In the evolving landscape of mental and behavioral health services, billing for psychiatric care has become increasingly complex. Among the lesser-understood but highly relevant CPT codes is 90863, which refers to pharmacologic management provided in conjunction with psychotherapy. Although this code can significantly improve reimbursement accuracy in collaborative care models, many practices either misuse it or avoid it due to confusion.
If you’re a psychiatrist, psychiatric nurse practitioner (PMHNP), or clinic owner working alongside therapists, this guide breaks down everything you need to know about billing CPT 90863 correctly. From who can bill it, when it applies, documentation best practices, and payer nuances—we’ll cover it all with practical, real-world advice. For clinicians offering a wide range of assessments, managing billing across multiple codes can get complex. This advanced guide to billing psychological testing services provides deeper insights into bundling, documentation, and payer expectations.
What is CPT Code 90863?
CPT code 90863 is officially described as:
“Pharmacologic management, including prescription and review of medication, when performed with psychotherapy services.”
This code is designed for prescribing providers (such as psychiatrists or PMHNPs) to bill when they provide medication management on the same day that psychotherapy is delivered by another licensed clinician (e.g., LCSW, LPC, LMFT).
In essence, 90863 reflects coordinated care: medication management by one provider, and psychotherapy by another, in the same encounter. This is common in multi-specialty clinics or collaborative behavioral health practices.
Many providers face confusion when billing for family sessions, especially regarding the presence or absence of the patient. A helpful overview on the difference between CPT codes 90846 and 90847 for family therapy can clarify when and how to use each code properly.
90863 vs. E/M Codes: Key Distinction
A major source of confusion arises from the distinction between 90863 and evaluation and management (E/M) codes like 99213 or 99214. Here’s the key:
- Use E/M codes when the same provider delivers both medication management and any elements of therapy.
- Use 90863 when two different providers—a prescriber and a therapist—are involved on the same day.
So, if a PMHNP prescribes medication and their LCSW colleague conducts therapy, the PMHNP may bill 90863 while the LCSW bills 90834. However, if the PMHNP provides both medication and therapy, they should bill 99213 + 90833 instead.
Who Can Bill 90863?
Only prescribing clinicians may bill 90863, including:
- Psychiatrists (MD or DO)
- Psychiatric Mental Health Nurse Practitioners (PMHNPs)
- Physician Assistants (PAs) in psychiatric settings
- Certain primary care physicians (depending on documentation and scope)
Non-prescribing professionals like psychologists or LCSWs cannot bill 90863, even if they’re involved in therapy.
When Should 90863 Be Used?
90863 is appropriate only when all the following are true:
- Psychotherapy (e.g., 90832, 90834, 90837) is performed by another clinician.
- Pharmacologic management is delivered by a prescribing provider.
- Both services are provided on the same day.
- There is distinct documentation for each service.
- The services are medically necessary and not duplicative.
A common scenario: A therapist provides a 45-minute therapy session (90834), and afterward, the patient meets with a PMHNP for 15 minutes of med check. The therapist bills 90834; the PMHNP bills 90863. Understanding how payers define “new” vs. “established” patients can prevent billing errors and denials. This article on mental health E/M coding breaks down the rules and how they apply in behavioral health settings.
Why Is 90863 Underused?
Despite its value, many providers shy away from using 90863. Here’s why:
- Confusion with E/M coding leads to incorrect usage.
- Some EHR systems don’t support dual provider billing easily.
- Insufficient documentation risks denials.
- Many billing companies lack behavioral health expertise.
That’s where a specialized partner like Global Tech Billing LLC comes in. We help clinics set up compliant workflows, configure EHR systems to track multi-provider sessions, and ensure proper use of CPT codes like 90863.
Texas Billing Tip: Many commercial insurers in Texas require prior authorization for services like physical therapy, mental health, and imaging—even when they seem routine. Verifying requirements before treatment helps avoid costly denials.
View our Texas services page to learn how we help providers stay compliant and get paid faster.
