CurrentMolina HealthcarePolicy N/A

Psychotherapy Add-On with High Level E/M Policy

Defines Molina Healthcare's reimbursement stance and billing/documentation expectations when psychotherapy add-on CPT codes (90833, 90836, 90838) are billed with high-level E/M services for Molina members; affects Molina providers submitting claims in applicable jurisdictions.

Policy Summary

PayerMolina Healthcare

PolicyPsychotherapy Add-On with High Level E/M Policy

Policy CodePolicy N/A

Change TypeNo material coverage changes

Effective DateN/A

Next Review DateN/A

Key ActionDo not bill psychotherapy add-on codes 90833/90836/90838 with high-level E/M codes 99204/99205/99214/99215 on the same date by the same provider; document psychotherapy and E/M time separately and clearly.

SourceLink

POLICY UPDATE CHANGES

Denial risk for concurrent billing: certain psychotherapy add-on + high-level E/M combinations are non-reimbursable.

Documentation requirement: clearly record separate psychotherapy and E/M time to support billing.

3psychotherapy add-on CPT codes named

4specific high-level E/M CPT codes referenced

4non-reimbursable combinations listed

Policy Summary

PayerMolina Healthcare

PolicyPsychotherapy Add-On with High Level E/M Policy

Policy CodePolicy N/A

Change TypeNo material coverage changes

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

Coverage criteria for psychotherapy add-ons with E/M

When psychotherapy add-on codes are billed with high-level E/M codes by the same provider on the same date:

Clinically improbable that both services could be substantial and independently identifiable without overlapping time.

Psychotherapy add-on codes require the psychotherapy service be substantial, separately identifiable, and non-overlapping with the E/M service.

Providers should confirm the psychotherapy component meets these requirements before billing as an add-on.

Documentation requirement: Psychotherapy time and E/M service time must be clearly documented, substantial, and independently identifiable; overlapping time cannot be counted toward both services.

Maintain time records showing separation of psychotherapy and E/M service intervals in the medical record.

State exceptions may apply; refer to applicable state or federal guidance and the state exceptions table where provided.

Follow state-specific rules when they differ from this policy.

Coding and Time Thresholds

Psychotherapy add-on CPT CodesCPT

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)

Referenced high-level E/M CPT CodesCPT

99204	Office or other outpatient E/M visit (high-level example listed in policy)
99205	Office or other outpatient E/M visit for a new patient; high-level example listed in policy
99214	Office or other outpatient E/M visit (high-level example listed in policy)
99215	Office or other outpatient E/M visit (high-level example listed in policy)

Time thresholds referenced in policy

Example: 45-59 minutesPolicy cites 45-59 minutes of total time on the date of the encounter as the time range used when selecting certain E/M codes based on time.

Example: 60-74 minutesPolicy cites 60-74 minutes of total time on the date of the encounter as the time range used when selecting higher-level E/M codes based on time.

Example: 40-54 minutesPolicy cites 40-54 minutes of total time on the date of the encounter as the time range used when selecting certain E/M codes based on time.

Provider Actions and Billing Guidance

Denial Risk

Denial risk when psychotherapy add-ons billed with high-level E/M

Claims that include psychotherapy add-on codes 90833, 90836, or 90838 billed on the same date of service by the same provider with high-level E/M codes 99204, 99205, 99214, or 99215 will be denied reimbursement because it is clinically improbable both services could be performed at a significant and independently identifiable level of time without overlap.

Non-reimbursable combinations: 90833/90836/90838 with 99204, 99205, 99214, or 99215 billed same date by same provider.

Documentation Required

Document distinct, substantial psychotherapy and E/M time

Document psychotherapy time and E/M service time as substantial, clearly recorded, and independently identifiable; overlapping time cannot be counted toward both services.

Ensure psychotherapy is separately identifiable and non-overlapping with the E/M service.

Definitions

Psychotherapy add-on — definition and requirements

DefinitionPsychotherapy add-on codes (90833, 90836, 90838) require the psychotherapy service to be substantial, separately identifiable, and non-overlapping with the E/M service.

Requirement for separate billingWhen billed with an E/M service, psychotherapy add-on services must be clearly documented as independent services; overlapping time cannot be billed to both services.

Denial circumstanceClaims with psychotherapy add-on codes billed by the same provider on the same date with high-level E/M codes (e.g., 99204, 99205, 99214, 99215) will be denied because concurrent substantial non-overlapping services are clinically improbable.

E/M time thresholds — examples

Time-based example: 45-59 minutesUsed when selecting an E/M code based on total time spent on the date of the encounter (policy example: 45-59 minutes).