Psychotherapy Add-On Fraud: Billing 90833 or 90836 for Medication Visits Alone

Psychotherapy add-on billing fraud occurs when a practice knowingly bills for separate psychotherapy that clinicians did not provide, or claims therapy time the visit cannot support. A medication visit becomes a claim for medication management and psychotherapy. The clinician may have documented one service while someone else added another before the claim reached the payer. For a clinician, biller or compliance employee, the question is concrete: what happened between the work in the room and the claim the government paid?

What 90833 and 90836 Represent

Codes 90833 and 90836 represent psychotherapy delivered alongside a separate evaluation and management service. The add-on buys additional clinical work. It does not turn everything said during a medication visit into psychotherapy.

The time bands in First Coast’s Medicare guidance make that distinction easier to see:

The same psychotherapy time band can appear in either column. What changes is whether the practitioner also performed a separately identifiable medical service. A longer appointment does not answer that question.

This is why an add-on case reaches beyond inflated session length. A claim can exaggerate the minutes spent on therapy. It can also add therapy to a visit in which the clinician provided medication management alone. The second problem starts with the existence of the service itself.

The Medication Visit Has Its Own Work

Psychotherapy time excludes time used for evaluation and management. First Coast’s guidance calls for start and stop times or total psychotherapy time, and documentation that makes the services separately identifiable when the same practitioner performs both.

The WPS Medicare billing guidance makes the division explicit: when psychotherapy accompanies an evaluation and management service, the medical service’s level is selected by medical decision-making. Time spent on medical activities stays out of the psychotherapy total.

A medical history, examination and decisions about medication can occupy much of a visit. The psychotherapy claim still needs its own work and time behind it. Repeating the overall encounter length in a psychotherapy field leaves the central question unanswered.

The Office of Inspector General at the Department of Health and Human Services found exactly that problem in an audited office visit. A provider documented a total encounter of 60 minutes and billed both psychotherapy and evaluation and management. The record did not show how much time went to psychotherapy or whether it met the minimum. Medicare had paid $99 for the unsupported psychotherapy. The patient also faced $25 in associated coinsurance. The missing division affected both the government’s payment and the patient’s bill.

When the Claim Changes After the Visit

The treating professional and the people preparing the claim can have different roles. In outpatient psychiatry, the practitioner assesses and treats the patient. The health care organization submits claims for that work. A person controlling the claim can change what the payer is told after the clinical encounter has ended.

False add-ons take money from government health programs for care the patient never received. When the submitted claim contains a service the clinician did not select, the difference points to a decision elsewhere in the business. The original note, the original codes and the submitted claim can show where the account of the visit changed.

Who entered the additional service? Who directed the change? What happened when the clinician or billing staff questioned it? The cases below show why those decisions matter alongside the treatment record.

What Are Some Examples of Unethical Billing Practices in Counseling?

Examples of unethical billing practices in counseling include claims for psychotherapy that never occurred and services added after the clinician finished the visit. The cases below also show what happened when employees challenged the billing.

American Psychiatric Centers and the Unsupported Add-On

American Psychiatric Centers, doing business as Comprehensive Psychiatric Services, agreed to a $2.75 million settlement over allegedly unsupported psychotherapy add-ons, announced in August 2025. The California provider offered behavioral medicine services to individuals and families. The Justice Department’s announcement identified claims using 90833 and 90836 alongside evaluation and management visits.

The government alleged that, from January 2015 through December 2022, the practice used those add-on codes for services its providers had not performed or had not sufficiently documented. Those are different ways a claim can lack support: the service is missing, or the record fails to show the claimed work.

For an insider, the useful comparison is between the add-on and the clinician’s account of the visit. A record showing a patient visit addresses only part of the claim: it still has to show the additional psychotherapy.

Mindpath and the Employee Concerns

Mindpath Care Centers paid $1.9 million to resolve allegations about Medicare psychotherapy and related claims, the Justice Department announced in December 2025. The case began with whistleblower allegations concerning psychotherapy and medication-management sessions.

The government alleged that Mindpath billed without documenting separate psychotherapy and its time from 2018 to 2020. It also alleged that the practice failed to adequately correct problems repeatedly raised by employees and disregarded concerns about billing fraud while concentrating on income.

The employee’s concern and management’s response can show what the business knew about the billing problem. In Mindpath, the government’s account put the missing documentation and the response to employees in the same case.

Nova and the Codes Added Outside the Billing Department

Nova Psychiatric Services and Patriot Eldercare, also known collectively as Prime Behavioral Health, agreed to a $1.4 million civil settlement over billing for care clinicians had not performed, announced in May 2026. The clinics operated in Quincy and Weymouth, Massachusetts. In the settlement, they admitted and accepted responsibility for specified facts.

Between January 2017 and May 2023, the clinics billed Medicare, Medicaid and the Massachusetts Group Insurance Commission for psychotherapy and medication-management services clinicians had not performed. Nova’s chief operating officer directed independent contractors, separate from the billing departments, to alter claims before submission by adding codes for additional services.

Employees repeatedly raised concerns to the owner and chief operating officer. The practices continued. The patient encounter had ended. The claim acquired more treatment afterward.

Turning Point and the Extra Medical Service

The whistleblower complaint involving Turning Point Care Center alleged the reverse: a patient received psychotherapy, but the claim added a medical service. The complaint described the change:

The alleged discrepancy was the extra kind of work on the claim.

What Evidence Is Needed to Prove Fraud?

The useful evidence connects the payer, billed service, actual care and the people who chose or changed the claim. For psychotherapy add-ons, we examine the original clinical note and code selection beside the submitted claim, then connect discrepancies to instructions and employee concerns.

The note can show the treatment delivered and its time. The claim shows what the payer was told. Scheduling and attendance records help establish when the patient was present.

Templates deserve the same comparison. A field labeled psychotherapy needs an account of the psychotherapy delivered and its time. We examine who supplied that content, when it appeared and whether the clinician’s own account supports it.

Timing can matter here too. In the national psychotherapy audit, OIG identified records created after it requested documentation, more than eight months after the sampled service dates. A note written during treatment and one produced in response to an audit tell different stories about how the claim acquired support.

The employee who knows what management was told can help explain a repeated pattern that the claim data alone cannot show. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

What the OIG Psychotherapy Audit Shows

The Office of Inspector General’s May 2023 psychotherapy audit examined Medicare services from March 2020 through February 2021. Providers failed Medicare requirements on 128 of 216 sampled enrollee-days. From the sample, OIG estimated $580 million in improper payments across the psychotherapy services it examined.

The audit’s practical value is in the missing support it identified. On six sampled days, providers billed psychotherapy with evaluation and management and documented the overall encounter time without identifying the psychotherapy portion. Other findings concerned missing or incomplete treatment plans and records that did not show psychotherapy had occurred.

The audit shows what a treatment plan can reveal beyond minutes. Under the Medicare contractor requirements it applied, plans needed to describe the type, amount, frequency and duration of services, the diagnosis and anticipated treatment goals. Some contractors also required a periodic summary of goals, progress and an updated plan. Those details connect the claimed therapy to treatment for the patient.

When the Claim Adds Care You Never Gave

If you see psychotherapy added to medication visits, or your original codes changed before submission, speak with our whistleblower experts about the billing you know. We work beside you to build your strongest psychotherapy billing case around the care delivered, the claims submitted and the decisions that connect them. We bring in healthcare fraud whistleblower lawyers who understand psychiatric billing and stay with you through the case.