CPT 90863
Global XXXPharmacologic mgmt w/psytx
CPT 90863 Billing & Documentation Guide
CPT code 90863 (Pharmacologic mgmt w/psytx) is classified under Psychiatry with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.48, a non-facility practice expense RVU of 0.27, and a malpractice RVU of 0.03, a total non-facility RVU of 0.78 and facility RVU of 0.62. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $26.63, though rates vary from $24.3 to $34.21 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 90863, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 90863 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Invalid for Medicare; not separately payable
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 90863 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 90863
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.48 | 0.48 |
| Practice Expense RVU | 0.27 | 0.11 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 0.78 | 0.62 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 90863
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $27.82 | $21.5 | $26.73 - $31.34 | 29 |
| Florida | $27.03 | $21.67 | $26.16 - $27.95 | 3 |
| Georgia | $25.86 | $20.76 | $25.27 - $26.45 | 2 |
| Illinois | $26.72 | $21.55 | $25.83 - $27.51 | 4 |
| Michigan | $25.91 | $20.9 | $25.4 - $26.42 | 2 |
| North Carolina | $25.09 | $20.1 | $25.09 - $25.09 | 1 |
| New York | $28.21 | $22.26 | $25.3 - $29.64 | 5 |
| Ohio | $25.28 | $20.4 | $25.28 - $25.28 | 1 |
| Pennsylvania | $26.08 | $20.85 | $25.26 - $26.9 | 2 |
| Texas | $25.93 | $20.67 | $25.17 - $26.49 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 90863
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 90863 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0360T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0361T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0362T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0363T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0364T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0365T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0366T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0367T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0368T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 90863
What does CPT code 90863 mean? +
CPT code 90863 represents: Pharmacologic mgmt w/psytx. It's in the Psychiatry category with a global period of XXX.
What is the Medicare reimbursement for CPT 90863? +
The 2026 Medicare national average non-facility payment for CPT 90863 is $26.63. Rates range from $24.3 to $34.21 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 90863? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 90863? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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