90837 Audit Letter: What It Means and How to Respond
Got a 90837 letter? The 53-minute rule, what reviewers check on 60-minute psychotherapy claims, documentation that holds up, and how a group should reply.
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Direct answer
90837 audit letter: what operators need to know
Got a 90837 letter? The 53-minute rule, what reviewers check on 60-minute psychotherapy claims, documentation that holds up, and how a group should reply. 90837 requires at least 53 minutes of psychotherapy time with the patient; the code should match the actual time, not the scheduled slot.
CPT 90837 reports individual psychotherapy of 53 minutes or longer. It is the longest of the standard psychotherapy time codes, and payers watch it: Novitas Solutions, a Medicare administrative contractor, has run Targeted Probe and Educate reviews on 90832, 90834, and 90837, and commercial plans flag billing that falls outside typical patterns. A 90837 letter is the informal name clinicians give to the notice that follows: your share of 60-minute sessions is higher than your peer group's, please review documentation guidelines, and sometimes, please send records.
A first letter may be framed as education, but it signals that your claims are being watched. Optum's network manual describes its practice-management interventions as education and resources that help providers self-correct outlier billing, and lists treatment-record audits, performance improvement plans, and referral for recoupment and/or prepayment review among the possible results.
This guide explains the time rule, what reviewers look for, where start and stop times belong, and how a group practice should respond on behalf of its clinicians, including when the letter asks for records.
Key takeaways
The short version
- 90837 requires at least 53 minutes of psychotherapy time with the patient; the code should match the actual time, not the scheduled slot.
- Reviewers look first at documented time and at a clinical reason the session needed that length.
- Start and stop times are not psychotherapy notes under HIPAA; they belong in the progress note a payer can see.
- Respond at the group level: run your own 90837 distribution and self-audit before you answer.
- Do not switch everyone to 90834; code the time you actually spent.
Take the template with you
Free to copy · no email required
A per-session check for time, the clinical reason for the length, the treatment plan, and record basics. Use it for self-audits and as the prompt list in your note template.
A short written acknowledgment that confirms how the group applies the time rule and asks what the payer needs next. Confirm every statement is true for your practice before sending.
One row per sampled session: documented times, minutes, whether the code and the length are supported, findings, and corrective action. Use clinician and session references, not patient identifiers.
session_ref,clinician_id,payer,date_of_service,code_billed,start_time,stop_time,total_minutes_documented,code_supported_by_time,reason_for_length_documented,treatment_plan_current,signature_present,telehealth_modality_documented,late_entry_labeled,finding,corrective_action,potential_overpayment,reviewer,review_date ,,,,,,,,,,,,,,,,,,
1. What a 90837 letter is, and what it is not
The letter can be one of four things, and each needs a different response. Payers describe the machinery in their manuals. Optum's practice-management team identifies practices outside typical billing patterns and expected utilization, then intervenes through direct conversations, written communication, treatment-record audits, and site audits. In Medicare, a contractor starting a provider-specific review must tell the provider the specific reason for selection and, when selection rests on comparative data, show how the provider differs from others in the same specialty or locality.
| What arrives | What it asks | Your next step |
|---|---|---|
| Educational outlier letter | Review documentation guidelines; no records requested | Self-audit the flagged clinician and reply in writing |
| Records request | Notes for a sample of 90837 sessions | Records-request workflow with a per-session index |
| Prepayment review notice | Records before 90837 claims are paid | Prepayment workflow and a written request for release criteria |
| Overpayment demand | Refund for sessions found unsupported | Overpayment workflow; dispute claim by claim |
2. The time rule behind 90837
APA Services summarizes how the individual psychotherapy codes are counted, and Novitas's Medicare education uses the same time ranges.
- Count time spent in psychotherapy with the patient and/or family member; APA Services notes that time spent arranging services, writing reports, and communicating with other professionals is not included
- Select the code that most closely matches the actual time: 90834 for a 50-minute session, 90837 for a 55-minute one
- Record start and stop times for every session; APA Services warns that from an insurer's standpoint, a session without those details was not delivered
- When a prescriber bills an E/M service and psychotherapy on the same day, psychotherapy is reported with the add-on codes 90833, 90836, or 90838, and time spent on the E/M service does not count toward psychotherapy time
| Code | Descriptor time | Report for sessions of |
|---|---|---|
| 90832 | 30 minutes | 16 to 37 minutes |
| 90834 | 45 minutes | 38 to 52 minutes |
| 90837 | 60 minutes | 53 minutes or longer |
| No psychotherapy code | Not applicable | Under 16 minutes |
3. What reviewers check on a 90837 claim
Novitas publishes its top reasons for denying psychotherapy claims in Targeted Probe and Educate. They map directly onto what a commercial reviewer will read for.
