CPT 90785: Psychotherapy Increased Work Intensity

Medicare pays $15 on average nationally for this procedure.

CPT code 90785 is an add-on code used to indicate increased work intensity for psychotherapy services when additional complexity or effort adds difficulty to delivery of the psychotherapy encounter; it is reported in conjunction with primary psychotherapy procedure codes to reflect the service type of psychotherapy with elevated clinician effort and is typically used in outpatient or office-based mental health settings as the typical site of service.

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CPT 90785: Psychotherapy Increased Work Intensity

Medicare pays $15 on average nationally for this procedure.

Customize your policy alerts

Sign up for cpt 90785 policy alerts

Get alerted when payer policies referencing 90785 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with severe, treatment-resistant major depressive disorder who is receiving outpatient psychotherapy. During a scheduled 60‑minute psychotherapy session, the patient becomes acutely agitated and expresses imminent suicidal intent requiring the clinician to engage in prolonged crisis management, intensive safety planning, coordination with emergency services, and family notification. The psychotherapy visit includes the usual therapeutic work plus substantially increased intensity and time spent addressing safety, arranging urgent higher‑level care, and documenting the steps taken.

The clinical workflow begins with the clinician (licensed psychologist, clinical social worker, or psychiatrist) conducting the psychotherapy session and recognizing the need for enhanced intervention. The clinician documents the baseline psychotherapy service (time, modality, therapeutic interventions) and then documents the additional complexity and intensity that justify the use of the add‑on code 90785. Billing staff append 90785 to the primary psychotherapy CPT code (for example, 90834 or 90837) when payer policy allows add‑on reporting for increased work intensity. Clinical documentation includes specific behaviors, risk assessment, time devoted to crisis management, contacts made (family, emergency services), and discharge or transfer plan. Payment determination follows each payer’s policy; common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90834`	Psychotherapy, 45 minutes with patient when performed with an evaluation and management service	Common primary psychotherapy code; `90785` is billed as an add‑on when additional intensity occurred during a `90834` session.
`90837`	Psychotherapy, 60 minutes with patient when performed with an evaluation and management service	Used for longer psychotherapy sessions; `90785` attaches when substantially increased work intensity is present.
`90846`	Family psychotherapy (without the patient present), 50 minutes	When family involvement without patient increases complexity, `90785` may be used alongside the primary family psychotherapy code if payer allows.
`90847`	Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes	Conjoint sessions that require crisis management and additional work intensity may justify `90785` with the primary code.
`99214`	Office or other outpatient visit for established patient, moderate complexity (typically 25 minutes)	When an E/M is performed in addition to psychotherapy or for coordination of urgent medical care, `90785` documents the added psychotherapy intensity but is billed only with allowable primary psychotherapy codes.
`99354`	Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service (first hour)	When prolonged direct patient contact due to crisis extends beyond typical psychotherapy time, documentation may support `99354` for prolonged E/M or `90785` as intensity add‑on depending on payer rules.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101Y00000X	Counselor	A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
1041C0700X	Clinical Social Worker	A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of p…
101YA0400X	Addiction (Substance Use Disorder) Counselor	Behavioral Health & Social Service Providers · Counselor
106H00000X	Marriage & Family Therapist	A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related menta…
207YX0602X	Otolaryngic Allergy Physician	An otolaryngologist who specializes in the diagnosis and treatment of otolaryngic allergies and other allergic diseases.
261QP2000X	Physical Therapy Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy i…
261QR1100X	Research Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207SG0203X	Clinical Molecular Genetics Physician	A clinical molecular geneticist demonstrates competence in performing and interpreting molecular analyses relevant to the diagnosis and management of …

Related Payer Policy Updates

Specialty: Psychiatry/Behavioral Health1 / 2

10 rows

Policy	Payer	Effective Date
Community-Based Mobile Crisis Response Services	California Department of Health Care Services	2027-04-01
Immersive Virtual Reality Therapy for Chronic Lower Back Pain	Bluecross Idaho	2026-09-01
Attention Deficit Hyperactivity Disorder Non-Stimulant Medications	Cigna	2026-08-15
Attention Deficit Hyperactivity Disorder (ADHD) Stimulant Medications for Individual and Family Plans	Cigna	2026-08-01
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders	Premera Bluecross	2026-08-01
Inpatient and Outpatient Mental Health	UnitedHealthcare	2026-08-01
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders	Premera Bluecross	2026-08-01
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders	Premera Bluecross	2026-08-01
Autism Spectrum Disorders Mandate (Payment Policy)	Blue Cross Blue Shield - Rhode Island	2026-08-01
Tribal notification for proposed SPA to expand SMI/SED coverage (IMD-related)	New Mexico Health Care Authority	2026-07-01

