If you integrate psychotherapy into medication visits, 90833 is one of the most useful codes available to you. It is also one of the most misunderstood.
Plenty of PMHNPs delivering real therapeutic work are not reporting it at all. Others report it without the documentation to support it. And some report it on visits where the therapy did not really happen, which is a different problem with different consequences.
What CPT 90833 Is
90833 is an add-on psychotherapy code. You report it when you provide individual psychotherapy as a distinct service during the same encounter as an evaluation and management visit.
It is not a standalone code. It attaches to a primary E/M service. If you are providing therapy without medication management or medical decision-making, you are in standalone psychotherapy territory, which uses a different code set selected on total face-to-face time.
The Constraint Most Guides Leave Out
When you report an add-on psychotherapy code, the E/M must be selected on medical decision-making, not time.
Psychotherapy is the time-based service. The E/M is not. Your documentation has to support the MDM complexity of the level you reported, whether that is Problem, Data, and Risk adding up to a 99213 or a 99215.
This rules out the most common way providers think about these visits. You cannot take a 30-minute encounter, assign 16 minutes to psychotherapy, and treat the remaining 14 as the E/M. The same clock cannot support both services, and the E/M portion has no minimum time requirement at all. For a stable patient, the medication portion may take only a few minutes and still support the level, as long as the decision-making is documented.
The 16-Minute Threshold
To report 90833, you need at least 16 minutes of distinct, medically necessary psychotherapy during the encounter.
That is psychotherapy time only. Not total visit time. Not the combined E/M and therapy time. It also should not be rounded up.
Record it separately from the E/M. Cumulative time may be acceptable when clearly documented, but start and stop times give stronger audit defensibility, because they show a distinct service period rather than a total that may or may not overlap with the E/M work.
Past 37 Minutes, the Code Changes
90833 covers 16 to 37 minutes. Two other add-on codes exist and most PMHNPs never use them:
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90836 for 38 to 52 minutes
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90838 for 53 minutes and above
If you regularly deliver 40 or 45 minutes of therapy alongside a medication visit and report 90833 every time, you are undercoding. The code should match the time you actually provided.
What Belongs to Each Service
The E/M portion covers assessing symptom response and functional impairment, reviewing adherence and side effects, assessing safety, weighing the risks and benefits of treatment decisions, confirming or adjusting the medication plan, and providing brief monitoring guidance.
The psychotherapy portion covers a distinct therapeutic intervention that extends beyond medication review or symptom check-in. Cognitive restructuring, behavioral interventions, emotional processing, skills-based work, and crisis-focused intervention all qualify when directed at functional impairment or symptom reduction.
Two points that trip providers up.
You do not have to name a theoretical school. The intervention can be described by therapeutic function. Skills-based, behavioral, cognitive, or crisis-focused is sufficient, and it is often more accurate than claiming a manualized protocol you did not deliver.
Psychoeducation can qualify, but only when it is tied to symptom management and treatment planning rather than delivered as general information. The same applies to supportive work. Supportive psychotherapy on its own may not meet the criteria unless it reflects structured therapeutic intent, links to a goal, and involves active clinical work beyond reassurance.
What Your Note Has to Show
Six elements:
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The psychiatric problem or symptom domain addressed during the therapy
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Medical necessity, shown through functional impairment, symptom severity, or clinical risk
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A distinct therapeutic intervention, not medication counseling
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A description of the therapeutic approach or function
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The patient's response to the intervention
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Psychotherapy time documented separately from the E/M
Structural separation matters as much as content. Distinct headings for the two services strengthen audit defensibility and reflect the work more accurately than a single narrative block.
The Question to Ask Before You Bill
If an auditor removed the medication portion of this note, would the psychotherapy section stand alone as a medically necessary service?
If yes, the claim is defensible. If no, revise before billing.
Common Mistakes
Counting total visit time toward the threshold. The 16 minutes is psychotherapy time only.
Selecting the E/M on time. Not available when an add-on psychotherapy code is reported.
Writing "supportive therapy provided" or "discussed coping skills." Neither describes an intervention.
Blending the two services in one narrative. If a reviewer cannot see where the E/M ends and the therapy begins, the add-on is at risk.
Defaulting to 90833 regardless of time. Check whether the session actually supported 90836 or 90838.
Leaving out medical necessity. Time and technique are not enough on their own. The note has to show why therapy was needed for this patient today.
The Part That Is Not About Coding
Undercoding and overcoding get framed as opposite problems. They are the same problem, which is a note that does not match the visit.
The advice circulating in PMHNP groups to "just vary your time" so the add-on looks supportable is worth naming directly. It is not a workaround. It produces a claim for a service the patient did not receive, and it puts your license behind that claim.
The standard is not complicated. Psychotherapy means a real therapeutic exchange, with reflection, insight, and applied skill work. If that happened, document it specifically and bill it confidently. If it did not, the visit was a medication visit, and that is a complete and valuable service on its own.
The Bottom Line
90833 is a legitimate service for PMHNPs delivering structured psychotherapy inside medication visits. The clinical work is usually already happening. What determines whether it gets paid is whether the note shows two distinct services, with the E/M supported by decision-making and the psychotherapy supported by time and content.
Want note examples that show both services documented side by side?
The Psychotherapy Documentation and Coding Handbook includes full note examples for 99213 through 99215 with add-on psychotherapy and the MDM breakdown for each, a template for combined medication and psychotherapy visits, brief intervention descriptors you can use as documentation language, and reference tables for time thresholds and billing criteria.
Crystal Stone, PMHNP-BC, FNP-BC, CPMA, CPC, and CPB of New Leaf Billing, Coding, and Auditing Solutions, LLC, conducted an independent content review of the Psychotherapy Documentation and Coding Handbook for general alignment with documentation and coding standards.
This content is intended as general educational information and does not constitute coding, billing, or legal advice. Coding requirements and payer policies vary by plan, state, and setting. Providers should verify requirements against current CPT, CMS, and payer-specific guidance, and should follow the documentation, supervision, and scope-of-practice requirements applicable to their licensure.