Practice business tool
Are you under-coding your therapy sessions?
Many therapists bill a 53+ minute session as 90834 (the 45-minute code) because the session length was never documented. See how much legitimate reimbursement that leaves on the table in your state, plus missed 90785 add-ons. Built from public CMS and payer data.
90834 vs 90837: the difference that adds up
90834 and 90837 are both individual psychotherapy codes. The only difference is documented session time: 90834 covers 38 to 52 minutes, 90837 covers 53 minutes or more. Because 90837 reflects a longer session, it reimburses more — about $53 more per session at Medicare rates, and roughly $31 more in commercial in-network terms in our data. A clinician who runs 53+ minute sessions but defaults to 90834 for a full caseload can lose well over $10,000 a year in legitimate reimbursement.
The leak is documentation, not aggressive coding
The single most common source of lost therapy revenue is not under-charging — it is a 53-minute session you cannot prove, which gets downcoded to 90834. The fix is not to bill a bigger code; it is to document the session you actually provided, including start and end times, so the code you bill holds up. This tool estimates the gap between what you may be billing and what your documented sessions would support. Bill only what you delivered and recorded — over-coding is fraud, and that is the opposite of the point here.
The 90785 add-on most practices forget
CPT 90785 is an interactive-complexity add-on you can bill alongside intake and psychotherapy codes when specific factors complicate the work: using an interpreter or communication device, a caregiver whose behavior disrupts treatment, a sentinel event that triggers mandated reporting, or high-conflict family dynamics. It only pays a small amount per session, but on eligible sessions it is real money that is frequently left off the claim. Add your weekly eligible sessions in the calculator to include it in the estimate.
How the numbers are calculated
Every figure traces back to public data and a documented formula. The full method and the entire dataset are open source at coralehr/oon-therapy-benchmark.
- Medicare anchor. Each code's Medicare rate is computed from CMS relative value units and the published conversion factor — a stable, public reference.
- Commercial proxy. In-network negotiated rates from major payer Transparency-in-Coverage files stand in for out-of-network allowed amounts (which payers publish but leave effectively empty).
- State adjustment. National rates are scaled to your state by the Medicare geographic index (GPCI).
- The gap. Annual estimate = (90837 rate − 90834 rate) × your weekly 53+ minute sessions × 50 weeks, plus any missed 90785 add-ons.
Snapshot 2026-06-07. This is a sample of plans, not a census; in-network is a proxy, not a measured out-of-network amount; and every figure is an estimate, not a guarantee.
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Frequently Asked Questions
How much more does 90837 pay than 90834? +
At Medicare rates 90837 (60-minute session) pays about $53 more per session than 90834 (45-minute session); the commercial in-network gap in our data is roughly $31. Across a full caseload that difference adds up to thousands of dollars a year. Use the calculator to see the figure for your state and weekly volume.
Is billing 90837 more often a way to make more money? +
No, and that is the wrong way to think about it. You bill the code that matches the session you actually provided and documented: 90834 for 38-52 minutes, 90837 for 53+ minutes. The revenue "leak" this tool estimates is the legitimate reimbursement clinicians lose when a genuine 53+ minute session gets downcoded to 90834 because the session length was not documented. Never bill a longer code than you delivered.
What is the time requirement for 90834 vs 90837? +
90834 is for individual psychotherapy sessions lasting 38 to 52 minutes. 90837 is for sessions lasting 53 minutes or longer. The deciding factor is documented session time, so noting start and end times protects the code you bill.
What is the 90785 add-on and why is it missed? +
CPT 90785 is the interactive-complexity add-on, billable with psychotherapy and intake codes when specific factors complicate the session: an interpreter or special communication device, a caregiver whose behavior interferes with care, a sentinel event requiring mandated reporting, or high-conflict caregiver dynamics. It pays a small amount per eligible session and is frequently left off claims that qualify.
Where do these reimbursement numbers come from? +
The CMS Medicare Physician Fee Schedule (computed from public RVUs and the conversion factor) as the anchor, plus in-network negotiated rates from major payer Transparency-in-Coverage files as a commercial proxy, scaled to your state by Medicare GPCI. It is an open dataset; the methodology and code are linked on the page.
Is this billing or coding advice? +
No. It is an educational estimate to help you see whether documentation gaps may be costing you legitimate revenue. CPT codes have specific time and documentation requirements, and payer rules vary. Confirm coding decisions with your payer or a certified coder.
Keep going
Stop losing revenue to documentation gaps
CoralEHR timestamps your sessions and drafts the note from what you type, so the code you bill matches the session you provided — and superbills generate automatically for out-of-network clients.
See CoralEHR billing