- Time: documentation lacks evidence of the time spent performing psychotherapy
- Code level: documented time does not support the code billed, so the claim is recoded to the level the time supports
- Medical necessity: documentation does not show a reasonable and necessary psychotherapy service
- Scope: documentation does not show the practitioner acting within scope of practice
- Supervision: documentation does not show required supervision when billing under a physician
- Non-response: records not submitted in time
4. Build the progress note a reviewer expects
Optum's treatment-record standards list what a commercial reviewer will expect in each progress note: the practitioner's signature, the date of service, telehealth documentation where used, the member's strengths and limitations in reaching treatment-plan goals, interventions consistent with those goals, and, for time-based services, either start and stop time or total time in session. The treatment plan needs measurable goals, updates when goals are met or new problems appear, and re-evaluation when the member is not progressing. Entries made more than 24 hours after the service should carry the date of service, the date of entry, and a late-entry notation.
HIPAA gives psychotherapy notes, the separate notes a mental health professional keeps about the contents of a session, extra protection: a covered entity needs the patient's authorization to disclose them and may not condition payment on the patient signing one. But the definition excludes session start and stop times, modalities and frequencies of treatment, medication monitoring, test results, and summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress.
That excluded material is exactly what supports a 90837 claim. Optum's manual says a records request may ask for session start and stop times, modalities and frequencies, and summaries of diagnosis, functional status, treatment plan, prognosis, and progress. Medicare bars its contractors from requesting psychotherapy notes, says combining excluded information into the same document does not make it protected, and puts the burden on the provider to extract what supports medical necessity; if that is not submitted, the claim is denied.
- Keep the progress note (time, interventions, diagnosis, plan, progress) in the medical record
- Keep process notes separately, and never let them be the only place the session length or the clinical reason for it appears
- Never send process notes to prove a session was long enough
5. How a group practice should respond
- 01
Log and classify
Record the issuer, the clinician or clinicians named, the codes and period cited, what the letter asks for, and any deadline. Route records requests, prepayment notices, and demands to their own workflows.
- 02
Pull your own distribution
For the payer and period cited, compare each clinician's mix of 90832, 90834, and 90837 with the group's. Check whether documented times look like actual times or like the scheduled slot copied into every note.
- 03
Self-audit a sample
Review a small sample of the flagged clinician's 90837 sessions (for example, ten) against the documentation checklist on this page: 53 or more documented minutes, a reason for the length, a current treatment plan, a signature, and the modality.
- 04
Fix forward
Require actual start and stop times in the template, drive code selection from documented minutes, and prompt for the clinical reason when minutes exceed 52. Date the change and train on it.
- 05
Decide on the past with counsel
If the self-audit finds 90837 billed without 53 documented minutes, you may have overpayments to address. For Medicare, identified overpayments must be reported and returned within 60 days, with up to 180 days for a timely, good-faith investigation of related claims; for commercial plans, follow the contract and applicable law.
- 06
Reply in writing
Acknowledge the letter, confirm how the group applies the time rule, describe any changes, and ask what, if anything, the payer needs next. Do not volunteer records that were not requested, and do not concede errors you have not verified. A named person approves the reply.
6. What not to do
- Do not switch every clinician to 90834; APA Services' guidance is to select the code closest to the actual time, and systematic undercoding misreports services too
- Do not add times to old notes; Medicare requires amendments and delayed entries to show their date and author, and Optum asks that late entries be labeled
- Do not send psychotherapy notes to prove session length
- Do not ignore an educational letter; the same manuals describe escalation paths that end in audits, prepayment review, or recoupment
- Do not let each clinician answer separately; one group-level response keeps the position consistent
Common questions
Answers before you build.
How many minutes is 90837?+
90837 is reported for psychotherapy of 53 minutes or longer. Sessions of 38 to 52 minutes are 90834 and 16 to 37 minutes are 90832; psychotherapy codes are not reported for sessions under 16 minutes.
