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What's Going On With Alma, Aetna, and 90837?

By Dax Earl • May 21, 2026

Trying to keep insurance billing sustainable while payers change the rules? Bomi helps therapy practices with credentialing, claims, eligibility, and A/R so clinicians can spend less time chasing reimbursement and more time seeing clients.

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TL;DR

  • Alma providers are reacting to a reimbursement change involving Aetna and psychotherapy CPT codes 90837 and 90834.

  • Based on the provider communication being circulated publicly, starting July 15, 2026, Aetna-related 90837 sessions through Alma will be reimbursed at the same rate as 90834.

  • This does not appear to mean that 90837 is going away, and it does not change what the CPT code means.

  • The practical issue is that a 53+ minute psychotherapy session may still be clinically appropriate and correctly coded as 90837, but under this arrangement it may no longer be paid differently.

As of May 21, 2026, this looks less like a public, across-the-board Aetna coding-policy change and more like a contract or reimbursement-rate change being implemented through Alma's relationship with Aetna.

What changed?

According to the Alma announcement being discussed among providers, Aetna-related reimbursement through Alma is changing for individual psychotherapy codes 90837 and 90834. The publicly available discussion says that, starting July 15, 2026, sessions billed as 90837 will be reimbursed at the same rate as 90834. It also says Alma disagrees with the change and is collecting provider feedback to share with Aetna. See the provider megathread quoting Alma's announcement.

That distinction matters. It suggests this is not simply Alma renaming 90837 or telling clinicians not to provide longer sessions. It also does not appear to be a change to the CPT code itself. The practical effect is narrower and more concrete: for Aetna clients seen through Alma, a 53+ minute psychotherapy session may no longer pay more than a shorter 90834 session.

Quick refresher: what are 90834 and 90837?

For time-based individual psychotherapy codes:

  • 90834 generally refers to a psychotherapy session lasting 38-52 minutes.

  • 90837 generally refers to a psychotherapy session lasting 53 minutes or more.

CMS guidance describes psychotherapy codes 90832-90838 as time-based and says to report the code closest to the actual time: 38-52 minutes for 90834 and 53 or more minutes for 90837. Alma's own provider guidance says the same thing and explains why 90837 is often called an extended session in billing language, even though many clinicians experience 53-60 minutes as a normal therapy hour. Sources: CMS billing and coding article A56937 and Alma's CPT 90837 documentation guidance.

So the important point is simple: 90837 still means 53+ minutes.

Is this an Aetna policy change or an Alma decision?

The most accurate answer is probably: both, but in different ways.

The provider communication being discussed frames the change as something Alma disagrees with and says it will share provider feedback with Aetna. That points toward Aetna being central to the reimbursement pressure.

At the same time, Alma is the platform through which providers are experiencing the change. Alma negotiates, administers, and operationalizes payer relationships for its providers. So even if Aetna is the payer pushing the reimbursement change, Alma is still the contracting intermediary implementing it for clinicians using the Alma platform.

What I have not seen, as of this writing, is a public Aetna bulletin saying Aetna is changing 90837 reimbursement for all therapists everywhere. Aetna's public provider-news archive and fee-schedule pages point providers toward portal-based tools for rates and payment estimates, which means a contract-specific fee-schedule change can exist without a broad public bulletin. Sources: Aetna OfficeLink Updates archive and Aetna cost estimator and fee schedules page.

That is why this currently looks like a contract-specific reimbursement change, not a universal Aetna-wide coding policy change.

Why would this happen?

The likely explanation is cost and utilization management.

90837 has historically reimbursed at a higher rate than 90834 because it reflects a longer psychotherapy service. Alma's documentation notes that 90837 can pay more than 90834 and that payers often scrutinize it more closely.

If a payer equalizes reimbursement between 90834 and 90837, it removes the financial difference between a shorter session and a longer session. Clinically, the distinction still matters. Financially, the distinction becomes much less meaningful for the provider.

