90838 do's and don'ts for long medication visits
Medicare's 2026 national rate for a 99214 with 90838 is $272.22 for physicians. Bill the add-on when the psychotherapy alone ran 53 minutes or more.
Head of Growth and Operations, JotPsych
You see a patient for a long medication visit, and the psychotherapy alone runs 55 minutes. Add 90838 to your 99214. Write those 55 minutes in your note, apart from the medication work.
Bill the E/M code on the same claim
Write the psychotherapy start and stop time
Bill 90838 only for 53 minutes or more
Counting E/M time toward the 53 minutes
Writing only the visit's total time
Rounding psychotherapy under 53 minutes up to 90838
Time rules from the CPT code set, as quoted in audit report A-09-21-03021 (2023), and Medicare's add-on code edits. A note or claim that breaks one of those rules doesn't support 90838.
Three do's for 90838
Bill the E/M code on the same claim.
90838 is an add-on to your evaluation and management (E/M) visit. Your add-on line pays only beside a paid E/M code for the same patient and date, under Medicare's add-on code edits.
Write the psychotherapy start and stop time.
Put your psychotherapy start and stop time on its own line, apart from your medication work, or give a total instead, such as "55 minutes." Federal auditors accepted either format in a 2023 audit report.
Bill 90838 only for 53 minutes or more.
90838 starts at 53 minutes of psychotherapy. You'd bill 90836 for 38 to 52 minutes and 90833 for 16 to 37.
Three don'ts for 90838
Don't count E/M time toward the 53 minutes.
Your history, exam, and medical decision-making don't count as psychotherapy time under CPT, per the same audit report. Subtract your medication work first.
Don't write only the visit's total time.
Of the 216 psychotherapy visits the auditors sampled, 32 carried an add-on, and in 6 of those 32, the note gave only the visit's total time.
In one of those 6 visits, from June 25, 2020, the note gave 60 minutes in total. Medicare paid $99 for the add-on. Federal auditors found the $99 unallowable, because the note never showed how many of those minutes went to psychotherapy, or whether the psychotherapy ran at least 16 minutes.
Don't round up to 90838.
Your 50 minutes of psychotherapy bill as 90836, even in a 90-minute visit with 40 minutes of medication work. Your psychotherapy minutes pick the code. Your visit's length doesn't.
| Payer | 90836, 38 to 52 minutes | 90838, 53 minutes or more |
|---|---|---|
| Medicare 2026, physicians | $103.21 | $136.61 |
| Blue Cross/Anthem | $92.08 | $123.17 |
| UnitedHealthcare | $97.56 | $133.08 |
| Aetna | $110.06 | $133.12 |
| Cigna | $123.07 | $191.42 |
Medicare's figures are its 2026 national rates for physicians, from the 2026 fee schedule files; 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 90836 and 90838 rates from each payer with that payer's row.
For physicians, Medicare's 2026 national rate for the 90838 add-on is $136.61, up 11.1% from $122.92 in 2025. Cigna is the one commercial payer whose 90838 and 90836 averages both top Medicare's physician rates, per PayerPrice's national 90838 and 90836 averages.
JotAudit in JotPsych checks the 99214 and 90838 on each note before you sign and flags a code mismatch.
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.
- PayerPrice, CPT 90838 Fee Schedule by Payer: national payer-file averages, verified August 2026.
- PayerPrice, CPT 90836 Fee Schedule by Payer: national payer-file averages, verified August 2026.