Real-World Examples
Let’s explore some use cases:
Correct Use Case
A patient sees their LCSW for 60-minute psychotherapy (90837). Later that day, they met with a PMHNP for 20 minutes to discuss medication. The PMHNP documents med review, response to meds, and any changes. This is an ideal scenario for 90863.
Incorrect Use Case
A PMHNP provides both therapy and medication management in one session. Billing 90863 would be incorrect. The right approach is 99213 + 90833 if the criteria are met for both.
Documentation Requirements
Proper documentation is essential. Here’s what’s required for 90863:
- Date and time of service
- Provider name and credentials
- Summary of medication review: response, side effects, dosage changes
- Clinical rationale for continuing, discontinuing, or adjusting meds
- Confirmation that another clinician provided psychotherapy on the same day
- Both clinicians’ notes must be separately documented but coordinated.
Reimbursement Considerations
Most commercial payers and Medicare accept 90863 if billed correctly. However:
- Medicaid rules vary by state. Some bundle pharmacologic management under therapy codes or have carve-outs.
- Check with payer policy manuals to confirm.
- Some payers may require modifier usage (e.g., -25 or -59) to differentiate services.
If you’re uncertain, Global Tech Billing LLC routinely reviews payer policies and helps practices determine how to maximize reimbursement within compliance boundaries.
Common Billing Mistakes
- Billing 90863 alone: It must always be paired with a psychotherapy code from another provider.
- Using 90863 for same-provider visits: Use E/M instead.
- Poor documentation: Missing med changes, clinical rationale, or provider credentials.
- Lack of communication between clinicians: Without coordination, documentation may not meet payer requirements.
Integration with EHR Systems
Many billing issues arise from improperly configured EHRs. Not all systems natively support multi-provider, same-day billing. To reduce errors:
- Use templates that support SOAP notes and separate provider documentation.
- Link appointments correctly to avoid “duplicate visit” flags.
- Leverage billing rules and alerts that flag noncompliant code pairings.
At Global Tech Billing LLC, we integrate directly with EHRs like DrChrono, SimplePractice, and AdvancedMD to streamline this process and reduce your administrative burden.
Advantages of Using 90863
- Reflects the true scope of services provided
- Increases revenue opportunities for prescribing providers
- Promotes collaborative care models
- Provides better clinical visibility to payers
If your practice is offering dual services but missing this code, you may be leaving money on the table.
How to Implement 90863 Billing in Your Practice
Here’s a step-by-step checklist:
- Identify eligible providers: Only prescribers can bill 90863.
- Coordinate session scheduling: Ensure both services occur on the same day.
- Educate providers: Make sure both prescribers and therapists understand when and how 90863 is used.
- Update documentation templates: Ensure distinct, detailed entries.
- Test claim submission: Review with a few patients, and confirm payer acceptance.
- Track denials or rejections: Adjust workflows as needed.
Need help? Global Tech Billing LLC provides onboarding, staff training, and audit-proof billing systems so you don’t have to navigate this alone.
Final Thoughts
CPT 90863 offers a powerful way to properly reflect the collaborative, integrative care many behavioral health practices now provide. But billing it incorrectly can result in denials—or worse, audits.
When used right, it ensures your prescribers are compensated fairly and reflects the real work being done across your care team. With the right tools, guidance, and documentation, 90863 can improve both clinical accuracy and financial outcomes.
FAQs
Q1: Can a psychiatrist bill 90863 if they provide both therapy and medication management?
No. In that case, use an E/M code (e.g., 99213) plus a psychotherapy add-on (e.g., 90833), not 90863.
Q2: Can 90863 be billed with 90832, 90834, or 90837 on the same day?
Yes, but only when psychotherapy is provided by another clinician, not the prescribing provider.
Q3: Is 90863 reimbursable by Medicaid or Medicare?
Yes, but policies vary. Some Medicaid programs bundle these services. Always verify with the payer.
Q4: Can therapists bill 90863?
No. Only prescribing providers can bill this code.
Q5: What’s the best way to avoid denials with 90863?
Ensure thorough documentation, separate provider services, and correct code pairing.
