CPT 90833 note example: an audit-ready E/M plus psychotherapy add-on note, annotated
If you prescribe in psychiatry, you have probably had this moment: you spent real time doing supportive therapy inside a medication visit, you billed 90833, and then you stared at your note wondering whether it would survive an audit. Most documentation advice for 90833 is written for billers, not for the clinician holding the pen. This guide shows a complete example note, with annotations explaining exactly what a payer reviewer looks for in each section.
What 90833 actually is
CPT 90833 is an add-on code for 30 minutes of psychotherapy performed on the same day, by the same clinician, as an evaluation and management (E/M) service. In practice that means a medication management visit (99212 to 99215) where you also provided a distinct block of psychotherapy. It is never billed alone. Under CPT time rules, the 30-minute code covers psychotherapy time of 16 to 37 minutes. Longer sessions move to 90836 (38 to 52 minutes) or 90838 (53 minutes or more).
The three rules that decide whether your note survives
- Psychotherapy time is documented separately and is at least 16 minutes. The minutes spent on psychotherapy cannot include medication management, med education, or care coordination. A note that says "45-minute visit" without splitting out the therapy time fails this test.
- The E/M level is selected on medical decision making, not time. When you bill psychotherapy with an E/M on the same visit, CPT prohibits time-based E/M selection, because the same minutes cannot count twice. Your 99214 has to stand on MDM alone.
- The psychotherapy section reads like psychotherapy. A modality, what you actually did, and how the patient responded. If the paragraph describes explaining side effects or adjusting a dose, a reviewer will reclassify it as E/M work and deny the add-on.
Most payers also expect modifier 25 appended to the E/M code to signal a significant, separately identifiable service. Requirements vary by payer, so confirm with the plans you bill.
The example note
The patient below is fictional. The structure is the part to copy: a complete E/M note, then a clearly separated psychotherapy add-on section.
E/M portion (99214, established patient, MDM-based)
Interval history: J.M. is a 34-year-old with major depressive disorder, recurrent, moderate, on sertraline 100 mg daily, returning for follow-up after 4 weeks. Reports mood "maybe a 5 out of 10, up from a 3." Sleep improved to 6 hours. Denies suicidal ideation, intent, or plan. Reports significant work stress after a demotion this month, describing it as "I feel like I got benched in front of everyone." Appetite fair. No side effects except mild morning nausea in the first week, now resolved.
Mental status: Alert, cooperative, adequately groomed. Speech normal rate and tone. Mood "a 5," affect congruent, brighter than prior visit. Thought process linear. No SI/HI. No psychotic symptoms. Insight and judgment intact.
Assessment: MDD, recurrent, moderate (F33.1), partial response at 4 weeks on sertraline 100 mg with new psychosocial stressor.
Plan: Increase sertraline to 150 mg daily; reviewed rationale, common side effects, and serotonin syndrome warning signs. PHQ-9 today: 12 (down from 17). Continue monthly follow-up; patient to call if worsening or side effects. Safety plan reviewed and unchanged.
90833 psychotherapy add-on documentation
Psychotherapy duration: 18 minutes of face-to-face psychotherapy provided, separate from E/M time.
Behaviors or symptoms addressed: Patient processed the demotion at work and the shame attached to it, stating "I feel like I got benched in front of everyone." Explored how this event reactivated longstanding beliefs of being "never quite good enough" that predate this episode.
Assessment of symptoms: Improved.
Treatment approach: Supportive therapy. Selected because the patient is processing an acute self-esteem injury and benefits from validation and reinforcement of existing coping before deeper work.
How interventions were applied: Validated the grief and embarrassment tied to the demotion without minimizing it. Reframed the demotion as an event rather than a verdict on his worth, and reinforced his decision to keep attending his running group as active coping. Patient engaged, offered his own counterexamples of recent competence.
Treatment goals and response: Goal remains restoring functioning at work and reducing self-critical rumination. Patient responded well, left with an agreed plan to log rumination triggers before next visit.
Progress toward primary treatment goal: Progressed.
Follow-up plan: Continue brief psychotherapy alongside medication management at monthly visits while the occupational stressor is active.
The five ways 90833 notes get denied
- No separate time statement. "50-minute appointment" is not psychotherapy time. State the psychotherapy minutes explicitly.
- Under 16 minutes. Fifteen minutes of therapy is zero minutes for billing purposes. Some billing platforms block claims below the threshold automatically.
- Psychotherapy section describes E/M work. Reviewing side effects, titration plans, or lab results belongs in the E/M portion. If your therapy paragraph could appear in a med check note, it will be read as one.
- Cloned language. Identical psychotherapy paragraphs across visits and patients are the fastest route to a records request. Session-specific detail, ideally with the patient's own words, is your best protection.
- Time-based E/M selection. Selecting 99214 "because the visit took 25 minutes" while also billing 90833 double-counts the same minutes. The E/M must stand on MDM.
Quick reference
| Code | Psychotherapy time | Billed with |
|---|---|---|
| 90833 | 16 to 37 minutes | E/M same day, same clinician |
| 90836 | 38 to 52 minutes | E/M same day, same clinician |
| 90838 | 53 minutes or more | E/M same day, same clinician |
Frequently asked questions
Can I bill 90833 at every medication visit?
Only when you actually provided 16 or more minutes of psychotherapy and documented it. A pattern of 90833 on every claim is itself an audit trigger, so let the clinical reality drive the code, not the other way around.
Does the 16 minutes include medication education?
No. Medication education, side-effect review, and treatment planning are E/M work. The psychotherapy clock only runs on psychotherapy.
Do I need modifier 25?
Most payers expect modifier 25 on the E/M code when billed with a psychotherapy add-on. Some do not. Confirm with each payer you bill, or with the billing platform that processes your claims.
What counts as psychotherapy for a prescriber?
Supportive therapy, motivational interviewing, and mindfulness-based techniques are all defensible within a prescriber's scope in most settings. Naming a protocol-heavy modality such as EMDR or DBT in a 16-minute add-on invites questions you do not want.
OneStep Scribe is an AI scribe built for psychiatric prescribers. It listens to the visit and drafts the full note, including a separated, audit-ready 90833 section with the patient's own words, for your review and signature. Every account is NPI-verified.
Start a 14-day free trialThis article is educational and reflects one clinician's documentation approach. It is not legal, billing, or payer-specific advice, and it does not guarantee reimbursement. CPT is a registered trademark of the American Medical Association. Always verify requirements with your payers and compliance advisors. The patient described is fictional.