Reimbursement
$103.21
Threshold
45m
2026 Status
Active
What is CPT Code 90836?
CPT 90836 is defined as: Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management (E/M) service. This add-on code covers mid-length therapeutic sessions integrated with medical management.
This code is primarily used for Behavioral services. It falls under the category of Psychotherapy & Behavioral Assessments and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
2.17
Physician Effort
PE (Non-Fac)
0.79
Practice Expense
Malpractice
0.13
Risk Factor
Total RVU
3.09
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Shielded from the -2.5% efficiency cut applied broadly in 2026.
high value incentive
99214 + 90836 is one of the highest-reimbursement encounters in outpatient psychiatry, paying ~$231.
audit scrutiny alert
The high reimbursement value triggers increased RAC and TPE audit focus on documentation proof.
site neutrality impact
Non-facility rate protected at $103.21 to support office-based intensive behavioral care.
Administrative Framework
Global Period
000
Place of Service
Key Modifiers
Required Primary Codes
Must be billed alongside a primary service.
Operational Requirements
minimum time
38 minutes (Range: 38-52 minutes)
staff type
Prescribing Psych providers (Psychiatrist, Psychiatric NP/PA)
frequency
Typically once per day
add on codes
time rule
Time spent on psychotherapy (38-52 min) must be documented separately from the time spent on the E/M portion of the visit.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Must select E/M level based on MDM. Do not use total time for E/M selection when billing 90836.
Common Clinical Scenarios
CMS Eligibility: Severe or complex cases requiring significant therapeutic restructuring and medical oversight. Variable
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 90837
99214 + 90836 (~$231) significantly exceeds the standalone 60-min therapy code 90837 (~$167).
VS 90833
90836 pays specifically for the extra 15 minutes of therapeutic intensity compared to 90833.
integration_advantage
Favors the 'one-stop' med-psych model over split care.
Frequently Asked Questions
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