CPT Code 90836: Extended Psychotherapy Add-On to E/M (38+ Minutes)

CPT code 90836 is a psychotherapy add-on code for 38 or more minutes of individual psychotherapy provided on the same day as an evaluation and management (E/M) service. Like 90833, it is never billed alone — only alongside an E/M code from the 99202–99215 range.

90836 vs 90833: Which to Use

The two psychotherapy-with-E/M add-on codes are differentiated by time:

• 90833 — psychotherapy 16–37 minutes with E/M
• 90836 — psychotherapy 38+ minutes with E/M

Use 90836 when the documented, face-to-face psychotherapy component reaches at least 38 minutes. Sessions billing 90836 will typically run 60–75 minutes total when the E/M component is included.

Who Can Bill CPT 90836?

The same provider restrictions apply as with 90833. Only prescribers who also provide psychotherapy can bill 90836:

• Psychiatrists (MD or DO)
• Psychiatric nurse practitioners and other NPs with prescribing authority and psychotherapy training

Non-prescribing therapists use standalone individual therapy codes (90832, 90834, 90837) rather than the add-on series.

Documentation Requirements

For 90836, documentation must clearly separate the E/M and psychotherapy components:

• Start and stop time (or total face-to-face time) for the psychotherapy portion, confirming 38+ minutes
• Content of the psychotherapy (modality, goals addressed, patient response)
• A separately documented and supportable E/M level in the same note
• A single diagnosis can support both the E/M and the psychotherapy, but document the clinical rationale for both services

Typical Reimbursement

Because 90836 represents more psychotherapy time than 90833, its add-on reimbursement is higher:

• Medicare non-facility rate: approximately $67–$73 (add-on amount)
• Commercial insurance: $60–$95 added to the base E/M rate

Some commercial payers require prior authorization for extended psychiatric sessions. Verify with the patient's plan before scheduling 90836 sessions routinely.

Superbill and Patient Reimbursement

For OON psychiatric providers issuing superbills, list the base E/M code and 90836 as separate line items. Include the time-based documentation in the clinical record in case the payer requests it during claims review. Patients submitting these superbills to commercial insurance should expect review at the higher-complexity E/M level to be scrutinized alongside the extended psychotherapy add-on. See the full guide on prior authorization for mental health services for guidance on managing authorization for these session types.