CPT 90853 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Psychiatry Services and Procedures |
| Common Place of Service | • 11 - Office • None |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Moderate |
National average reimbursement for CPT 90853 by major payers:
$34.35
$38.70
$43.66
$39.97
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 90853 vs. Other Psychiatry Services and Procedures Codes
The CPT 90853 code is part of the Medicine Services and Procedures services used for Psychiatry Services and Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 90853 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 90832 | Low | Psychotherapy, 30 Minutes With Patient; Medicaid Level Of Care 7, As Defined By Each State |
| 90834 | Low | Psychotherapy, 45 Minutes With The Pt And/Or Famil Y Member. Pt Must Be Pressent For All Or Some Of The Service. Focus Of The Session Is Still On The Pt And Not On The Family Unit. |
| 90837 | Low | Psychotherapy 60 Minutes Member Of High Risk Population-Use W Immunizations Via Interactive Audio And Video Telecommunication |
| 90853 | Low | Group Medical Psychotherapy(Other Than Of A Mltpl-Family Grp) By A Physician, With Continuing Medi- Cal Diagnostic Eval And Drug Mngmnt Whe |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90853. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90853 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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