That creates a real problem: a therapist may determine that a longer session is clinically appropriate, document it correctly, bill the accurate CPT code, and still be paid as though the session were shorter.

Does this mean therapists should stop using 90837?

No.

The correct CPT code should still be based on the service provided, including the actual psychotherapy time. If the session is 53 minutes or longer and meets the requirements for 90837, then 90837 may still be the accurate code.

The issue is reimbursement, not the existence of the code.

That said, this change is a reminder that 90837 is watched closely. Alma's guidance recommends documenting why the longer session was medically necessary, including the time, diagnosis, functional impairment, treatment goals, and why a shorter session would not have met the client's clinical need. Aetna's behavioral health provider manual also describes utilization management, medical necessity review, treatment record review, and audit-related oversight as part of its behavioral health program. Source: Aetna Behavioral Health Provider Manual.

What should clinicians document?

For 90837, documentation should clearly support both the time and the clinical need. A solid note should answer:

  • Why did this client need 53+ minutes today?

  • What symptoms, risks, impairments, or clinical complexity required the longer session?

  • What intervention was provided?

  • How did the longer session connect to the treatment plan?

  • Why would a shorter 90834-length session have been insufficient?

This does not mean writing longer notes for the sake of longer notes. It means writing clearer notes that make medical necessity obvious to someone reviewing the chart later.

What this is not

  • This does not appear to be a change to the definition of 90837.

  • This does not mean longer sessions are never clinically appropriate.

  • This does not mean therapists should shorten sessions that clinically need more time.

  • This does not mean clinicians should bill inaccurately to match a payer's preferred reimbursement pattern.

It does mean providers may need to think carefully about financial sustainability, caseload planning, client communication, and documentation practices.

Why providers are upset

The concern is not just about one billing code.

For many therapists, a 53-60 minute session is not an unusual luxury. It is the normal rhythm of outpatient therapy. When a payer treats that as an extended service while reimbursing it like a shorter one, clinicians experience it as a pay cut for the same amount of clinical work.

The impact may be especially hard for providers who built their practice around insurance accessibility. Many clinicians join platforms like Alma because they want to accept insurance without carrying the full administrative burden of direct credentialing, claims submission, eligibility checks, and payer follow-up. When reimbursement changes abruptly, it can affect the therapist's income and client access at the same time.

What providers can do now

  • Review the new rates in the Alma portal. Calculate the impact on your actual Aetna caseload, especially the share of sessions currently billed as 90837.

  • Tighten 90837 documentation. Make the time and medical necessity clear enough that a reviewer can understand the clinical reason for the longer session.

  • Respond to Alma's feedback process if it applies to you. The circulated announcement says Alma is collecting aggregated, de-identified provider feedback for Aetna.

  • Think through client communication before making rushed changes. If the rate change affects your ability to keep seeing Aetna clients through Alma, clients may need time to understand their options.

  • Watch whether similar changes appear elsewhere. Right now, the clearest public discussion is Alma and Aetna. It is not yet clear whether other platforms or direct Aetna contracts will follow.

A note on the DOJ settlement

Some providers have connected this news to Aetna's recent False Claims Act settlement. I would be careful with that. The DOJ settlement involved Medicare Advantage diagnosis and risk-adjustment allegations, not psychotherapy CPT 90837 reimbursement. It may be part of a broader compliance and cost-control environment, but I would not treat it as the direct explanation for this change. Source: Department of Justice settlement announcement.

Bottom line

This appears to be an Aetna-related reimbursement change being implemented through Alma, not a change to what 90837 means.

90837 remains the code for 53+ minutes of psychotherapy. The clinical question is still: what does the client need? The documentation question is still: does the note support the time, complexity, and medical necessity of the service? The business question is now: can providers continue offering longer sessions under a reimbursement structure that no longer pays differently for them?

For therapists, that is the real concern. Not just a code. Not just a rate. The deeper concern is whether insurance-based care remains financially sustainable for the clinicians providing it.

Sources