UPDATED AUGUST 7, 2026

There has been a great deal of confusion about billing for psychotherapy sessions that last longer than 60 minutes.  How should they be coded?   Will health insurance plans cover these longer sessions?  Must the therapist get preauthorization?

  Must the therapist document these sessions differently?

This article will address these questions, review the billing codes that have been used for these codes, and bring you up to date on the latest billing options.

What are CPT billing codes?

CPT codes are the 5-digit codes used on health insurance claim forms and superbills (also called statements) to identify the types of services rendered by the medical professionals, including mental health clinicians. The American Medical Association (AMA) maintains these codes and updates them regularly.

The history of CPT codes for longer sessions

Prior to 2012, there was a special CPT code for longer sessions. That code, 90808, was used for sessions 75 – 80 minutes long.  

However, in 2013, when the AMA did a major revision of the CPT codes, the 90808 code was deleted. The AMA then offered only three timed codes for individual psychotherapy, where the longest one was 90837:

• 90832:  30-minute psychotherapy (16 – 37 minutes)
• 90834:  45-minute psychotherapy (38 – 52 minutes)
• 90837: 60-minute psychotherapy (53 minutes and above)

Since 90837 was to be used for any session over 53 minutes, there was no way to distinguish a 60-minute session from a longer session. Because of this, insurance reimbursement for a longer session (ex a 90- or 120-minute session) would be the same as the 60-minute rate.

Then in 2016, the AMA allowed Prolonged Services codes 99354 and 99355 to be used by non-medical personnel. These “add-on codes” could be added to a CPT 90837 for individual sessions 90 minutes and more.  Then in 2017, the AMA allowed these codes to be added to family or couples therapy CPT code 90847 sessions that lasted 80 minutes or more.

While some health plans never covered Prolonged Services codes, many did, so for a few years some therapists and clients enjoyed a significant increase in reimbursement for longer sessions.  

Then, on January 1, 2023, codes 99354 and 99355 were deleted from the CPT code set.   

The codes 99417 or G2212 were deemed to be the replacement codes for 99354 and 99355.  However, coding experts agreed that these codes could not be used in conjunction with psychotherapy codes 90837 or 90847.  

So, what billing options are left for billing extended sessions?  

• As of this writing, there is no CPT code for a psychotherapy session longer than 60 minutes other than 90837.  Unfortunately, for this code you will be paid the same rate as you would for a 53-minute session. 

Will health plans cover routine 90837s for a client? While some health plans have no issue with 90837 being used regularly for all your sessions, some plans feel that a 45-minute session should be sufficient for routine therapy. These plans view the 90837 53-minute-or-longer session as necessary only for complex cases, dual diagnoses, or specialized modalities that take additional session time.  

These modalities might include EMDR, Systematic Desensitization, Specialized Trauma Treatments, and DBT protocols. In fact, up until 2018 United Health/OPTUM required preauthorization for use of the 90837. While preauthorization is no longer needed by this health plan for 90837, even now in a records audit, some health plans like Medicare, Blue Cross, and United/OPTUM might not see the routine use of 90837 as medically necessary.  For these plans especially, you may want to vary your session length for routine sessions, or be sure to document the clinical need for longer sessions.  And ALWAYS document your session start and stop times for all health plans.  It is wise to question the health plan to research their 90837 reimbursement policy, and verify if preauthorization is needed.  

• While it may be a long shot, for a 90-minute session, you might ask the health plan if it is possible to bill for two units of 90834, or for a 120-minute session, two units of 90837. For an extended couples or family session you might check if you can bill for two units of 90847 (this seems less accepted).   Some therapists have reported that they have been reimbursed when they billed for two units, but this doesn’t seem typical.  And there are risks for billing in this way.  The health plan could deny payment for the session instead of just paying for the first 60 minutes.  And even if the health plan pays, billing for two units on one day could increase your risk of an audit.  After auditing your notes, the health plan may decide they should NOT have paid for the extra time, and may request money back.  

• If you are a network provider, can you bill one 45- or 60-minute session to insurance, and contract privately with the client to pay any additional time out of pocket? As always, it’s best to check your health plan contract to see if there is anything that might forbid this.  In my view, a client should retain the right to pay for any services that are not covered by their plan.  However, it is a gray area, and if you are audited, the health plan may say you violated your contract by charging the client more than their copayment and deductible for a “covered session.” But is this extra time part of the “covered session,” or should you treat it like a separate session, with a separate session note and billing?  One insurance network executive told me billing clients for the extra time would be allowed as long as clients signed a Self-Pay Agreement in advance stating they understood that this additional time would be their responsibility, and understood how much would be owed for the sessions.  (I have such a Self-Pay Agreement available for purchase in my Practice Forms Packet).

• If the session meets the criteria for a crisis session, the choice might be made to bill using the crisis CPT codes: 90839 for the first 60 minutes of a crisis session, and 90840 as the add-on for each 30 minutes of additional time after the 60 first minutes. Note that  90840 is an add-on code that can only be used with 90839, and 90839 cannot be used with any other psychotherapy code.  In order for the crisis codes to apply, the presenting problem must require immediate attention to a client in high distress, including life-threatening or at least highly complex crisis clinical situations.  See my article on crisis codes here.

• Can you use 90837 for ongoing couples or family therapy?  One of the biggest mistakes clinicians make with the 90837 CPT code is using this code for couples or family therapy.  Often this is done when the health plan’s reimbursement rate is higher for CPT 90837 than for the couples/family code 90847.  But for ongoing family or couples therapy you must use 90847 if the client is present, and 90846 if the client is not present.  The only exception to this rule is when you are doing ongoing individual therapy and bring a parent or partner or other “informant” in once or occasionally or for part of a session, to inform you in your treatment of the individual client.  In this case, the main client must be present for all or most of the session.

• So, how do you code extended couples sessions?  Once again, the same problem exists as with individual therapy:  There is no designated CPT code for this service.  And since the couples and family codes 90847 and 90846 are for sessions 26 minutes and above, there is no way to distinguish a longer session from a 26-minute or 50-minute session, and the health plan will pay at the same rate.

Documentation of longer sessions

Must you document longer 90837 sessions differently?  Since longer sessions are more vulnerable to health plan scrutiny and audit, It is essential to document in every session note why the longer session was clinically necessary.  The rationale must be deemed medically necessary and related to the client’s needs and not just their convenience or desire.  For example, a trauma-related treatment modality such as EMDR may require a prolonged service time.  For more on understanding medical necessity and how to document it, see my webinar “What’s Missing From Your Charts: Writing Great Notes.“)

Some final words

The absence of an extended session CPT code has led many therapists who do longer sessions to resign from insurance networks. Many therapists feel they are unable to be adequately reimbursed for the extra time they are putting in, which may be essential to the type of treatment they provide.

While we can look for different ways to code and bill for these longer sessions, and hope that new codes emerge for longer sessions, it must be acknowledged that our discussions are the result of an industry-wide trend toward encouraging briefer treatment, and disincentivizing longer sessions.