Quick Reference: Psychotherapy Add-On Codes (PMHNP)

Use add-on psychotherapy codes only when psychotherapy is provided in addition to E/M, psychotherapy time meets thresholds, and required elements are documented. Keep E/M psychotherapy documentation high-level and place detailed content in a separate psychotherapy note.

⚠︎ Audit-Proof Self-Check (Must Have All)

  • ✓
    E/M performed (medication management)
  • ✓
    Psychotherapy provided (beyond med education)
  • ✓
    Psychotherapy time documented and meets threshold Time is psychotherapy time, not total visit time.
  • ✓
    Modality documented (CBT/DBT/EMDR/supportive, etc.)
  • ✓
    High-level focus in E/M note; detailed content in separate psychotherapy note Protect sensitive content in routine record requests.
  • ✓
    Treatment plan within 30 days if therapy continues
When in doubt: bill E/M only and ask billing/compliance before submitting.

Add-On Code Selection

+90833

16–37 min

Brief psychotherapy provided in addition to E/M.

+90836

38–52 min

Extended psychotherapy provided along with E/M.

+90838

52+ min

Full therapy session with brief E/M.

Modifiers: Use 25 for E/M and 59 for add-on only when supported and defensible. Do not apply routinely.

Psychotherapy Add-On Codes with E/M (PMHNP)

This page is designed to make you confident, consistent, and audit-proof when adding psychotherapy codes to a medication-management visit. Keep the E/M note high-level and protect sensitive content in a separate psychotherapy note.

Use only when psychotherapy is provided in addition to E/M Document modality + psychotherapy time + high-level focus Separate psychotherapy note for detailed content

⚠︎ Add-On Code Selection (with E/M)

Use add-on codes only when psychotherapy is provided in addition to E/M and required elements are documented.

⚠︎ HIGH

+90833

16–37 min

Brief psychotherapy provided in addition to E/M.

Example: Meds reviewed; provider addressed mood and taught coping skills.

+90836

38–52 min

Extended psychotherapy provided along with E/M.

Example: Meds managed; provider explored symptoms and provided therapy.

+90838

52+ min

Full session of therapy performed along with E/M.

Example: Brief med check; full session spent on therapy and treatment planning.

iTime is psychotherapy time (not total visit time) iPsychotherapy must be distinct from medication education

⚠︎ What Goes in the E/M Note (Brief Psychotherapy Section)

Include only required billing elements. Keep it high-level. This section may be released in routine record requests.

⚠︎ HIGH
  • 1
    Statement that psychotherapy was provided
  • 2
    Modality (CBT, DBT, EMDR, supportive therapy, etc.)
  • 3
    Psychotherapy time (must match +90833 / +90836 / +90838 thresholds)
  • 4
    High-level focus Examples: “Reviewed coping strategies for anxiety,” “Continued CBT interventions for mood regulation,” “Brief trauma-focused work.”

Important: protect sensitive details

Do not include trauma narratives, detailed disclosures, quotes, or specific conflict details here. Put detailed content in a separate psychotherapy note.

Copy/Paste Example (E/M Brief Psychotherapy Section)

Psychotherapy:
Provided supportive therapy and CBT for 24 minutes in addition to medication management. Focused on emotional regulation and coping strategies for anxiety.

⚠︎ What Does NOT Qualify as Psychotherapy

These items alone do not support psychotherapy add-on codes. If the visit consists primarily of the below, bill E/M only.

⚠︎ HIGH

Do NOT bill add-on codes for:

Medication education or side-effect counseling
Reviewing labs/vitals
Discussing adherence/refills
General reassurance/supportive conversation only
Case management / care coordination only
Safety checks without time-based psychotherapy intervention

Psychotherapy add-ons require:

Time-based psychotherapy (meets minimum threshold)
Identified modality (CBT/DBT/EMDR/supportive therapy, etc.)
Active therapeutic intervention (skills, restructuring, exposure, processing, etc.)
Clear separation from medication management

● Separate Psychotherapy Note (Detailed Content)

Document detailed narrative separately. This is where protected content belongs.