Do we need start and stop times for 90837?+
Optum requires either start and stop time or total time for time-based services, APA Services advises recording start and stop times for every session, and Medicare reviewers deny psychotherapy claims when documentation does not support the time. Recording actual start and stop times is the safest practice.
Is a 90837 letter an audit?+
Not always. Some begin as educational outreach about billing patterns. But payers' own manuals describe records audits, prepayment review, and recoupment as possible next steps, so treat the letter as the start of a case.
Can a payer demand psychotherapy notes to support 90837?+
Not without the patient's authorization, and a covered entity may not condition payment on the patient signing one. The information that supports 90837, including start and stop times and treatment-plan summaries, is excluded from the definition of psychotherapy notes and belongs in the progress note.
Should we stop billing 90837?+
No. Bill it when the session lasted 53 minutes or more and the note shows why. The goal is documentation that supports the code, not avoiding the code.
Practical closeout
Use this operator checklist.
- 90837 requires at least 53 minutes of psychotherapy time with the patient; the code should match the actual time, not the scheduled slot.
- Reviewers look first at documented time and at a clinical reason the session needed that length.
- Start and stop times are not psychotherapy notes under HIPAA; they belong in the progress note a payer can see.
- Respond at the group level: run your own 90837 distribution and self-audit before you answer.
- Do not switch everyone to 90834; code the time you actually spent.
Continue through the cluster
Verified customer case studies are added only with customer permission and supporting evidence; none is implied by these operational examples.
Sources & methodology
Trace the operational claims.
Marsa Health Editorial reviewed the primary and research sources below on September 21, 2026. We translate them into workflow controls, distinguish proposals from final rules, and flag where plan, program, state, contract, or clinical requirements vary.
- 01Psychotherapy Services Frequently Asked Questions American Psychological Association ServicesTime ranges for 90832, 90834, and 90837, what time counts, and the advice to record start and stop times for every session.Accessed or rechecked September 21, 2026
- 02Psychiatric services: Psychotherapy (CPT 90832, 90834, and 90837) Novitas Solutions (Medicare Administrative Contractor)Targeted Probe and Educate results page updated September 14, 2026, listing top denial reasons including unsupported time, recoding by time, and medical necessity.Accessed or rechecked September 21, 2026
- 03Targeted Probe and Educate: Psychotherapy Services Novitas Solutions (Medicare Administrative Contractor)2018 education deck on time ranges, same-day E/M add-on codes, and individualized duration; it notes it was current when presented, so confirm against the current local coverage documents.Accessed or rechecked September 21, 2026
- 04Behavioral Health Services National Provider Network Manual OptumPublished July 1, 2026, effective September 1, 2026: practice-management interventions, treatment-record standards, records-request contents, audits, and offset.Accessed or rechecked September 21, 2026
- 0545 CFR 164.501: Definitions Electronic Code of Federal RegulationsHIPAA Privacy Rule definitions of psychotherapy notes, which exclude session start and stop times and treatment summaries, and of payment, which includes medical-necessity and retrospective review.Accessed or rechecked September 21, 2026
- 0645 CFR 164.508: Uses and disclosures for which an authorization is required Electronic Code of Federal RegulationsRequires patient authorization for nearly all disclosures of psychotherapy notes and bars covered entities from conditioning payment on an authorization.Accessed or rechecked September 21, 2026
- 07Medicare Program Integrity Manual, Chapter 3: Verifying Potential Errors and Taking Corrective Actions Centers for Medicare & Medicaid ServicesRev. 13821 (June 2026): review targeting, provider notice, additional documentation request time frames, Targeted Probe and Educate, 100 percent prepayment review, signature attestation, amendments, and the bar on requesting psychotherapy notes.Accessed or rechecked September 21, 2026
- 0842 CFR 401.305: Requirements for reporting and returning of overpayments Electronic Code of Federal RegulationsIdentified Medicare overpayments must be reported and returned within 60 days, suspended up to 180 days for a timely good-faith investigation, with a six-year look-back.Accessed or rechecked September 21, 2026
Organizational author. Editorial review covers source accuracy, search intent, workflow boundaries, and human-oversight requirements. This material is educational and does not provide clinical, legal, coding, or coverage advice.
No named clinical or legal expert reviewer is attributed to this version. Marsa Health does not invent reviewer credentials.
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What changed and when
September 21, 2026
Initial publication, source review, and operational editing.