How to add 90833 to a medication visit
Bill 90833 with the evaluation and management (E/M) code when your note shows 16 to 37 psychotherapy minutes, counted apart from the E/M work.
Head of Growth and Operations, JotPsych
You've spent 20 minutes on psychotherapy inside a medication visit, and the claim carries only the 99214. With 90833 on the claim, Medicare's 2026 national rate for the visit rises from $115.27 to $184.55 for a nurse practitioner.
Medicare's national rate for nurse practitioners is 85% of the physician rate for each code, per the 2026 fee schedule files. The added amount is the 90833 add-on, which needs 16 to 37 psychotherapy minutes in the note.
- Bill your E/M code on the same claim. Medicare's add-on code edits pay your 90833 only beside a primary code paid to you, for the same patient, on the same day.
- Keep your psychotherapy apart from your E/M work. CPT rules require your two services to be significant and separately identifiable. Your time on the history, the exam, and medical decisions counts toward the E/M visit alone.
- Note the psychotherapy minutes on their own. You bill 90833 for 16 to 37 minutes of psychotherapy, 90836 for 38 to 52 minutes, and 90838 for 53 minutes or more, by the time in your note. Give your start and stop time, or a total, for the psychotherapy alone. The visit's total won't do.
- Total the minutes when the psychotherapy comes in pieces. Add up the pieces. Leave out the E/M minutes. First Coast, the Medicare contractor for Florida, Puerto Rico, and the U.S. Virgin Islands, notes that psychotherapy time in a medication visit "may not be continuous." Elsewhere, check your own Medicare contractor's billing rules.
Medicare and commercial rates for 90833
Medicare's figure is its 2026 national rate for nurse practitioners; the commercial figures are PayerPrice national averages, August 2026, one per payer with no split by clinician type. Each amount is the add-on alone. Compare your contracted 90833 rate from each payer with that payer's bar.
Medicare's national rate for 90833 is $81.50 for physicians, and nurse practitioners get 85% of that rate. Each of the four commercial averages tops the nurse practitioner rate, per PayerPrice.
Ask each payer whose average tops your contracted 90833 rate to raise your rate to at least that average at your next contract renewal.
Add the E/M + Add-on Psychotherapy template in JotPsych, and each note gets its own psychotherapy section with the minutes.
Book 15 minutes- Centers for Medicare & Medicaid Services (CMS), Physician Fee Schedule Relative Value Files, RVU25A (released 2025-01-10) and RVU26A (released 2025-12-29): national non-facility rates.
- CMS, Medicare National Correct Coding Initiative (NCCI) Add-on Code Edits, read October 1, 2026.
- U.S. Department of Health and Human Services, Office of Inspector General (OIG), Medicare Improperly Paid Providers for Some Psychotherapy Services, Including Those Provided via Telehealth, During the First Year of the COVID-19 Public Health Emergency, report A-09-21-03021, May 2, 2023.
- First Coast Service Options, Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520), version 43, revision effective January 1, 2025, read October 2, 2026.
- CMS, Medicare Learning Network, Medicare & Mental Health Coverage, booklet MLN1986542, March 2026, pages 13 to 24: physicians and psychologists paid 100% of the fee schedule amount, nurse practitioners 85%, and clinical social workers, marriage and family therapists, and mental health counselors 75% of the psychologist amount.
- PayerPrice, CPT 90833 Fee Schedule by Payer: national payer-file averages, verified August 2026.