Aetna's 90837 change through Alma: what you can't appeal — and what you still can

Starting July 15, 2026, Aetna reimburses a 53+ minute psychotherapy session (90837) at the same rate as a 45-minute session (90834) when billed through Alma. The rate policy itself has no appeal process — we'll say that plainly before anything else. But the blast radius around this change is full of things that do carry appeal rights: downcoded claims, denials, and clawbacks. This page is an honest map of both halves.

1. What's changing, who's affected, and when

On May 20, 2026, Alma notified its providers of three Aetna changes taking effect July 15, 2026, as reported by Behavioral Health Business:

• Session-length flattening: 53+ minute sessions (90837) will be paid at the same rate as 37–52 minute sessions (90834).
• Complexity flattening: evaluation-and-management visits for highly complex patients will be paid the same as those for moderately complex patients.
• Credential flattening: reimbursement for those E/M visits by doctoral-level providers drops to the master's-level rate.

Alma told providers "We disagree with these changes" and said it is collecting clinician feedback to share with Aetna (BHB). Aetna, for its part, told BHB that its overarching behavioral-health reimbursement policies have not changed — this is specific to the Alma arrangement. Professional associations have also weighed in; the Psychotherapy Action Network has a summary of the changes and responses.

Who is affected: clinicians billing Aetna plans through Alma. If you are credentialed with Aetna directly, your fee schedule is a separate contract — verify it directly rather than assuming either way.

What it costs you: that depends on your own fee schedule, so we won't quote a universal number. The math is simple and worth doing with your actual rates: (your 90837 rate − your 90834 rate) × your weekly Aetna-through-Alma 90837 sessions × your working weeks per year. Pull the current rates from your Alma portal and run it — it's the number every decision below should be weighed against.

2. The honest part first: the rate change itself has no appeal

Appeal rights attach to claim determinations — a denial, a downcode, a recoupment on a specific claim. They do not attach to the contracted fee schedule. A payer changing what it pays for a code, with notice, through a platform contract is a business action, not an adverse benefit determination. There is no internal appeal, no external review, and no magic letter for the rate itself. If someone offers to "appeal the rate change" for a fee, that service does not correspond to any process that exists.

Your real levers on the rate are business decisions: submit feedback through Alma (they've said they'll bring it to Aetna), evaluate direct credentialing, adjust your payer mix, or revisit private-pay. Those are your calls, and reasonable clinicians will land in different places.

We build appeal tooling — and we're telling you there is nothing to appeal here. What follows is where appeal rights do exist, because that's the part that tends to get lost in the anger.

3. What you still control #1: other payers still pay 90837 — the time rule is the whole game

This change is one payer through one platform. Under the AMA's CPT time conventions, 90837 covers individual psychotherapy of 53 minutes or longer, and 90834 covers 38–52 minutes (see the APA Services psychotherapy-code reference). With your other payers, if the session ran 53+ minutes and your note documents it, 90837 is simply the correct code for the work you did.

• Document time, every session: total minutes or start/stop times in the note. In any later review, that line is your evidence that the code matched the session.
• "Defensive downcoding" is voluntary: billing 90834 for 53+ minute sessions to stay under the radar is not required by any payer policy — it's donating income for work you already did. If you've been doing it out of audit anxiety, that's an understandable response to a real climate; it's just not a rule, and documentation is the sturdier shield.
• If a payer questions your 90837 usage: the answer is your documentation, not preemptive undercoding. Utilization letters are not determinations, and they don't change the CPT time rule.

4. What you still control #2: downcoded and denied claims can be appealed

Different situation entirely: you billed 90837 and the payer paid it as 90834 (downcoding), or denied it. That is a claim-level determination, and determinations carry review rights. In general you can:

• request the specific basis for the adjustment in writing (the remittance codes alone often understate it);
• submit a reconsideration or provider appeal with your time documentation and clinical rationale for the extended session;
• escalate per your provider manual if the first level fails.

Deadlines come from your contract, the payer's provider manual, and state law — they are real and usually short, so calendar them the day the remittance lands. We won't promise outcomes; what we can say is that appeal rights exist, and unexercised ones pay exactly zero.

5. What you still control #3: clawbacks come with rules and deadlines

A recoupment letter is a demand, not a judgment. At an overview level — the specifics vary by state and by plan type:

• Notice: plans are generally required to identify the claims, amounts, and reasons in writing before recovering.
• Lookback limits: many states cap how far back a commercial plan can reach (commonly in the one-to-two-year range, with fraud exceptions); see this state-by-state overview of overpayment-recovery laws and check your own state's rule.
• A dispute window: you typically have a defined period to challenge the recoupment before offsets begin — limited and usually short, so check your own state’s rule and your contract for the exact timeframe.
• Different rulebooks: self-funded employer plans and government programs (e.g., Medicare's overpayment rules) follow their own frameworks.

The practical takeaway: don't treat a clawback letter as self-executing, and don't let the dispute window lapse while deciding how you feel about it. Read it, calendar the deadline, and respond within the window. We're keeping this at overview level on purpose — what applies to your case depends on your state, your contract, and the letter in your hand.

6. Thinking about leaving the platform? Look before you leap

Some clinicians will respond to July 15 by leaving. That may or may not be right for your practice — not our call — but walk out with your eyes open:

• Credentialing takes months: direct payer credentialing is routinely a multi-month process. Line up the new arrangement before ending the old one, or budget for the gap.
• Audit exposure survives departure: contract audit and recoupment provisions typically apply to claims from the contract period even after termination. Leaving doesn't erase the past — export and keep your documentation, remittances, and portal records while you still have access.
• Clients in transit: plan for continuity of care and check what your agreement says about client transitions and outreach.
• Open claims and appeals: confirm how pending claims, appeals, and disputes will be handled after your end date, and who receives the correspondence.

7. Keep your appeal rights where you can see them

They denied it. They clawed it back. They downcoded it. You still did the work — and the appeal rights to get it paid are already yours. We write the letters; you approve every one.