CPT 90865 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 22 - On Campus Outpatient Hospital 52 - Psychiatric Facility-Partial Hospitalization |
| Common Modifiers | None 59 - Distinct Procedural Service SL |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 90865 |
| Medicaid Fee Schedule | View Medicaid rates for 90865 |
National average reimbursement for CPT 90865 by major payers:
$196.86
$211.58
$195.75
$188.60
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 90865 | $190.44 | 1275564197 - PAUL BERKOWITZ | 842494027 - BRIGHTSIDE MEDICAL | IN | Psychiatry Physician (2084P0800X) |
United | 90865 | $270.07 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IN | Psychiatry Physician (2084P0800X) |
United | 90865 | $249.77 | 1710275110 - PRAVESH DEOTALE | 430654872 - ST LOUIS UNIVERSITY | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90865 | $320.14 | 1679968697 - JEREMIAH BREWER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 90865 | $334.07 | 1174859284 - MATTHEW NIEDZWIECKI | 910844563 | WI | Psychiatry Physician (2084P0800X) |
United | 90865 | $385.64 | 1578957676 - LAURA VERNON | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90865 | $251.24 | 1730263617 - MARK ALTER | 910844563 | WI | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 90865 | $342.04 | 1225211600 - JOHN MILLICHAP | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90865 | $267.95 | 1568752665 - ANDREW KNOX | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90865 | $298.66 | 1437298361 - ALIYA HAFEEZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90865 | $282.47 | 1609239243 - MEGAN GINSBURG | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 90865 | $316.89 | 1386755486 - DOUGLAS NORDLI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 90865 | $334.07 | 1245252303 - MARY FAHRMEIER | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 90865 | $153.27 | 1689166027 - ANIRUDDHA DEKA | 911780160 | CT | Psychiatry Physician (2084P0800X) |
United | 90865 | $289.76 | 1801849559 - CHARLES MARCUCCILLI | 911780120 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 90865 vs. Other Psychiatry Services and Procedures Codes
The CPT 90865 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 90865 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 |
|---|---|---|
| 90865-CPT | Low | Psychiatric Interview, A Psychiatrist Interviews A Person After They Have Been Given Sodium Amobarbital (Amytal) To Induce A Hypnotic State. The Drug Helps To Access Repressed Memories. Drug Effects Are Monitored Overnight. |
| 90867-CPT | Moderate | Brain Stimulation Planning, Treatment Planning For Tms (Transcranial Magnetic Stimulation) A Technique For Gently Stimulating The Brain Using Magnetic Pulses. Tms Is A Treatment For Depression And Anxiety. |
| 90868-CPT | Moderate | Brain Activity Stimulation, Tms (Transcranial Magnetic Stimulation) Treatment A Technique For Gently Stimulating The Brain Using Magnetic Pulses. Tms Is A Treatment For Depression And Anxiety. |
| 90869-CPT | Moderate | Tcran Magn Stim Redetemine, Transcranial Magnetic Stimulation Treatment (Stimulates Nerve Cells In Brain To Improve Symptoms Of Depression) Subsequent Motor Threshold Re-Determination With Delivery And Management |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 90865. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 90865 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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