What is CPT (Current Procedural Terminology) 90836?

CPT Code 90836: Psychotherapy with Evaluation and Management Service

CPT code 90836 is a billing code for psychotherapy with evaluation and management services, specifically representing a 45-minute psychotherapy session with E/M service for an established patient. 1

Definition and Usage

CPT code 90836 is part of the individual psychotherapy code series (90832-90838) that can be used for telemedicine services. This code specifically represents:

• 45 minutes of psychotherapy
• Includes evaluation and management (E/M) services
• Used for established patients
• Can be provided via telemedicine when appropriate telecommunications systems are used

Provider Eligibility

Not all practitioners can bill using this code. According to Medicare guidelines:

• Physicians, physician assistants, nurse practitioners, nurse-midwives, and clinical nurse specialists can bill using code 90836
• Clinical psychologists (CPs) and clinical social workers (CSWs) cannot bill for this code as they are not permitted to bill for psychotherapy services that include medical services or medical evaluation and management services under Medicare 1

Documentation Requirements

When using CPT code 90836, providers must document:

• The 45-minute psychotherapy session
• The evaluation and management component
• Medical necessity for the service
• For telemedicine: documentation that an interactive audio and video telecommunications system was used that permitted real-time communication

Telemedicine Considerations

This code is eligible for telemedicine services under Medicare when:

• The patient is at an authorized originating site
• Real-time audio and video telecommunications are used
• The patient is present and participating in the session
• The medical examination is under the control of the distant site provider 1

Billing Context

When billing for psychotherapy with E/M services:

• The primary service is the E/M service
• Time spent providing psychotherapy is added to the E/M service
• The level of E/M service is selected based on the complexity of the E/M service
• Documentation must clearly distinguish the psychotherapy service from the E/M service

Common Pitfalls to Avoid

1. Insufficient documentation of both the psychotherapy and E/M components
2. Clinical psychologists or social workers incorrectly using this code
3. Not meeting the full 45-minute requirement for the psychotherapy portion
4. Failing to document medical necessity for both components
5. In telemedicine settings, not using or documenting the required interactive telecommunications system

Understanding the proper use of CPT code 90836 is essential for accurate billing and reimbursement for psychotherapy services that include evaluation and management components.