What your 90837 actually pays: Medicare's 2026 rate, and the audit flag that comes with it

The 60-minute session pays the most of the three psychotherapy time bands, and Medicare's own auditors have a specific number in mind for how often you can bill it before your claims get a second look.

The code, and the number payers watch

CPT code 90837 is individual psychotherapy with a patient, 53 minutes or more of face-to-face therapy time. It pays more than 90834 for the same reason a longer visit pays more anywhere in medicine: more clinician time. It is also the psychotherapy code under the most documentation scrutiny. The Office of Inspector General (OIG), the federal watchdog that audits Medicare payments, has an active work plan on Medicare Part B psychotherapy payments, and one of its stated triggers is specific: if a clinician's 90837 claims exceed 80% of their total psychotherapy volume, that pattern alone is enough to flag the clinician for medical review.

That does not mean billing 90837 correctly and often is wrong. A caseload of patients who genuinely need and benefit from a full hour is a legitimate clinical pattern. It means the documentation has to hold up: the note has to state the actual start and stop time, or the total minutes, for every session billed this way, not just for the ones a reviewer happens to pull.

What Medicare pays in 2026

Medicare pays $167.00 nationally for 90837 in 2026, up from $154.29 in 2025, an increase of 8.2%. The number underneath that move is the Medicare conversion factor, a single dollar multiplier that CMS applies to every code on the physician fee schedule. It fell for five straight years, from a peak of $36.09 in 2020 to $32.35 in 2025, before this year's rule reversed course: $33.40 for 2026, a 3.26% increase. Time-based psychotherapy codes were explicitly exempted from a separate 2.5% efficiency cut applied to roughly 7,700 other codes in the same rule.

What commercial payers pay

PayerPrice shows national average commercial rates for 90837 from $138.60 (UnitedHealthcare) to $180.84 (Cigna) as of August 2026. A separate OIG review of psychotherapy claims paid during the first year of the COVID-19 public health emergency found $580 million in improper payments out of $1 billion reviewed, with undocumented time and missing signatures as the leading causes, a reminder that the documentation gap, not the billing itself, is what turns into a repayment demand.

The so-what

• Know your own 90837 share. If it is above 80% of your psychotherapy volume, that is not automatically wrong, but it means your documentation needs to be airtight on every one of those claims, not just the ones you remember clearly.
• Time every session precisely. A note that states actual start and stop time survives a review. A note that says "session ran the full hour" without minutes does not.