90836 counts only the psychotherapy minutes in the visit
Federal auditors found 6 of 32 sampled add-ons improper because the note gave only the visit's total time. Write the psychotherapy minutes on their own line.
Head of Growth and Operations, JotPsych
You add 90836 to a 99214 when the visit includes 38 to 52 minutes of psychotherapy. Use three note lines.
Medication management (99214): history, exam, medication changes.
Psychotherapy (90836): 10:00 a.m. to 10:45 a.m., 45 minutes.
Psychotherapy time excludes the time spent on medication management.
Federal auditors accepted psychotherapy time written as a start and stop time or as a total, per audit report A-09-21-03021 (2023). A note with only the visit's total time doesn't show the psychotherapy minutes.
Why the minutes get their own line
CPT rules count only psychotherapy time toward your add-on. Your time on the history, the exam, and medical decisions belongs to the evaluation and management (E/M) visit, per the CPT rules a 2023 federal audit report quotes. In that audit, 6 of the 32 sampled add-on visits gave only the visit's total time. Auditors found those psychotherapy payments improper.
What each line does
Your first line names the medication work. Your second line gives the psychotherapy start and stop time and the total. Your third line states the CPT rule. Anyone who reads your note then sees that the 45 minutes leave out the medication work.
When to use the three lines
Use the three lines on every medication visit with psychotherapy, and name the add-on your minutes support in the second line. Bill 90836 for 38 to 52 minutes, 90833 for 16 to 37, and 90838 for 53 or more. Don't round up. Your 30 minutes stay a 90833, even when you've spent an hour with the patient.
| Psychotherapy minutes | Add-on code | Medicare 2026, physicians |
|---|---|---|
| 16 to 37 | 90833 | $81.50 |
| 38 to 52 | 90836 | $103.21 |
| 53 or more | 90838 | $136.61 |
Time bands per CPT, as quoted in audit report A-09-21-03021 (2023); physician rates from the 2026 Medicare fee schedule files. Each add-on pays only beside an evaluation and management code on the same claim.
What 90836 pays at Medicare and four payers
At Medicare's 2026 national rates, a physician's 99214 plus 90836 totals $238.82. The add-on alone is $103.21 for physicians. PayerPrice's national averages for the add-on include every clinician type and put Aetna at $110.06 and Cigna at $123.07, both above Medicare's physician rate. UnitedHealthcare averages $97.56 and Blue Cross/Anthem $92.08, both below that rate.
Pick the E/M + Add-on Psychotherapy template in JotPsych to keep the medication work and psychotherapy minutes in separate sections.
Book 15 minutes- 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.
- 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.
- PayerPrice, CPT 90836 Fee Schedule by Payer: national payer-file averages, verified August 2026.