You just spent 58 minutes with a client processing complex trauma. You documented thoroughly. You're emotionally spent. And then you billed for a 45-minute session.

Sound familiar? Most of us didn't get into this field for the billing—and many of us actively avoid thinking about it. But here's the thing: underbilling isn't humility. It's a fast track to burnout and an unsustainable practice.

The good news? You don't need to do more work to earn more. You just need to bill accurately for what you're already doing. Here are five habits to adopt this quarter.

1. Bill for the Full Hour You're Actually Providing

If your sessions regularly run 53–60 minutes, you should be using CPT 90837 (53+ minutes), not 90834 (38–52 minutes). The difference? Roughly 15–20% more per session—often an extra $20–$40.

What this looks like in practice:

Your session runs 55 minutes of intensive EMDR processing. You document: "53-minute session; extended time clinically necessary for trauma reprocessing and adequate stabilization before session end." You bill 90837.

Over a year, this single change can mean thousands of dollars—without seeing a single additional client.

2. Use Crisis Codes When You're Actually Managing a Crisis

We've all had that session: a client arrives in acute suicidal crisis, and the next 75 minutes become intensive stabilization, safety planning, and coordination. That's not a standard therapy session—and it shouldn't be billed as one.

The codes:

90839: First 30–74 minutes of crisis psychotherapy
90840: Each additional 30-minute block beyond 74 minutes


Documentation musts: Your risk assessment findings, interventions used (safety planning, grounding, contacting supports), and how the client was stabilized.


These sessions take everything out of you. Bill accordingly.

3. Claim Interactive Complexity When Sessions Require Extra Effort

Some sessions are just harder—not because of the diagnosis, but because of communication demands. Think: play therapy with a nonverbal child, a family session with hostile interrupting members, working through an interpreter, or a client with severe dissociation requiring constant grounding.

CPT 90785 is an add-on code (never billed alone) that captures this extra complexity. It adds $5–$15 per session—small individually, but meaningful over time.

Example documentation: "90785 add-on applied—session required use of therapeutic play and visual aids due to client's developmental communication limitations."

Most therapists never use this code, even when they should. If your session was markedly more demanding than usual, claim it.

4. Get Paid for Collateral Work and Care Coordination

Therapy doesn't end when the client leaves. You're emailing teachers, calling psychiatrists, meeting with parents. That's clinical work—and much of it is billable.

Two codes to know:

90846: Family therapy without the patient present (e.g., parent coaching session for a child client)

G0546–G0551: New Medicare codes (as of 2025) for interprofessional consultation—that 15-minute call with your client's PCP now has a billing pathway

Pro tip: Medicare also introduced G0560 specifically for safety planning interventions. The field is finally recognizing that comprehensive care includes more than face-to-face therapy. Use the codes that exist.

5. Bill for Outcome Measures You're Already Using

Administering a PHQ-9 at intake? GAD-7 quarterly? AUDIT-C for substance use screening? That's billable.

CPT 96127 covers brief standardized assessments—about $5 per instrument, up to 4 per visit.

The math: PHQ-9 + GAD-7 at intake = ~$10. Quarterly PHQ-9 across 50 clients = $200+/year.

It's not life-changing money, but it adds up—and it reinforces a practice (routine outcome monitoring) that actually improves clinical outcomes. Win-win.

The Mindset Shift

Here's what I want you to sit with: Accurate billing is ethical practice.

It's not about squeezing every dollar from insurance companies. It's about sustainability. When you're chronically underpaid for your labor, resentment builds. Burnout accelerates. And eventually, your clients lose a good clinician.

You don't need to bill for things you didn't do. You need to bill for things you did do—the extra 10 minutes, the crisis you stabilized, the parent you coached, the screener you scored. That work has value. Claim it.

Your Q1 Challenge

Pick one habit from this list that you've been leaving money on the table with. Implement it this month. Track the difference.

Then come back and tell us how it went—we'd love to hear what shifted for you.

Quick Resources

CMS 2025 Physician Fee Schedule — Latest reimbursement rates and new codes (cms.gov/medicare/payment/fee-schedules/physician)

APA Practice Organization Billing Resources — CPT code guidance for psychologists (apaservices.org/practice/reimbursement)

Your EHR's billing guide — Most have code lookup features; use them

A note on compliance: Always verify codes with your specific payers, document thoroughly, and consult your billing specialist or supervisor when uncertain. Policies vary by state and insurance plan.

What billing habit are you committing to this quarter? Hit reply and let us know.