Avoiding Denials: Proving Your 60-Minute Sessions Are Medically Necessary

If you’ve been using CPT code 90837 for your 60-minute sessions, you might have noticed that insurance companies are cracking down - more and more claims are getting denied or flagged for review which puts more pressure on you to to justify why your client actually needed that full hour. The best way to support continued use of the code is to ensure your documentation provides a clear explanation of the functional impairments a client is experiencing that warrant longer therapy sessions.

Why Are Insurance Companies Targeting 90837?

Despite the work clinicians do to support clients, thus keeping them out of crisis units and reducing overall medical costs, commercial is a business and they are always trying to protect their bottom line. They are concerned with making money and reducing what they pay out. As such, insurers are looking for patterns that scream “overbilling” or “lack of medical necessity.” Here’s what’s raising red flags in 2026:

If the bulk of your sessions are billed as 53+-minute 90837 claims, payers may assume you’re padding time or overusing the code without it being clinically appropriate. Insurance wants details on why the session needed to be 60 minutes, leaving you to find a balance between writing notes that have enough, but not too much, information in them. Additionally, insurance wants to make sure we are providing services that meet the client’s clinical needs, not services that benefit our bank accounts.

How to Document 90837 Like a Pro (And Avoid Denials)

1. Start with the “Why”

Before you even think about billing 90837, ask yourself:

• What’s the client’s diagnosis? (e.g., PTSD, severe anxiety, bipolar disorder in a depressive episode)

• How severe are their symptoms? (e.g., “Client reports suicidal ideation, inability to sleep, and panic attacks 5x/week”)

• How does this session address their needs? (e.g., “Session focused on crisis intervention and safety planning”)

Example:

“Client presented with acute distress due to recent trauma trigger. Required extended time to process emotions, develop coping strategies, and complete a safety plan.”

2. Provide an Accurate Accounting of Work in the Session

Insurers want to see exactly what happened during those 53+ minutes. Make sure you are documenting ‘enough’ data and interventions to support the length of the session.

Pro Tip: Use standardized measures like the PHQ-9, GAD-7, or PCL-5 to show symptom severity and progress. Payers love this!

3. Connect the Dots for Payers

Your note should answer:
 Why 60 minutes? (e.g., “Client’s symptoms required intensive intervention”)
 What did you do? (e.g., “Used DBT for rumination and grounding techniques”)
 How did the client respond? (e.g., “Client reported reduced distress and ability to identify triggers”)

Example:

“Session extended to 60 minutes due to client’s acute crisis state. Interventions included cognitive restructuring for intrusive thoughts and safety planning to prevent self-harm. Client demonstrated improved emotional regulation by session’s end.”

4. Avoid These Common Mistakes

Generic notes: “Client discussed issues from the week” → Nope. Be specific!


No time tracking: “Session lasted about an hour” → Denied. Always log exact times.

Overusing 90837: If most of your clients don’t need 60 minutes, mix it up with 90834 (45 minutes).


Ignoring payer policies: Some insurers require pre-authorization for 90837 or limit it to certain diagnoses.

What If You Get a Denial?

Write an appeal letter: Explain why the session was medically necessary. Include:

• Diagnosis and symptom severity

• Exact session breakdown (time + interventions)

• Client’s response and progress

Real-Life Example: A therapist in Florida was denied for billing 90837 for a client with chronic depression and suicidal ideation. The payer said, “No medical necessity.” The therapist appealed with:

• A note detailing 15 minutes of crisis intervention and 20 minutes of CBT.

• A PHQ-9 showing a 10-point drop post-session.

• A letter explaining the acute risk and need for extended time.

Result? The denial was overturned!

Consulting with an attorney that specializes in mental health can also be beneficial to ensure you provide the most appropriate information in the notes.

Quick Checklist for 90837 Documentation

• Exact start/end times (e.g., 2:05 PM–3:08 PM = 63 minutes)

• Diagnosis and symptom severity (e.g., “Severe PTSD with nightmares and hypervigilance”)


• Interventions and duration (e.g., “15 min: Safety planning, 20 min: Trauma processing”)


• Client’s response (e.g., “Reported reduced distress and ability to identify triggers”)


• Connection to treatment plan (e.g., “Aligned with goal to stabilize acute symptoms”)

Need Help? We’ve Got Your Back!

Insurance companies aren’t trying to make your life harder - they’re trying to save money. But with the right documentation, you can prove the value of your work and keep getting paid what you deserve.

If your documentation feels shaky or you’re tired of fighting denials, we can help. At TherAssistFL, we specialize in clean billing, bulletproof documentation, and keeping your practice compliant.

We would love to offer you support by:

• Reviewing your current 90837 notes for red flags

• Setting up a team training on clinical necessity documentation

• Creating a customized template for your practice

• Exploring alternative billing strategies for high-acuity clients

Book a free 15-minute consult to review your 90837 notes or train your team.