy add-on codes. Its NCCI manual also states that E/M codes should not be reported with 90791 or 90792.

Therefore, a billing team should not treat 90791 or 90792 as interchangeable with the E/M services used to support 90833 or 90836.

What About 99417?

Prolonged-service coding can also create confusion. When psychotherapy with E/M codes such as 90833, 90836, or 90838 are reported, CMS states that prolonged services should not be reported based on the E/M time for that encounter.

This means billing teams should carefully review the rules before adding a prolonged-service code to a psychotherapy-with-E/M claim.

Never add a prolonged-service code simply because the patient was in the office for a long time. The applicable coding requirements must be met.

Common Billing Mistakes With 90833 and 90836

Small coding mistakes can lead to claim edits, denials, or lost reimbursement. Some of the most common problems include:

• Billing 90833 or 90836 without the required E/M service
• Choosing 90836 when the documented psychotherapy time supports 90833
• Reporting psychotherapy that was not actually performed
• Using the psychotherapy time to select the E/M level
• Failing to document the separate E/M service
• Adding modifier 25 automatically without reviewing payer rules
• Using 90833 or 90836 when a standalone psychotherapy code is more appropriate
• Ignoring payer-specific requirements

A strong billing process should review the documentation before the claim is submitted.

How Billing Teams Can Capture Missed Revenue

The first step is to review the provider's documentation and identify visits where both E/M and psychotherapy services were actually provided.

The billing team can then check whether the documentation supports an add-on code and whether the provider is eligible to report the services. Claims should be submitted according to the applicable payer and coding requirements.

It can also be useful to review historical claims. If a practice regularly provides psychotherapy during E/M visits but has only been billing the E/M service, a coding review may identify opportunities for improved reporting. Any corrections should follow applicable payer rules rather than being added simply to increase payment.

How Psychotherapy Medical Billing Services Can Help

Psychiatric billing requires attention to CPT codes, documentation, payer edits, eligibility, claim submission, denials, and follow-up. Add-on codes can be especially easy to miss when billing teams focus only on the primary E/M service.

Professional Psychotherapy Medical Billing Services can help practices create a consistent process for reviewing psychotherapy claims. A billing team can check whether the submitted codes match the documentation, identify claim errors, track denials, and follow up on unpaid claims.

The goal is accurate reimbursement for services that were actually provided and properly documented—not simply adding more codes to a claim.

A Simple Rule to Remember

A simple way to remember the difference is:

90833 = shorter psychotherapy + E/M

90836 = longer psychotherapy + E/M

Both are add-on codes. Neither should be reported as a standalone psychotherapy service. The documentation must support the psychotherapy, the E/M service, medical necessity, and any applicable payer requirements.

Conclusion

CPT 90833 and 90836 can be important codes for psychiatric practices that provide psychotherapy during an E/M visit. When the requirements are met, reporting the appropriate add-on code can help ensure the claim accurately reflects the services provided.

But these codes should never be added automatically. The psychotherapy must actually occur, the E/M service must be separately supported, the documented time must support the psychotherapy code, and payer-specific rules must be followed.

For practices using Psychotherapy Medical Billing Services, a consistent documentation and claim-review process can help reduce missed opportunities while protecting the practice from unnecessary denials and billing errors.