● MEDIUM

Examples of content that belongs in a separate psychotherapy note:

Trauma processing / EMDR targets and reprocessing notes
Abuse history or disclosures
Detailed cognitive themes/distortions
Family conflict specifics
Quotes or highly personal narrative content
Anything not appropriate to disclose without explicit authorization

Copy/Paste Example (Separate Psychotherapy Note)

Psychotherapy Note (separate):
CBT and DBT-informed psychotherapy provided. Focused on identifying triggers for mood reactivity, validating distress, and practicing distress tolerance and emotion regulation skills. Patient engaged and demonstrated insight. Continued work on coping strategies and treatment planning.

⚠︎ Treatment Plan (Required if Therapy Will Continue)

If you plan to continue psychotherapy, a treatment plan is required within 30 days.

⚠︎ HIGH

Copy/Paste Template (Psychotherapy Treatment Plan)

Psychotherapy Treatment Plan:
Diagnosis:
Modality:
Frequency:
Goals:
1)
2)
Interventions:
Progress measure (optional):
Review date (within 30 days):

Audit tip

Ongoing psychotherapy billing without a treatment plan increases audit risk. If you’re integrating therapy into med visits, document a clear plan and review it.

⚠︎ Modifier Reminder

Use modifiers only when supported and defensible.

⚠︎ HIGH

Modifier 25 (E/M)

Use on the E/M code when psychotherapy is separately identifiable from the E/M service.

Modifier 59 (Add-on)

Use on the psychotherapy add-on only when supported and defensible. Do not apply routinely.

Do not “default” modifiers

A pattern of routine modifier use is a common audit trigger. If it doesn’t add clarity and defensibility, don’t use it.

⚠︎ Visit Examples (Meets Criteria vs Does Not)

Use these as a reference for documentation quality, code selection, and treatment plan expectations.

⚠︎ HIGH

Example A: Meets criteria for +90833

Appointment duration: 35 minutes
Psychotherapy time: 24 minutes
E/M provided: Yes
Psychotherapy provided: Yes
Add-on: +90833

Example B: E/M only (no add-on)

Appointment duration: 20 minutes
Psychotherapy time: Not met / not documented
E/M provided: Yes
Psychotherapy provided: No (supportive conversation only)
Add-on: Not appropriate

Example A (E/M Brief Psychotherapy Section)

Psychotherapy:
Provided supportive therapy and CBT for 24 minutes in addition to medication management. Focused on emotional regulation and coping strategies for anxiety.

Example B (What this looks like in an E/M-only visit)

Visit focus:
Medication management performed. Reviewed symptoms, response, and side effects. Provided reassurance and brief guidance. No psychotherapy provided.

Example A (Separate Psychotherapy Note)

Psychotherapy Note (separate):
CBT and DBT-informed psychotherapy provided. Focused on identifying triggers, practicing distress tolerance, and strengthening coping skills. Patient engaged and demonstrated insight. Treatment plan reviewed and continued.

Example A (Treatment Plan Snapshot)

Psychotherapy Treatment Plan:
Diagnosis: (ex: GAD, PTSD, mood dysregulation)
Modality: CBT / DBT-informed
Frequency: integrated into med visits as clinically appropriate
Goals: improve emotional regulation; reduce anxiety symptoms; increase coping skills use
Review date: within 30 days

Pattern and copy/paste warning

Audits often start with billing patterns. Avoid identical psychotherapy language every visit. Document what actually happened and keep it defensible.

⚠︎ Quick Self-Check (Audit-Proof)

If any item is missing, bill E/M only.

⚠︎ HIGH
  • ✓
    E/M performed (medication management)
  • ✓
    Psychotherapy provided (not just med education)
  • ✓
    Psychotherapy time documented and meets threshold
  • ✓
    Modality named (CBT/DBT/EMDR/supportive, etc.)
  • ✓
    High-level focus in E/M note; detailed content in separate psychotherapy note
  • ✓
    Treatment plan within 30 days if therapy continues
  • ✓
    Modifiers only when supported and defensible

○ NPM Coding Philosophy

We support conservative, defensible coding that protects providers and the practice.

○ LOW

You will never be penalized for conservative coding

If psychotherapy time or documentation is borderline, bill E/M only. If unsure, reach out to billing/compliance before submitting.