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See a sample rate comparisonCPT 90863 Fee Schedule
Last Verified: October 2026
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.
Pharmacologic Management Incl, Pharmacologic Management Including Prescription And Review Of Medication When Performed With Psychotherapy Services (List Separately In Addition To The Code For Primary Procedure)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Psychiatry Services and Procedures |
| Common Place of Service | 11 - Office |
| Common Modifiers | 95 - Telemedicine - audio and video GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 90863 |
| Medicaid Fee Schedule | $48.21 median of the 7 states in the free preview · View Medicaid rates for 90863 |
National average reimbursement for CPT 90863 by major payers:
$38.51
$34.32
$38.34
$48.19
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CPT 90863
5 of 25 sample ratesHigher to lower in this preview
Qurat Ul Ain Khan
Mass General Brigham Incorporated
$101.33Published rateHatem Hassanein
Orlando Health Medical Group Inc
$55.45Published rateWendy Izarnotegui Castillo
Orlando Health Medical Group Inc
$41.29Published rateTatayana Carter
Musculoskeletal Institute Inc. Florida Orthopaedic Institute
$33.28Published rateErin Kelly
Town Center Orthopaedic Associates, P.C.
$22.87Published rate
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See a sample payer proposalCPT 90863 vs. Other Psychiatry Services and Procedures Codes
The CPT 90863 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 90863 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-CPT | Low | Psychotherapy Session 30 Mins, Psychotherapy Session With Psychiatrist Psychologist Or Other Mental Health Professional; 30 Minutes. |
| 90834-CPT | 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-CPT | Low | Psychotherapy Session 60 Mins, Psychotherapy Session With Psychiatrist Psychologist Or Other Mental Health Professional; 60 Minutes. |
| 90863-CPT | Low | Pharmacologic Management Incl, Pharmacologic Management Including Prescription And Review Of Medication When Performed With Psychotherapy Services (List Separately In Addition To The Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90863. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90863 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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