Guide

A 90-minute EMDR session or a half-day intensive: what to bill

Summary

A 90-minute EMDR session bills as one unit of 90837, because the top psychotherapy time band is open-ended at 53 minutes or more and nothing in the code set sits above it. The prolonged-services add-ons that once extended psychotherapy were deleted for 2023, and their Medicare replacements attach only to evaluation-and-management codes. A half-day intensive is either multiple units against a published per-day edit, or priced privately with a written estimate.

By Gale Editorial · Updated 2026-09-01. Every figure cited to a dated source. How we write.

What a 90-minute session bills as

One unit of 90837. The Medicare contractor article for the psychotherapy time bands puts 16 to 37 minutes on 90832, 38 to 52 on 90834, and 53 or more on 90837 1Ref 1First Coast Service Options, Inc. (A and B MAC, Jurisdiction N), for the Centers for Medicare & Medicaid Services (2025).Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520).The psychotherapy time bands as this Medicare contractor states them (16 to 37 minutes for 90832, 38 to 52 for 90834, 53 or more for 90837), and the article's own legacy sentence permitting a prolonged service code when non-E/M psychotherapy runs 90 minutes or longer without naming any such code. Cited as one MAC's jurisdiction-N guidance, not a national rule.. The top band is open at the far end. Ninety minutes falls inside it, and so does two hours.

Face-to-face time	Code
16 to 37 minutes	90832
38 to 52 minutes	90834
53 minutes or more	90837

Bands as stated in First Coast Service Options' article A57520, revision effective January 1, 2025. That is contractor guidance binding Florida, Puerto Rico and the U.S. Virgin Islands; other Medicare Administrative Contractors publish their own articles, and only this one was checked here.

The code set agrees on the shape. The American Medical Association's behavioral health coding resource lists the group as 90832, 90834, 90837 at 30, 45 and 60 minutes, with the evaluation-and-management add-ons beside it and no prolonged-services code anywhere in the family 2Ref 2American Medical Association (2025).Behavioral health coding resource.The shape of the psychotherapy CPT family as the code owner maps it: 90832, 90834 and 90837 at 30, 45 and 60 minutes, with the E/M add-ons alongside and no prolonged-services code in the group.. Sixty minutes is the time printed beside the code. It is not a ceiling on the band, and the 53-minute line is where the top one starts.

EMDR does not change that arithmetic. By convention the modality carries no procedure code of its own, so a reprocessing session bills as psychotherapy and the protocol lives in the note rather than on the claim.

The prolonged-services route closed for 2023

There used to be an add-on built for exactly this, and it is gone. The CY 2023 Physician Fee Schedule final rule finalized the CPT Editorial Panel's deletion of prolonged-services codes 99354 through 99357 3Ref 3Centers for Medicare & Medicaid Services (2022).Medicare and Medicaid Programs; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Implementing Requirements for Manufacturers of Certain Single-dose Container or Single-use Package Drugs To Provide Refunds With Respect to Discarded Amounts; and COVID-19 Interim Final Rules.The deletion of prolonged-services codes 99354 through 99357 effective CY 2023, the rule's own description of 99354 and 99355 as add-ons for prolonged evaluation and management or psychotherapy time beyond the primary procedure's typical service time, and the fact that the replacement G codes G0316, G0317 and G0318 describe prolonged services associated with certain types of E/M services.. The rule's own text records what two of them covered: 99354 and 99355 were add-on codes for prolonged evaluation and management or psychotherapy services beyond the typical service time of the primary procedure 3Ref 3Centers for Medicare & Medicaid Services (2022).Medicare and Medicaid Programs; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Implementing Requirements for Manufacturers of Certain Single-dose Container or Single-use Package Drugs To Provide Refunds With Respect to Discarded Amounts; and COVID-19 Interim Final Rules.The deletion of prolonged-services codes 99354 through 99357 effective CY 2023, the rule's own description of 99354 and 99355 as add-ons for prolonged evaluation and management or psychotherapy time beyond the primary procedure's typical service time, and the fact that the replacement G codes G0316, G0317 and G0318 describe prolonged services associated with certain types of E/M services..

The word psychotherapy in that description is what closed.