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90834`	Psychotherapy, 45 minutes with patient when performed with an evaluation and management service	Common primary psychotherapy code; `90785` is billed as an add‑on when additional intensity occurred during a `90834` session.
`90837`	Psychotherapy, 60 minutes with patient when performed with an evaluation and management service	Used for longer psychotherapy sessions; `90785` attaches when substantially increased work intensity is present.
`90846`	Family psychotherapy (without the patient present), 50 minutes	When family involvement without patient increases complexity, `90785` may be used alongside the primary family psychotherapy code if payer allows.
`90847`	Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes	Conjoint sessions that require crisis management and additional work intensity may justify `90785` with the primary code.
`99214`	Office or other outpatient visit for established patient, moderate complexity (typically 25 minutes)	When an E/M is performed in addition to psychotherapy or for coordination of urgent medical care, `90785` documents the added psychotherapy intensity but is billed only with allowable primary psychotherapy codes.
`99354`	Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service (first hour)	When prolonged direct patient contact due to crisis extends beyond typical psychotherapy time, documentation may support `99354` for prolonged E/M or `90785` as intensity add‑on depending on payer rules.

Related Modifiers

8 rows

Modifier	Description	When to Use
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
23	Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…	- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
62	Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…	- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
78	CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…	- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
80	CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…	- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
90	Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…	- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
101Y00000X	Counselor	A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
1041C0700X	Clinical Social Worker	A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of p…
101YA0400X	Addiction (Substance Use Disorder) Counselor	Behavioral Health & Social Service Providers · Counselor
106H00000X	Marriage & Family Therapist	A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related menta…
207YX0602X	Otolaryngic Allergy Physician	An otolaryngologist who specializes in the diagnosis and treatment of otolaryngic allergies and other allergic diseases.
261QP2000X	Physical Therapy Clinic/Center	An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy i…
261QR1100X	Research Clinic/Center	Ambulatory Health Care Facilities · Clinic/Center
207SG0203X	Clinical Molecular Genetics Physician	A clinical molecular geneticist demonstrates competence in performing and interpreting molecular analyses relevant to the diagnosis and management of …

Related Payer Policy Updates

Specialty: Psychiatry/Behavioral Health1 / 2

10 rows

Policy	Payer	Effective Date
Community-Based Mobile Crisis Response Services	California Department of Health Care Services	2027-04-01
Immersive Virtual Reality Therapy for Chronic Lower Back Pain	Bluecross Idaho	2026-09-01
Attention Deficit Hyperactivity Disorder Non-Stimulant Medications	Cigna	2026-08-15
Attention Deficit Hyperactivity Disorder (ADHD) Stimulant Medications for Individual and Family Plans	Cigna	2026-08-01
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders	Premera Bluecross	2026-08-01
Inpatient and Outpatient Mental Health	UnitedHealthcare	2026-08-01
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders	Premera Bluecross	2026-08-01
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders	Premera Bluecross	2026-08-01
Autism Spectrum Disorders Mandate (Payment Policy)	Blue Cross Blue Shield - Rhode Island	2026-08-01
Tribal notification for proposed SPA to expand SMI/SED coverage (IMD-related)	New Mexico Health Care Authority	2026-07-01

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

CPT 90785: Psychotherapy Increased Work Intensity

Sign up for cpt 90785 policy alerts

CPT 90785: Psychotherapy Increased Work Intensity

Sign up for cpt 90785 policy alerts

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

What is CPT 90785 and when is it used?

Which primary CPT codes can 90785 be billed with?

What documentation is needed to support billing 90785?

Will payers reimburse 90785 consistently?

How does 90785 differ from prolonged service codes such as 99354?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Payer Policy Updates

What is CPT 90785 and when is it used?

Which primary CPT codes can 90785 be billed with?

What documentation is needed to support billing 90785?

Will payers reimburse 90785 consistently?

How does 90785 differ from prolonged service codes such as 99354?

References