CurrentMolina HealthcarePolicy N/A

Psychotherapy add-on billing with E/M services

Governs appropriate billing and reimbursement when psychotherapy add-on codes (90833, 90836, 90838) are reported with certain high-level E/M codes for Molina Healthcare members; affects Molina-contracted providers submitting claims.

Policy Summary

PayerMolina Healthcare

PolicyPsychotherapy add-on billing with E/M services

Policy CodePolicy N/A

Change TypeTemplate updates and content additions

Effective DateN/A

Next Review DateN/A

Key ActionDo not bill 90833/90836/90838 with 99204/99205/99214/99215 for the same patient, same date, by the same provider; document psychotherapy and E/M times as substantial, separate, and non-overlapping.

SourceLink

POLICY UPDATE CHANGES

Added Reimbursement Guidelines section; added page numbers and PI number

Updated template and verified links

Updated template

Initial creation of policy

3psychotherapy add-on CPT codes addressed

4relevant high-level E/M CPT codes referenced

01/01/2023initial creation date

08/21/2025most recent revision date

Psychotherapy Add-on Billing with E/M Services — Coverage Criteria

Policy Summary

PayerMolina Healthcare

PolicyPsychotherapy add-on billing with E/M services

Policy CodePolicy N/A

Change TypeTemplate updates and content additions

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

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.

Coverage criteria for psychotherapy add-on codes with E/M

Covered only when documentation supports the following requirements. Claims that do not meet these criteria will be denied.

Claims that include psychotherapy add-on codes (90833, 90836, 90838) billed on the same date of service with high-level E/M codes (99204, 99205, 99214, 99215) by the same provider will be denied reimbursement unless documentation demonstrates that the psychotherapy service time was substantial, separately identifiable, and non-overlapping with the E/M service.

ALL of the following

Psychotherapy time and E/M service time must be clearly documented in the medical record.
Psychotherapy must be substantial and independently identifiable from the E/M service.
Overlapping time cannot be counted toward both the psychotherapy add-on and the E/M service.

Rationale: It is clinically improbable that both services could be performed at a significant and independently identifiable level of time without overlap; absence of clear, separate documentation will result in denial.

Relevant CPT Codes and Time Ranges

Psychotherapy add-on CPT CodesCPTCovered

90833	Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (add-on)
90836	Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (add-on)
90838	Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (add-on)

High-level E/M CPT CodesCPTCovered

99204	Office or other outpatient visit for the evaluation and management of a new patient...When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
99205	Office or other outpatient visit for the evaluation and management of a new patient...When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.
99214	Office or other outpatient visit for the evaluation and management of an established patient...When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
99215	Office or other outpatient visit for the evaluation and management of an established patient...When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.

E/M time ranges for code selection (minutes)

9920445-59 minutes total time

9920560-74 minutes total time

9921430-39 minutes total time

9921540-54 minutes total time

Billing, Documentation, and Denial Risk

Denial Risk

Denial risk: same‑day psychotherapy add‑on with high‑level E/M

Claims that include 90833, 90836, or 90838 billed on the same date of service with 99204, 99205, 99214, or 99215 by the same provider will be denied reimbursement. Providers must ensure that psychotherapy time and E/M service time are clearly documented, substantial, and independently identifiable; overlapping time cannot be counted toward both services.

Avoid billing psychotherapy add-on codes (90833, 90836, 90838) on the same DOS with high-level E/M codes 99204, 99205, 99214, 99215 by the same provider to prevent claim denial.
Document distinct start/stop times and separate content for psychotherapy and E/M so times are substantial and independently identifiable; do not double-count overlapping time.

OpenPayer

Psychotherapy add-on billing with E/M services

Psychotherapy Add-on Billing with E/M Services — Coverage Criteria

Relevant CPT Codes and Time Ranges

Billing, Documentation, and Denial Risk

Definitions and Acronyms