--- title: How to document 90833 add-on psychotherapy on a med visit | Nextvisit description: 90833 needs separately identifiable psychotherapy minutes (16-37), content, and an E/M selected by MDM. One combined time stamp fails. url: "https://nextvisit.ai/guides/how-to-document-90833-add-on-psychotherapy" type: static generatedAt: "2026-09-21T03:13:59.911Z" --- Guide # How to document 90833 add-on psychotherapy on a med visit 90833 needs separately identifiable psychotherapy minutes (16-37), content, and an E/M selected by MDM. One combined time stamp fails. Guide / For Psychiatrists, NPs and PAs / 4 min / Updated June 1, 2026 To bill 90833 with an office E/M, the note has to show two services: medical evaluation and management, plus 16 to 37 minutes of psychotherapy that is significant and separately identifiable. Split the minutes, split the content, and select the E/M by medical decision-making. CPT does not let visit time choose the E/M level when a psychotherapy add-on is on the claim. The add-on family is 90833 (16-37 min), 90836 (38-52), 90838 (53+). Under 16 minutes of psychotherapy, drop the add-on and bill the E/M only. [Reviewing mental health service codes](/guides/ai-compliant-upcoding-mental-health-revenue) is the code map; this page is the note. ## Split the visit before you write In your head, mark two piles. E/M pile: interval symptoms, meds, side effects, safety as medical risk, labs, refills, MDM. Psychotherapy pile: a psychotherapeutic intervention (CBT skill, exposure planning, motivational work, grief work, psychodynamic interpretation) with the patient present, plus the response. Taking a PHQ-9 and adjusting sertraline is E/M. Teaching the patient to run a thought record on the fight they described, and rehearsing it, is psychotherapy. “I listened supportively while I did the med review” is still E/M. If you cannot name the technique, you do not have 90833. ## Document the E/M on MDM, not on clock time Write a compact medical note: problem(s), data reviewed, risk, and the medical decision. 99213 vs 99214 is about complexity of that medical work. Do not write “45-minute visit, 99214.” That invites a reviewer to treat the whole clock as E/M and then deny the add-on as double-counting. Noridian and other MACs want minutes or start/stop for each service. Even though MDM selects the E/M, documenting E/M minutes (or a clearly separate medical block) is how you prove the psychotherapy minutes were not borrowed from med management. ## Document psychotherapy minutes and content separately A dedicated heading is the cleanest defense. > Psychotherapy (90833): 22 minutes. CBT, cognitive restructuring of “the lithium means I am defective.” Patient generated two alternative appraisals and agreed to log one workday. Affect shifted from shame to irritated-but-engaged. This work is separate from today’s lithium level review. Include: total psychotherapy minutes or start/stop, modality, specific technique, patient response, and the treatment-plan goal it served. Family can be present; the patient still has to be there for all or most of the psychotherapy time. Do not count the same sentence in both piles. Counseling about side effects is E/M. Prolonged services are not billable on top of E/M plus psychotherapy add-on. ## Keep the claim and the note in the same story If the medical work was straightforward (stable meds, straightforward refill) and the hour was therapy, consider 90834 or 90837 without an E/M. If the medical work was the visit and you did eight minutes of supportive talk, skip 90833. Modifier 25 on the E/M is a commercial-payer habit more than a Medicare one. Follow the payer in front of you; the documentation standard does not change. ## Sample combined note ``` E/M (MDM; estimated 18 minutes medical work) Interval: residual insomnia, PHQ-9 12 (was 14). Sertraline 100 mg, missed 1 dose. Lithium not applicable. BP 118/76. C-SSRS since-last-visit negative. MDM: MDD, recurrent, moderate, partial response. Continue sertraline 100 mg. No change today; 4 more weeks to complete adequate trial. Follow-up 4 weeks. Psychotherapy add-on 90833: 24 minutes (not included in E/M selection) Intervention: behavioral activation plan for mornings (activity schedule, graded return to gym). Patient identified two 15-minute actions for the next 3 days. Response: engaged, some skepticism, wrote the plan in notes app. Goal: restore morning routine that collapsed in March. Total face-to-face: 42 minutes. Patient present throughout. ``` ## Questions people ask Can I use visit time to pick 99215 and also bill 90833? No. With the add-on, E/M level is MDM only. Does “supportive psychotherapy, 20 minutes” hold? Rarely, unless you say what was supported and what changed in the room. Name a method. See it on your workflow ## Twenty minutes, one mock visit. You leave with a note in your template. We run a mock session live, draft the note, and walk through what the downstream claim would look like. No slides. No sales deck. [Book a demo](https://nextvisit.cal.com/ryan/demo) [Talk to sales](mailto:hello@nextvisit.ai) Live in 2 weeks or less BAA signed by default