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BehavioralAdd-on2026 Compliant

CPT 90836

2026 Billing Guide

Psychotherapy Add-on 45 min

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)

Standard Formula Applied

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

11 (Office)10 (Telehealth Provided in Patient's Home)21 (Inpatient Hospital)22 (On Campus-Outpatient Hospital)

NCCI Exclusions

Do not bill with:908329083390837

Key Modifiers

25Significant, Separately Identifiable Evaluation and Management Service. Essential for paired billing with 90836.
95Synchronous Telemedicine Service.

Required Primary Codes

99202-9920599212-9921599304-9931099341-99350

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

Exact Start/Stop times for the 45-minute therapy session
Detailed progress notes referencing specific therapeutic interventions (e.g., cognitive restructuring)
Proof of 'Separately Identifiable' effort for the E/M portion
Modifier 25 on the primary E/M code

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

Major depressive disorder with significant functional impairment requiring intensive CBT and medication titration
Psychiatric management of complex co-morbidities where 30 minutes is insufficient
Integrated 'med-psych' visit involving detailed exposure therapy

CMS Eligibility: Severe or complex cases requiring significant therapeutic restructuring and medical oversight. Variable

Target Specialties & Utilization

PsychiatryPsychiatric Nursing

Typical Clinical Indications (ICD-10)

F33.2 (Major depressive disorder, recurrent, severe without psychotic features)F31.4 (Bipolar disorder, current episode depressed, severe, without psychotic features)F42.2 (Mixed obsessional thoughts and acts)

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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CPT Code 90836 for Psychotherapy Add-on 45 min - 2026 Reimbursement & Rules