For many therapists, the 60-minute session is standard. This is particularly true if you provide time-sensitive techniques like EMDR or Somatic Therapy, or if you work with complex cases, trauma, families, and couples.

But many clinicians have begun to wonder whether it is wise to offer routine 60-minute sessions, coded as CPT 90837. Some health plans now treat these as “extended sessions,” sometimes asking to see session notes to determine the medical necessity for this session length.

Other health plans suppress the use of 60-minute sessions by reimbursing them at the same rate as 45-minute sessions. I recently reported on Aetna’s implementation of this policy for their providers who bill using the billing platform Alma. This flat pay scenario may also be true with Employee Assistance Plans (EAPs) and some Managed Medicaid Plans.

Before you quit accepting insurance or resign from a particular health plan, do some income calculations related to a change in your practice. Ask yourself: Could you switch to routinely providing 45-minute sessions instead of 60 minutes? And could you do so without losing something vital in your treatment?

Address your feelings about making this shift

Even when the decision is practical or necessary, it’s normal to have feelings about this change. When you are used to 60 minutes, it’s logical that shorter sessions might feel like you are short-changing your clients, and offering them less support. You may worry this will lead to higher levels of anxiety and depression.

You may worry about client reactions, and feel anxious about disappointing them, triggering abandonment concerns, or facing anger.

You may feel angry that insurance policies or business realities are shaping your clinical frame. If 60-minute sessions have felt central to your way of working, and you like a slower pace of therapy, this shift could feel like a real loss.

You may consider resigning from insurance plans altogether, but feel this isn’t an option if you know your clients can’t afford to see you privately.

Let’s review: The rules of 45-minute sessions

• The CPT code 90834, defined as 45-minute psychotherapy, technically can be used for sessions 38-52 minutes long.
• 90834 can only be used for individual sessions or for sessions when a member of the client’s support network is brought into ongoing individual therapy. The code cannot be used for ongoing couples or family therapy.
• The Identified Patient (IP) must be present for all or most of the session.

Prior to making the transition

Give careful thought before transitioning.

• Consider: Will you move all clients to 45-minute sessions? Just those with mild or moderate symptoms? Just those whose health plans don’t pay for or support longer sessions?
• Before transitioning, bring your feelings to consultation, supervision, or therapy. The more grounded you feel, the more confidently you can hold the change for your clients.
• Give yourself permission to grieve while also staying open to discovering new strengths in a shorter, more focused format. Remind yourself that thoughtful, well-structured 45-minute sessions can still be clinically effective and ethically sound.
• Role-play with a colleague how to deal with each client’s anticipated reactions. Preparing language can help you stay regulated and compassionate in these conversations.
• Inform clients at least 2 to 3 sessions before any change in session length takes effect. Inform them in person, when possible, then follow up with a written notification.

When telling your clients

• Be transparent but professional when informing your clients. Avoid badmouthing their insurance plan (which can negatively impact you) or the insurance bureaucracy. Let them know the facts of the change.
   
  Example: “I need to start our session today by letting you know that your health plan has updated insurance policy requirements for network providers like myself. Your plan will now cover only a 45-minute therapy session. I want to make it possible for you to continue to use your insurance without interruption, so we will need to adjust our regular session length from 60 minutes to 45 minutes starting next month.”
• Document what you said to them and the client’s reactions in their chart.
• Give the client an opportunity to express their feelings. Validate their frustration or disappointment, but pivot to addressing how things will look in therapy going forward.
   
  Example: “I understand your frustration. But to keep taking your insurance so your out-of-pocket costs don’t skyrocket to cash pay rates, I have to work within their new time blocks, and we can talk about how to do that.”
• Your attitude matters. While you don’t have to pretend to love the change, have an attitude of confidence that together you can still work within the new structure to meet their therapeutic goals
   
  Example: “I get it. But my commitment to you is that we will make these 45 minutes highly structured and focused so you don’t lose any of the clinical value or progress we’ve been making.”
• If it triggers a rejection response: Reassure clients who express concern that you just want to spend less time with them.
   
  Example: “I am really glad you brought that up. This has nothing to do with you, our relationship, or how much I value working with you. This is strictly a policy shift from the health plan that affects all of my clients who use their network. If it were up to me, our time wouldn’t change. I am making this adjustment precisely because I want to keep working with you as your therapist while still allowing you to use your health benefits.”

Emphasize potential benefits

See if you can come up with any potential positives related to a shorter session.

• For some trauma clients: Example: “I absolutely understand that unpacking trauma requires careful pacing, and your safety is my top priority. Sometimes, routine 60-minute sessions can actually lead to emotional overwhelm, leaving you feeling drained or destabilized for the rest of the week. So sometimes shorter, highly contained 45-minute blocks can actually be safer for some people who are processing trauma. It forces us to do deep work in shorter bursts, leaving a solid 10 minutes at the end strictly for grounding, stabilization, and closing the container safely so you leave here feeling regulated.”
• Benefits for the therapist and client: Example: “One benefit of this new schedule is that it gives me a longer break between sessions. That time helps me prepare more thoughtfully before we meet and to reflect, document, and plan more carefully afterward. In turn, that helps me be more present, focused, and effective in the care I provide to you.”

Getting the most out of your 45-minute sessions

At this point, pivot to planning with your client. Invite them to brainstorm. “Let’s discuss ways we can adjust our routine to maximize our time together.” Some ideas might include:

• Have a quick check-in at the start of the session
• Have the client keep a between-session journal, and come in prepared to talk about issues that come up between sessions
• Watch the time, and remind clients when they have 30 and 15 minutes left. Example: “We have about 15 minutes left before we do our summary, and I want to make sure we address the most important piece of this before we close out.”
• Keep firm boundaries. Be willing to say “that’s a great topic! Since we’re out of time today, why don’t you write about that, and share it next time?”
• Use the last 10 minutes to have the client summarize key takeaways, to assign homework, and schedule the next visit.
• Increase homework: Utilize behavioral experiments, journaling prompts, or worksheets between sessions

The wrap up

Switching from 60-minute to 45-minute sessions can feel like a big change, and bring up worry or uncertainty for both you and your clients. But a shorter session does not mean therapy must be less effective. It can be a great clinical opportunity to address with clients how they deal with change. And with planning, clear communication, and a more intentional structure, you can still do powerful, meaningful work in 45 minutes. Over time, the new format may even bring some unexpected benefits like better focus and clearer boundaries, and lead to less therapist burnout.