If you work in medical billing or mental health, you’ve probably come across CPT code 90863. It’s an important code, but also one that gets mixed up a lot. Knowing how and when to use 90863 can make a big difference in billing accuracy, insurance approval, and how providers get paid for the care they give.
Let’s break it down step by step.
What is CPT Code 90863?
CPT code 90863 is used when a provider prescribes or manages medication during a psychotherapy session. In other words, it’s not just a regular therapy visit—it’s a therapy session that also involves evaluating or adjusting the patient’s medications.
Here’s the key point:
- 90863 is an add-on code. That means it’s always billed with another psychotherapy code, not on its own.
- It’s most often used by psychiatrists, nurse practitioners, or other providers who can legally prescribe medications.
So, if a patient is in therapy and the provider also reviews or changes their medication, 90863 should be added to the psychotherapy code for that visit.
Common Misunderstanding About 90863
Some people think 90863 is for family therapy or short sessions, but that’s not correct. That confusion usually comes from mixing it up with other therapy codes like 90847 (family therapy) or 90832 (30-minute individual therapy).
Here’s the truth:
- 90863 = Psychotherapy with medication management
- 90847 = Family therapy
- 90832, 90834, 90837 = Individual psychotherapy of different lengths (30, 45, 60 minutes)
How 90863 Works in Billing
Since 90863 is an add-on, you’ll almost always see it attached to another CPT code. For example:
- 90837 + 90863 → A 60-minute therapy session where the provider also manages medications.
- 90834 + 90863 → A 45-minute therapy session with medication management included.
Think of 90863 as the “extra” part that tells the insurance company: This wasn’t just therapy. The provider also handled medication management.
90863 vs. Other Similar Codes
It’s easy to confuse 90863 with other billing codes, so let’s clear it up:
- 90833 – Add-on for psychotherapy (30 minutes) with E/M service (used when the provider does both medical evaluation and therapy in one visit).
- 90836 – Add-on for psychotherapy (45 minutes) with E/M service.
- 90838 – Add-on for psychotherapy (60 minutes) with E/M service.
- 99213 / 99214 – Evaluation and management (E/M) office visits, often used by psychiatrists for med checks without therapy.
The big difference is that 90863 is specific to psychotherapy sessions that also include medication management, not just a med check visit.
When to Use Modifiers with 90863
Sometimes, you’ll need to add a modifier to make the billing clear. One common one is:
- Modifier 25 – Used when a provider gives a significant, separately identifiable medical service on the same day as therapy.
Example: If a psychiatrist does therapy, manages medication, and also treats a separate medical issue (like high blood pressure), modifier 25 may apply.
Documentation Tips for 90863
Insurance companies want proof that the medication management was real and necessary. That means providers should carefully document:
- The specific medication discussed or prescribed.
- Any changes made to the medication (dosage, frequency, switching meds).
- The reason for the change (side effects, lack of improvement, etc.).
- How the medication ties into the therapy session.
Example documentation note:
“Discussed patient’s ongoing symptoms of anxiety. Adjusted SSRI dosage from 20 mg to 40 mg due to limited effectiveness. Reviewed possible side effects with patient. Integrated discussion of coping skills during therapy.”
That level of detail makes the claim much stronger and reduces the chance of denial.
Why 90863 Matters
Using 90863 correctly helps in two ways:
- For providers – It ensures they get paid for the extra work of handling medication in addition to therapy. Without it, they may lose out on reimbursement.
- For patients – It means care is being billed and tracked correctly, which can lead to better coordination of treatment.
This code also reflects the reality of mental health treatment: many patients benefit most when therapy and medication are combined.
Actionable Tips for Billers and Providers
- Double-check session notes – Make sure the provider clearly documented medication management.
- Pair 90863 with the right code – Never bill it by itself. Always attach it to a primary psychotherapy code.
- Know your payer rules – Some insurance companies have unique rules about when they’ll reimburse for 90863.
- Use billing software wisely – Many EHR systems can flag when add-on codes like 90863 are needed.
- Stay updated – Coding guidelines change. Regular training helps avoid costly errors.
Final Thoughts
CPT code 90863 is more than just a billing detail—it’s a way to capture the full scope of care provided in mental health treatment. When used properly, it ensures providers are fairly reimbursed and patients get accurate, well-documented care.
The key takeaways:
- 90863 = psychotherapy session with medication management.
- Always pair it with a primary psychotherapy code.
- Document carefully and check payer policies.
By mastering this code, billers and providers can protect revenue, reduce denials, and support better patient care.