Prior Authorization
Anthem Prior Authorization for CPT 90837
Individual psychotherapy, 53+ minutes face-to-face with patient · Standard commercial plans
Source
Anthem Provider Prior Authorization Lookup and Behavioral Health Guidance 2025Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Routine outpatient psychotherapy under Anthem commercial plans does not require prior authorization. This row should not be applied to Medicaid line-of-business rules or session-limit exceptions that can trigger authorization later.
Documentation checklist
- ✓Diagnosis in progress note
- ✓Start and stop times
- ✓Documentation supporting 53+ minutes of psychotherapy
2026 Medicare rate for CPT 90837
Office (non-facility)
$167.00
Facility
$135.27
Total RVUs (office)
5.00
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Anthem's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 90837 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Diagnosis in progress note, Start and stop times, Documentation supporting 53+ minutes of psychotherapy.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Anthem require prior authorization for CPT 90837?
- No. Anthem does not list CPT 90837 on its current prior-authorization list for Standard commercial plans.
- What documentation does Anthem require for CPT 90837?
- Diagnosis in progress note; Start and stop times; Documentation supporting 53+ minutes of psychotherapy
- How much does Medicare pay for CPT 90837 in 2026?
- In 2026, the national Medicare allowable for CPT 90837 is $167.00 in an office setting and $135.27 in a facility. Commercial allowables for Anthem are typically negotiated against this benchmark.
- What if Anthem denies the PA for CPT 90837?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Anthem PA lookups
CPT 90837 prior authorization by payer
No PA needed — is Anthem paying CPT 90837 correctly?
When prior auth isn't the blocker, underpayment is. Check 90837 against the 2026 Medicare benchmark and run a free leak check — no signup.