The Medicare-specific replacements do not reach back to it. CMS created G0316, G0317 and G0318 to describe prolonged services associated with certain types of evaluation-and-management services 3Ref 3Centers for Medicare & Medicaid Services (2022).Medicare and Medicaid Programs; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Implementing Requirements for Manufacturers of Certain Single-dose Container or Single-use Package Drugs To Provide Refunds With Respect to Discarded Amounts; and COVID-19 Interim Final Rules.The deletion of prolonged-services codes 99354 through 99357 effective CY 2023, the rule's own description of 99354 and 99355 as add-ons for prolonged evaluation and management or psychotherapy time beyond the primary procedure's typical service time, and the fact that the replacement G codes G0316, G0317 and G0318 describe prolonged services associated with certain types of E/M services., and an add-on written for an E/M code has nothing to attach to on a claim whose only line is 90837.

But the older guidance has not all been rewritten, and clinicians keep finding a sentence that seems to say otherwise. First Coast's article still states that a physician or other qualified health care professional can report a prolonged service code if the psychotherapy service, not performed with an E/M service, is 90 minutes or longer involving direct patient contact 1Ref 1First Coast Service Options, Inc. (A and B MAC, Jurisdiction N), for the Centers for Medicare & Medicaid Services (2025).Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520).The psychotherapy time bands as this Medicare contractor states them (16 to 37 minutes for 90832, 38 to 52 for 90834, 53 or more for 90837), and the article's own legacy sentence permitting a prolonged service code when non-E/M psychotherapy runs 90 minutes or longer without naming any such code. Cited as one MAC's jurisdiction-N guidance, not a national rule.. It names no code. Read against the 2023 deletion, there is no CPT prolonged code left for it to name, and one contractor's article is one jurisdiction. The sentence is worth recognising when you meet it, and worth nothing on a claim.

A half-day intensive on one date: units and the edit

Three hours on one date is a units question, and Medicare publishes a ceiling for it. A Medically Unlikely Edit is the maximum units of service reported for a code by one provider for one patient on one date of service, across the vast majority of appropriately reported claims 4Ref 4Centers for Medicare & Medicaid Services (2026).Medically Unlikely Edits.What a Medically Unlikely Edit is: the maximum units of service reported for a code by one provider for one patient on one date of service across the vast majority of appropriately reported claims, that not every code carries one, and that CMS reposts the tables quarterly.. Not every code carries one, and CMS reposts the tables quarterly, so any value you look up is stamped to its quarter.

For 90837 the published practitioner value is 2, with adjudication indicator 3, a clinical date-of-service edit, in the table effective October 1, 2026 5Ref 5Centers for Medicare & Medicaid Services (2026).Practitioner Services MUE Table (MCR_MUE_PractitionerServices_Eff_10-01-2026).The published practitioner MUE value of 2 and adjudication indicator 3 for 90837 in the table effective October 1, 2026, stamped to that effective date because CMS revises the table quarterly.. A third unit on one date is what that edit stops. The file name carries its own effective date, which is the thing to re-check before you rely on the number.

Read the edit for what it covers. CMS words it as typical reporting on the vast majority of appropriately reported claims 4Ref 4Centers for Medicare & Medicaid Services (2026).Medically Unlikely Edits.What a Medically Unlikely Edit is: the maximum units of service reported for a code by one provider for one patient on one date of service across the vast majority of appropriately reported claims, that not every code carries one, and that CMS reposts the tables quarterly., which is a claims-processing description of Medicare volume. It settles nothing about whether a commercial payer pays a second unit of the same code on one date; that sits in your contract and in that payer's own published policy, and neither is answered by anything in the NCCI tables.

Record the start and stop time of the face-to-face work either way. A time-based code is a claim about minutes, and the note is the only place those minutes exist.

What the extra time earns

Less than the clock suggests. Payment attaches to the code, and 90837 is one code however far past 53 minutes the session runs. For a nurse practitioner's professional services Medicare pays 80% of the lesser of the actual charge or 85% of the amount a physician gets under the Physician Fee Schedule 6Ref 6Centers for Medicare & Medicaid Services (2025).Medicare and Mental Health Coverage.Medicare's payment formula for a nurse practitioner's professional services: 80% of the lesser of the actual charge or 85% of the amount a physician gets under the Physician Fee Schedule.. Two sessions billed on that same line pay alike whether one ran 55 minutes and the other ran 95.

