Documenting Mental Health CPT Code 90837 in the Age of AI

Important Update for Therapists

Artificial Intelligence is reshaping insurance audits, increasing scrutiny of CPT code 90837 and long-term therapy. Here’s what therapists must document to remain compliant.

CPT code 90837 tends to stir up more uncertainty than almost any other psychotherapy code. Therapists often worry about medical necessity, audit exposure, and whether their documentation is strong enough to support billing for 53 minutes or more of psychotherapy. The key isn’t avoiding the code. The key is documenting it clearly and accurately.

In 2019, I wrote about how to document CPT code 90837 and establish medical necessity when billing for 53 minutes or more of psychotherapy. The fundamentals have not changed. What has changed is the landscape.

Insurance companies are now using artificial intelligence to monitor billing patterns across large numbers of providers. Time-based codes like 90837, along with long-term or so-called “maintenance therapy,” are being reviewed more closely.

If you’ve felt a shift in the conversation around audits, you’re not imagining it.

The concern many therapists feel right now is not about whether 90837 is legitimate. It is about whether using it will trigger attention.

Understanding how AI-driven audits work and how billing patterns are analyzed is essential if you want to practice confidently rather than defensively.

How AI is Changing Insurance Audits

Insurance audits no longer look the way they once did.

Years ago, audits required manual chart reviews. An auditor selected a small sample of records and examined them individually. It was slow, expensive, and relatively rare.

Today, insurance companies use artificial intelligence to monitor billing data continuously. This does not mean a robot is reading every progress note. It means software analyzes claims patterns across thousands of providers in real time.

AI systems compare data points such as:

• CPT codes billed
• Time associated with those codes
• Frequency of specific codes
• Length of treatment episodes
• How a provider’s billing patterns compare to peers

The goal is not to review individual sessions. The goal is to identify statistical outliers.

When a billing pattern falls outside expected parameters — whether unusually high, unusually low, or inconsistent — the system flags it for further review. Only then are records requested and documentation examined by human reviewers.

AI identifies patterns first. Humans review charts second.

Understanding this sequence matters. Audits are typically triggered by data misalignment — not by a single session or isolated note.

And this is where many well-meaning therapists unintentionally increase their risk.

The “Flying Under the Radar” Myth

As scrutiny increases around 90837 and long-term therapy, some therapists try to “play it safe” by billing 90834 — even when sessions run 55 or 60 minutes.

I hear it often:

“I give my clients the time they need, but I don’t bill 90837. I’d rather take the loss than risk an audit.”

That instinct makes sense. When oversight increases, the natural response is to make yourself smaller. To avoid attention.

But billing lower codes does not reduce risk if your documentation reflects something different.

When progress notes consistently document 53 or more minutes of psychotherapy, but billing reflects 90834, that mismatch becomes visible during review.

Accuracy — not avoidance — is what protects you.

90837 Exists for a Reason

Therapists are paid for the service they provide and in outpatient psychotherapy, that service is defined by time.

Many clinicians provide 55- to 60-minute sessions because:

• Trauma processing cannot be rushed
• Emotional regulation requires containment
• Crisis stabilization takes time
• Complex relational dynamics need space

When psychotherapy CPT codes were revised, 90837 was created to reflect this clinical reality. It was not a bonus. It was a correction.

For some clients, 53 minutes or more of face-to-face psychotherapy is medically necessary.

Billing 90837 when appropriate is not aggressive. It aligns billing with the service provided.

90834 and 90837 Are Time-Based CPT Codes

To remain compliant, it is critical to understand:

• 90834 covers 38 to 52 minutes
• 90837 covers 53 minutes or more

These are time-based CPT codes, not “intensity” codes.

If you document 53 minutes face-to-face, you have met the threshold for 90837. Billing 90834 in that situation is under-coding.

To be clear:

• Billing 90837 for a 45-minute session is fraud.
• Billing 90834 for a 60-minute session is also a misrepresentation of the service provided.

Compliance is not about billing for less time. It is about billing accurately.

If you’re still feeling cautious about 90837, that’s understandable. But many therapists assume the higher code itself increases audit risk. It does not. Misalignment does.

The Real Risk is Inconsistent Documentation

Using CPT code 90837 appropriately does not automatically trigger an audit.

What increases scrutiny is:

• Vague progress notes
• Inconsistent session time documentation
• Lack of clearly articulated medical necessity
• Billing patterns that do not align with documentation
• Prolonged treatment without documented clinical justification

AI systems are not searching for “bad therapists.” They flag patterns that fall outside expected norms.

That includes both high utilization of 90837 and extended courses of therapy sometimes labeled as “maintenance.”

Long-term treatment is often medically necessary, particularly when working with trauma, attachment wounds, chronic mood disorders, or complex relational dynamics. But necessity must be visible in the record.

Maintenance therapy is medically necessary when:

• Symptoms persist or fluctuate
• Functioning remains impaired
• Treatment goals remain active
• Clinical intervention continues to be required
• The client would likely decompensate without treatment

Discharging a client who still needs care out of fear of an audit is not the solution. Clear documentation is.

When your notes demonstrate medical necessity and your billing aligns with the time provided, scrutiny decreases significantly.

What Clear 90837 Documentation Looks Like

When billing 90837, connect the extended time directly to medical necessity in every progress note.

Examples:

• “90837 is medically necessary to contain acute crisis and complete safety planning.”
• “90837 is medically necessary due to significant trauma history requiring extended time for regulation and containment.”
• “90837 is medically necessary because emotional dysregulation required sustained intervention to ensure safe session termination.”
• “90837 is medically necessary to prevent relapse, as client presents with increased symptom activation requiring extended cognitive restructuring and stabilization.”

That statement cannot stand alone. It must be supported by the rest of the note.

Your progress note should tell a coherent clinical story:

• The diagnosis
• The client’s current presentation
• Interventions used
• Client response
• Progress
• Ongoing treatment need

The medical necessity statement is not an afterthought. It is the clinical conclusion of the session. When your reasoning is visible, reviewers, or anyone who reads it including the client, do not have to guess.

The Bottom Line

AI is not auditing your integrity. It is analyzing patterns.

Billing 90837 does not create risk when it accurately reflects the time and medical necessity of the service provided. Misalignment creates risk.

Under-billing to avoid attention may feel safer, but when documentation and billing do not match, that discrepancy draws scrutiny.

• Accuracy protects you.
• Clear documentation protects you.
• Confidence in your clinical reasoning protects you.

If you’ve found yourself shortening sessions, second-guessing your billing, or worrying that one audit could destabilize your practice, you are not alone. Oversight has changed. Documentation now carries more weight than it once did. But this does not mean you need to practice defensively. It means your documentation must clearly reflect your clinical reasoning and the medical necessity of the time you provide.

When your notes demonstrate medical necessity and your billing accurately reflects your work, scrutiny becomes far less intimidating. Confidence grows from the alignment between the service you provide, the time you document, and the code you bill.

When your documentation and billing align, your practice becomes more resilient.

If you want to feel secure documenting 90837, justifying long-term treatment, and responding to audits without panic, that’s exactly what I teach in Misery or Mastery®: Essential Documentation for Psychotherapists.