The Therapist Who Accidentally Gave Away Thousands of Dollars
Meet Lisa.
Lisa is a therapist who genuinely loves helping people. Every day, she listens, supports, and guides her patients through some of the toughest moments of their lives.
But when it comes to billing?
Let’s just say she’d rather listen to a patient explain a three-hour family argument than deal with insurance codes.
So, like many therapists, Lisa developed a simple system:
Every therapy session = bill 90834.
Easy. Safe. No headaches.
Or so she thought.
One day, her biller noticed something interesting. Many of Lisa’s sessions lasted nearly an hour, but she was still billing the same code she used for shorter appointments.
The result?
She had been leaving thousands of dollars on the table without realizing it.
If this sounds familiar, don’t worry. You’re not alone.
Let’s make psychotherapy billing simple.
The Three Codes You Need to Know
Think of psychotherapy codes like clothing sizes.
Small, Medium, and Large.
CPT 90832 = Small Session
Use this when therapy lasts about 30 minutes.
This is perfect for:
- Brief follow-ups
- Quick check-ins
- Focused problem-solving sessions
Think of it as the “short and productive” appointment.
CPT 90834 = Medium Session
This is the code most therapists use.
It generally applies to sessions around 45 minutes.
This is your standard therapy visit where you discuss challenges, work through emotions, and develop coping strategies.
If psychotherapy billing had a favorite child, it would probably be 90834.
CPT 90837 = Large Session
This code is for longer sessions, usually around 60 minutes.
These appointments often involve:
- Trauma work
- Complex mental health issues
- Crisis situations
- Deep therapeutic processing
Basically, when the session goes beyond a typical 45-minute visit, 90837 may be appropriate.
Why Therapists Avoid 90837
For some reason, many therapists treat 90837 like it’s a haunted house.
They know it exists.
They know they should probably go inside.
But they really don’t want to.
The biggest fear?
Audits.
Many providers worry that billing longer-session codes will attract unwanted attention from insurance companies.
The truth is much less scary.
Insurance companies don’t automatically reject claims just because you billed 90837.
They simply want documentation that supports the service you provided.
If the session lasted longer and your notes reflect that, you’re generally on solid ground.
The Most Common Billing Mistake
Here’s what happens every day in practices across the country.
A therapist schedules a 60-minute session.
The patient arrives.
The therapist spends nearly an hour working through significant issues.
The session ends.
Then out of habit, they bill 90834.
Why?
Because it’s familiar.
It’s comfortable.
And they don’t want to think about it.
Unfortunately, that habit can become expensive over time.
A few dollars here and there may not seem like much.
But over dozens of patients and hundreds of appointments, the difference adds up quickly.
Documentation Doesn’t Have to Be Complicated
Here’s some good news.
You do not need to write a novel after every session.
You don’t need ten pages of notes.
You don’t need to document every sentence the patient said.
You simply need to show:
How Long the Session Lasted
For example:
- 30 minutes
- 45 minutes
- 60 minutes
Simple.
What Was Discussed
Examples:
- Anxiety
- Depression
- Relationship stress
- Trauma
- Grief
What Therapeutic Techniques Were Used
Examples:
- CBT
- Supportive therapy
- Motivational interviewing
- Trauma-focused interventions
That’s it.
Clear documentation makes coding much easier.
Bill What You Actually Did
Imagine going to a restaurant and ordering a large pizza.
The waiter brings the large pizza.
But when the bill arrives, you discover they charged you for a small pizza.
You’d probably be confused.
Now flip the situation.
Many therapists provide a “large pizza” session but bill for a “medium pizza” appointment.
They delivered more service than they charged for.
While that might sound generous, it’s not a sustainable business strategy.
Your time has value.
Your expertise has value.
Your services have value.
Accurate billing simply reflects that reality.
A Simple Rule to Remember
When choosing a psychotherapy code, don’t ask:
“What code feels safest?”
Instead ask:
“What service did I actually provide?”
If the session was shorter, use the shorter-session code.
If the session was around 45 minutes, use the middle code.
If the session lasted about an hour and your documentation supports it, use the longer-session code.
Billing accurately isn’t aggressive.
It’s professional.
Final Thoughts
Most therapists didn’t enter the mental health field because they were passionate about CPT codes.
They entered the field because they wanted to help people.
That’s exactly why billing should be as straightforward as possible.
The next time you finish a therapy session, take a moment to review the actual time spent with the patient.
You might discover that you’ve been providing more value than you’re giving yourself credit for.
And unlike your patients, insurance companies rarely hand out gold stars for undercharging.
So stop guessing, stop billing on autopilot, and start billing for the care you actually provide.
Your future self and your revenue reports will thank you.