So the extended-session format is a clinical and scheduling decision that insurance mostly does not reward, and it is worth pricing that in before a practice builds a service line on it. Where 90834 vs 90837 moves what a claim pays, the gap between 55 minutes and 95 minutes moves nothing.

The intake is its own case.

A first appointment that runs long raises a different question, 90791 or 90837 for intakes. That one turns on what the work was rather than on how long it took.

Pricing the intensive privately

Off insurance the constraint moves from the code set to disclosure. An uninsured or self-pay individual gets a written good faith estimate of expected charges, and the deadline runs off the scheduling date: not later than 1 business day after scheduling when the service is scheduled at least 3 business days out, and 3 business days after scheduling when it is scheduled at least 10 business days out, or on request 7Ref 7U.S. Department of Health and Human Services (2026).45 CFR 149.610 — Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals..The good faith estimate duty for an uninsured or self-pay individual and its two business-day clocks, plus the requirement that the estimate be written and itemized with the expected service codes..

An intensive is where that clock bites hardest, because the format is usually booked weeks ahead and the total is larger than a session fee. The estimate is written, and it carries an itemized list of the expected services with the service and diagnosis codes attached 7Ref 7U.S. Department of Health and Human Services (2026).45 CFR 149.610 — Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals..The good faith estimate duty for an uninsured or self-pay individual and its two business-day clocks, plus the requirement that the estimate be written and itemized with the expected service codes., which means the code question above still has to be answered even when no payer will ever see the claim.

No dollar figure belongs on this page. Cash rates for extended work vary by market and by practice, and nothing in the federal rule sets or suggests one; the rule governs the disclosure, and the number in it is yours.

Before the next intensive goes on the calendar

Four things settle first, and none of them takes an hour. Confirm which band the session lands in and what a second unit would mean on that date. Confirm what the payer contract says about units per day. Confirm whether the client is self-pay, which starts the estimate clock. Then confirm the current quarter's edit value rather than the one quoted here.

Look up the current Practitioner Services MUE table on the CMS Medically Unlikely Edits page and read the value against its effective date; the October 1, 2026 file is the one behind the number above 5Ref 5Centers for Medicare & Medicaid Services (2026).Practitioner Services MUE Table (MCR_MUE_PractitionerServices_Eff_10-01-2026).The published practitioner MUE value of 2 and adjudication indicator 3 for 90837 in the table effective October 1, 2026, stamped to that effective date because CMS revises the table quarterly..
Read the units-per-day and same-day language in the payer contract before offering an extended format to clients covered by it.
Send the good faith estimate on whichever clock the lead time triggers when the client is uninsured or self-pay: 1 business day after scheduling for a service at least 3 business days out, 3 business days for one at least 10 business days out. Keep the copy 7Ref 7U.S. Department of Health and Human Services (2026).45 CFR 149.610 — Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals..The good faith estimate duty for an uninsured or self-pay individual and its two business-day clocks, plus the requirement that the estimate be written and itemized with the expected service codes..
Document start and stop times for every time-based line, and keep the modality in the narrative rather than on the claim.
Check your own Medicare Administrative Contractor's billing and coding article for psychotherapy before assuming the bands and any prolonged-services language above apply in your jurisdiction 1Ref 1First Coast Service Options, Inc. (A and B MAC, Jurisdiction N), for the Centers for Medicare & Medicaid Services (2025).Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520).The psychotherapy time bands as this Medicare contractor states them (16 to 37 minutes for 90832, 38 to 52 for 90834, 53 or more for 90837), and the article's own legacy sentence permitting a prolonged service code when non-E/M psychotherapy runs 90 minutes or longer without naming any such code. Cited as one MAC's jurisdiction-N guidance, not a national rule..

Common questions

No. The psychotherapy family maps to 90832, 90834 and 90837 at 30, 45 and 60 minutes, with no prolonged-services code in the group, and the top band is written as 53 or more minutes rather than 53 to 60. A 90-minute session and a 55-minute session both land on 90837, and the code set offers nothing above it.

Medicare publishes a practitioner Medically Unlikely Edit of 2 for 90837, with a clinical date-of-service adjudication indicator, in the table effective October 1, 2026. A third unit on one date is what that edit stops. Whether a commercial payer pays a second unit is a contract question, not an NCCI question, and the tables are reposted quarterly.

