`90863` Pharmacologic mgmt w/psytx

What 90863 is

CMS fee schedule short descriptor: Pharmacologic mgmt w/psytx.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 90863 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	0.48	0.27	0.03	0.78	$26.05
Facility (hospital, ASC)	0.48	0.11	0.03	0.62	$20.71

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Adjust for a Medicare locality:

Status: Not valid for Medicare purposes. Global period: Global concept does not apply.

Medically Unlikely Edit (MUE)

Medicare caps 90863 at 1 unit per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Nature of Service/Procedure. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 90863? These codes are bundled into it

90863 is a Column 1 code in 16 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`0362T`	Bhv id suprt assmt ea 15 min	0 - no modifier bypass	Check pair
`0373T`	Adapt bhv tx ea 15 min	0 - no modifier bypass	Check pair
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`96127`	Brief emotional/behav assmt	0 - no modifier bypass	Check pair
`96164`	Hlth bhv ivntj grp 1st 30	0 - no modifier bypass	Check pair
`96165`	Hlth bhv ivntj grp ea addl	0 - no modifier bypass	Check pair
`96168`	Hlth bhv ivntj fam ea addl	0 - no modifier bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`97151`	Bhv id assmt by phys/qhp	0 - no modifier bypass	Check pair
`97152`	Bhv id suprt assmt by 1 tech	0 - no modifier bypass	Check pair
`97153`	Adaptive behavior tx by tech	0 - no modifier bypass	Check pair
`97154`	Grp adapt bhv tx by tech	0 - no modifier bypass	Check pair
`97155`	Adapt behavior tx phys/qhp	0 - no modifier bypass	Check pair
`97156`	Fam adapt bhv tx gdn phy/qhp	0 - no modifier bypass	Check pair
`97157`	Mult fam adapt bhv tx gdn	0 - no modifier bypass	Check pair

90863 is bundled into these codes

90863 appears as a Column 2 code in 123 active edits. Reported with one of these Column 1 codes on the same date of service, 90863 is the code that denies.

Column 1 code	Short description
`0395T`	Hdr elctr ntrst/ntrcv brchtx	Check pair
`77261`	Ther radiology tx plng smpl	Check pair
`77262`	Ther radiology tx plng intrm	Check pair
`77263`	Ther radiology tx plng cplx	Check pair
`77280`	Ther rad simulaj field smpl	Check pair
`77285`	Ther rad simulaj field intrm	Check pair
`77290`	Ther rad simulaj field cplx	Check pair
`77293`	Respirator motion mgmt simul	Check pair
`77295`	3-d radiotherapy plan	Check pair
`77300`	Radiation therapy dose plan	Check pair
`77301`	Radiotherapy dose plan imrt	Check pair
`77306`	Telethx isodose plan simple	Check pair
`77307`	Telethx isodose plan cplx	Check pair
`77316`	Brachytx isodose plan simple	Check pair
`77317`	Brachytx isodose intermed	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.