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The CPT® Code 90863 refers to pharmacologic management, which encompasses the prescription and review of psychotropic medications when conducted alongside psychotherapy services. This code is specifically designated as an add-on code, meaning it is reported in addition to the primary procedure code for psychotherapy. The management of psychotropic medications is crucial in mental health treatment, as it ensures that the medications prescribed are effective in achieving the desired therapeutic outcomes. Furthermore, many psychotropic medications can have side effects that necessitate careful monitoring. During each psychotherapy session, the clinician conducts an interval history and mental status examination, focusing on the patient's response to the medication and any side effects experienced. The physician engages the patient in discussions regarding the perceived effectiveness of their medication and any adverse effects they may be encountering. In some cases, laboratory tests may be ordered to assess blood levels of the medication or to screen for potential adverse effects. Based on this comprehensive evaluation, the physician may adjust the medication dosage, discontinue a drug, or introduce a new medication to enhance the management of the patient's mental health condition. Overall, the pharmacologic management component represented by code 90863 is integral to the holistic treatment approach in psychotherapy, ensuring that medication management is effectively integrated into the therapeutic process.
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The pharmacologic management represented by CPT® Code 90863 is indicated for patients undergoing psychotherapy who require ongoing evaluation and adjustment of their psychotropic medications. This includes situations where:
The procedure associated with CPT® Code 90863 involves several key steps that ensure effective pharmacologic management during psychotherapy sessions. These steps include:
After the pharmacologic management procedure is completed, the patient is typically advised on the next steps regarding their medication regimen. This may include instructions on how to take the medication, potential side effects to monitor, and the importance of follow-up appointments to reassess the treatment plan. The clinician may schedule subsequent psychotherapy sessions to continue monitoring the patient's response to the medication and make further adjustments as necessary. It is crucial for the patient to maintain open communication with their healthcare provider regarding any new symptoms or concerns that may arise during their treatment.
| Short Descr | PHARMACOLOGIC MGMT W/PSYTX | Medium Descr | PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY | Long Descr | Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services (List separately in addition to the code for primary procedure) | Status Code | Not Valid for Medicare Purposes | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Non-Covered Service, not paid under OPPS | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5B - Specialist - psychiatry | MUE | 1 | CCS Clinical Classification | 218 - Psychological and psychiatric evaluation and therapy |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 90832 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychotherapy, 30 minutes with patient | 90834 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychotherapy, 45 minutes with patient | 90837 | Telehealth Service (Medicare) Telemedicine Service (AMA) Audio-Only Telemedicine (AMA) MPFS Status: Active Code APC Q3 Psychotherapy, 60 minutes with patient |
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | FQ | The service was furnished using audio-only communication technology | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | HP | Doctoral level |
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| 2021-01-01 | Note | Guidelines changed. |
| 2013-01-01 | Added | Added |
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