CPT 90837 + ICD-10 F43.10: Post-traumatic stress disorder, unspecified
Psychotherapy, 60 minutes billed with Post-traumatic stress disorder, unspecified — documentation requirements, denial reasons, modifiers, and reimbursement context.
CPT Code
90837
Psychotherapy, 60 minutes
ICD-10 Code
F43.10
Post-traumatic stress disorder, unspecified
Compatibility Notes
Widely used for trauma-focused therapy (EMDR, CPT, PE). F43.10 is appropriate when PTSD is confirmed but the acute vs. chronic specifier has not been determined. Most insurers require documentation of a precipitating traumatic event and DSM-5 criteria across all four symptom clusters (intrusion, avoidance, negative cognitions/mood, arousal/reactivity). Some plans require PTSD-specific prior authorization after the initial evaluation.
Documentation Required
- ✓Session start and stop times confirming 53+ minutes
- ✓Documented traumatic event(s) and DSM-5 cluster symptoms
- ✓PCL-5 or equivalent PTSD symptom scale score
- ✓Named evidence-based trauma modality (EMDR, CPT, PE, TF-CBT)
- ✓Safety plan on file if dissociation, suicidal ideation, or self-harm risk is present
- ✓Functional impairment in occupational or social domains
Common Denial Reasons
- ✗Diagnosis coded as F43.10 (unspecified) when F43.11 (acute, <3 months) or F43.12 (chronic, 3+ months) would be more accurate — payers may flag unspecified codes at audit
- ✗No documentation of trauma-specific treatment modality
- ✗Missing PCL-5 or equivalent outcome measure
- ✗Prior authorization not obtained before session 10 for plans requiring it
Applicable Modifiers
Reimbursement Notes
UCR for 90837/F43.10 is consistent with other 90837 pairings: $130–$210 OON. TRICARE and VA CCN may have separate reimbursement schedules for PTSD treatment. Some commercial plans offer enhanced benefits (lower OON cost-sharing) for PTSD when evidence-based protocols are documented.
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