90862

Pharmacologic Management (Psychiatric Medication Management)

CPT code 90862 was historically used to report pharmacologic management of psychiatric patients, specifically for the evaluation of medication use and results. This code was officially deleted from the CPT manual in 2013 and replaced by Evaluation and Management (E/M) codes (99202–99205 for new patients and 99212–99215 for established patients). In modern psychiatric practice, medication management entails a comprehensive clinical assessment of the patient's mental status and physiological response to psychotropic medications. The clinician evaluates the therapeutic efficacy of drugs such as antidepressants, mood stabilizers, antipsychotics, and anxiolytics. This process involves reviewing the patient’s history, assessing current symptoms of psychiatric disorders (e.g., Major Depressive Disorder, Bipolar Disorder, Schizophrenia), and identifying any adverse side effects or drug interactions. For established patients, a code like 99213 is utilized when the medical decision-making (MDM) is of Low complexity or the total time spent on the date of the encounter is 20-29 minutes. Conversely, 99214 is appropriate for encounters involving Moderate MDM or a duration of 30-39 minutes. The procedural scope includes ordering and interpreting laboratory tests necessary for monitoring drug toxicity or metabolic side effects. If psychotherapy is also provided during the same visit, the clinician must use the appropriate E/M code for the medical/pharmacologic component and an add-on psychotherapy code (e.g., +90833, +90836, or +90838) to reflect the distinct therapeutic intervention. Documentation must clearly delineate the medical management components, including the medication reviewed, dosage adjustments made, and the rationale for the therapeutic plan based on MDM or time spent.

Clinical Indications

  • Major Depressive Disorder (MDD)
  • Bipolar Affective Disorder
  • Schizophrenia and Schizoaffective Disorders
  • Generalized Anxiety Disorder (GAD)
  • Attention-Deficit/Hyperactivity Disorder (ADHD)
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive-Compulsive Disorder (OCD)
  • Panic Disorder
  • Psychosis not otherwise specified
  • Mood stabilization for personality disorders

Procedure Steps

  1. Review patient’s interval history and subjective reporting of symptoms.
  2. Perform a targeted mental status examination (MSE).
  3. Evaluate the efficacy of the current psychotropic medication regimen.
  4. Assess the patient for adverse side effects or signs of drug toxicity.
  5. Review relevant laboratory data (e.g., therapeutic drug levels, metabolic panels).
  6. Discuss treatment options, risks, and benefits with the patient.
  7. Adjust medication dosages or prescribe new agents as clinically indicated.
  8. Coordinate care with other providers if systemic health issues intersect with psychiatric treatment.
  9. Document the clinical encounter, focusing on medical decision-making or time spent.

Coding Guidelines

  • CPT 90862 is a deleted code; use E/M codes 99202-99215 for psychiatric medication management.
  • For established patients: 99212 requires Straightforward MDM or 10-19 mins; 99213 requires Low MDM or 20-29 mins; 99214 requires Moderate MDM or 30-39 mins; 99215 requires High MDM or 40-54 mins.
  • For new patients: 99202 requires Straightforward MDM or 15-29 mins; 99203 requires Low MDM or 30-44 mins; 99204 requires Moderate MDM or 45-59 mins; 99205 requires High MDM or 60-74 mins.
  • If psychotherapy is performed (minimum 16 minutes), use add-on codes +90833 (30 min), +90836 (45 min), or +90838 (60 min) with the primary E/M code.
  • The E/M code should be selected based on either the level of Medical Decision Making (MDM) or the total time spent on the date of the encounter.
  • Medication management codes do not include extensive psychotherapy; if only minimal counseling is provided, only the E/M code is reported.

Associated ICD-10 Codes