90833

Psychotherapy, 30 minutes, with Evaluation and Management Service

CPT code 90833 is a formal add-on code used to report 30 minutes of psychotherapy when performed in conjunction with an evaluation and management (E/M) service on the same day by the same physician or other qualified healthcare professional. The psychotherapy component involves a range of techniques designed to alleviate emotional distress and foster positive personality change or growth through communication. These techniques may include insight-oriented, behavior-modifying, supportive, or cognitive-behavioral therapies. Because 90833 is an add-on code, it cannot be reported as a standalone service; it must be paired with an appropriate E/M code, such as those for office or other outpatient visits (99202-99215), hospital observation (99217-99220), or inpatient care (99221-99233). The clinical documentation must clearly reflect both the medical management (E/M) portion—which typically focuses on diagnosis, physical examination, and medical decision-making regarding pharmacological or other biological treatments—and the psychotherapy portion. To report 90833, the psychotherapy session must last at least 16 minutes and up to 37 minutes. If the psychotherapy lasts less than 16 minutes, it is not separately reportable. The provider must document the specific time spent in psychotherapy, distinct from the time spent on the E/M service, and include details regarding the therapeutic techniques used, the patient's progress, and the goals of the session. This integrated approach allows for the simultaneous management of a patient's medical and psychological health needs.

Clinical Indications

  • Major Depressive Disorder requiring both medication management and therapeutic intervention.
  • Generalized Anxiety Disorder with comorbid physical symptoms requiring medical monitoring.
  • Bipolar Disorder where pharmacological stabilization is paired with cognitive behavioral therapy.
  • Post-Traumatic Stress Disorder (PTSD) involving physiological arousal and the need for therapeutic processing.
  • Adjustment Disorder where medical issues are complicating the psychological response.
  • Panic Disorder with agoraphobia requiring medication adjustment and exposure therapy techniques.
  • Schizoaffective Disorder requiring medication compliance monitoring and supportive therapy.
  • Dysthymic Disorder requiring long-term pharmacological and psychotherapeutic support.
  • Obsessive-Compulsive Disorder (OCD) when pharmacotherapy is combined with response prevention therapy.
  • Attention-Deficit/Hyperactivity Disorder (ADHD) in adults where medication titration is combined with behavioral coaching.

Procedure Steps

  1. Perform the Evaluation and Management (E/M) component, including a review of systems and physical examination if relevant.
  2. Conduct Medical Decision Making (MDM) related to the patient's psychiatric diagnosis, medication side effects, and laboratory results.
  3. Initiate the psychotherapy session, ensuring a distinct transition from the medical management portion.
  4. Employ specific psychotherapeutic techniques such as Cognitive Behavioral Therapy (CBT), Psychodynamic Therapy, or Dialectical Behavior Therapy (DBT).
  5. Monitor the patient's psychological response to the therapeutic interventions.
  6. Track the duration of the psychotherapy component using a stopwatch or by recording start and stop times.
  7. Conclude the session and provide a summary of the plan of care including both medical and psychological components.
  8. Document the psychotherapy time separately from the E/M time in the medical record.
  9. Record the specific therapeutic modalities used and the patient's response to the treatment.

Coding Guidelines

  • CPT 90833 is an add-on code (+90833) and must be billed with a primary E/M code (e.g., 99202-99215, 99221-99223).
  • Psychotherapy time must be at least 16 minutes to bill 90833. The range for this code is 16 to 37 minutes.
  • Do not use CPT 90833 in conjunction with the standalone psychotherapy codes 90832, 90834, or 90837.
  • The time spent on the E/M service is not counted toward the psychotherapy time.
  • Modifier -25 is generally not required on the E/M code when reported with 90833, as the add-on code structure inherently describes a separate service.
  • The provider must be a physician (MD/DO) or a qualified healthcare professional (NP/PA) who is licensed to perform both E/M and psychotherapy.
  • If psychotherapy is performed with an E/M service, the E/M code is selected based on MDM or total time; however, if the E/M is selected based on time, the time spent on psychotherapy must be subtracted from the total time used to select the E/M level.
  • Documentation must justify the medical necessity of both the E/M service and the psychotherapy service.

Associated ICD-10 Codes