CPT 90837 + ICD-10 F43.12: Post-traumatic stress disorder, chronic
Psychotherapy, 60 minutes billed with Post-traumatic stress disorder, chronic — documentation requirements, denial reasons, modifiers, and reimbursement context.
CPT Code
90837
Psychotherapy, 60 minutes
ICD-10 Code
F43.12
Post-traumatic stress disorder, chronic
Compatibility Notes
F43.12 is used for PTSD persisting 3 or more months from the precipitating trauma. This is a high-specificity code favored by payers over the unspecified F43.10 for established PTSD patients. EMDR, CPT, and PE are the evidence-based modalities most commonly associated with this pairing. VA/TRICARE plans have specific documentation requirements for chronic PTSD.
Documentation Required
- ✓Session start and stop times confirming 53+ minutes
- ✓Established PTSD diagnosis with trauma onset date confirming chronicity (3+ months)
- ✓Current PCL-5 or PTSD Checklist score
- ✓Named evidence-based trauma modality with progress notes
- ✓Safety screen for suicidal ideation and self-harm
- ✓Functional impairment across domains
Common Denial Reasons
- ✗Using F43.10 (unspecified) when chronicity is clearly established — specificity improves claims acceptance
- ✗No outcome measure tracked over time for a chronic condition
- ✗Prior authorization lapsed for long-running PTSD treatment
Applicable Modifiers
Reimbursement Notes
UCR $130–$210 OON, consistent with all 90837 pairings. VA CCN and TRICARE may reimburse at different rates. Some plans offer enhanced mental health parity reimbursement for documented evidence-based trauma protocols.
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