The CY 2023 Physician Fee Schedule final rule finalized the deletion of 99354 through 99357. The rule describes 99354 and 99355 as add-ons for prolonged evaluation and management or psychotherapy beyond the primary procedure's typical time, which was the route psychotherapy used. The Medicare replacements G0316, G0317 and G0318 attach to evaluation-and-management services only.

That sentence appears in one contractor's psychotherapy article and it names no code. The CPT prolonged add-ons that once served psychotherapy were deleted for 2023, and the Medicare G-code replacements are evaluation-and-management add-ons. Only that one contractor's article was checked here, so treat the line as jurisdiction-specific text and confirm with your own contractor before billing anything on it.

By convention EMDR has no procedure code of its own. The session is billed under the psychotherapy codes on face-to-face time, the same way any other modality is, and the protocol, the phase and the target belong in the note. Nothing about the modality changes which time band the session falls into or what the claim can carry.

An uninsured or self-pay individual gets a written estimate of expected charges, itemized with service and diagnosis codes. The deadline is not later than 1 business day after scheduling when the service is at least 3 business days out, and 3 business days after scheduling when it is at least 10 business days out, or on request.

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References

1.First Coast Service Options, Inc. (A and B MAC, Jurisdiction N), for the Centers for Medicare & Medicaid Services (2025). Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520). CMS Medicare Coverage Database — Billing and Coding Article. link ✓The psychotherapy time bands as this Medicare contractor states them (16 to 37 minutes for 90832, 38 to 52 for 90834, 53 or more for 90837), and the article's own legacy sentence permitting a prolonged service code when non-E/M psychotherapy runs 90 minutes or longer without naming any such code. Cited as one MAC's jurisdiction-N guidance, not a national rule.
2.American Medical Association (2025). Behavioral health coding resource. American Medical Association. link ✓The shape of the psychotherapy CPT family as the code owner maps it: 90832, 90834 and 90837 at 30, 45 and 60 minutes, with the E/M add-ons alongside and no prolonged-services code in the group.
3.Centers for Medicare & Medicaid Services (2022). Medicare and Medicaid Programs; CY 2023 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Implementing Requirements for Manufacturers of Certain Single-dose Container or Single-use Package Drugs To Provide Refunds With Respect to Discarded Amounts; and COVID-19 Interim Final Rules. Federal Register, 87 FR 69404 (final rule, document 2022-23873, published 2022-11-18). link ✓The deletion of prolonged-services codes 99354 through 99357 effective CY 2023, the rule's own description of 99354 and 99355 as add-ons for prolonged evaluation and management or psychotherapy time beyond the primary procedure's typical service time, and the fact that the replacement G codes G0316, G0317 and G0318 describe prolonged services associated with certain types of E/M services.
4.Centers for Medicare & Medicaid Services (2026). Medically Unlikely Edits. Centers for Medicare & Medicaid Services (CMS). link ✓What a Medically Unlikely Edit is: the maximum units of service reported for a code by one provider for one patient on one date of service across the vast majority of appropriately reported claims, that not every code carries one, and that CMS reposts the tables quarterly.
5.Centers for Medicare & Medicaid Services (2026). Practitioner Services MUE Table (MCR_MUE_PractitionerServices_Eff_10-01-2026). Centers for Medicare & Medicaid Services, Medicare NCCI. link ✓The published practitioner MUE value of 2 and adjudication indicator 3 for 90837 in the table effective October 1, 2026, stamped to that effective date because CMS revises the table quarterly.
6.Centers for Medicare & Medicaid Services (2025). Medicare and Mental Health Coverage. CMS Medicare Learning Network (MLN1986542). link ✓Medicare's payment formula for a nurse practitioner's professional services: 80% of the lesser of the actual charge or 85% of the amount a physician gets under the Physician Fee Schedule.
7.U.S. Department of Health and Human Services (2026). 45 CFR 149.610 — Requirements for provision of good faith estimates of expected charges for uninsured (or self-pay) individuals.. Electronic Code of Federal Regulations (eCFR), Office of the Federal Register. link ✓The good faith estimate duty for an uninsured or self-pay individual and its two business-day clocks, plus the requirement that the estimate be written and itemized with the expected service codes.

https://www.gale.care/for-providers/pq-ninety-minute-emdr-above-90837 · 7 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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