Billing code 90865: Drug-assisted sessionMedicare rate & RVUs

Medicare pays $170.68 for 90865 nationally in the office and $114.57 in a hospital or facility. Local office rates run $158.49–$220.80.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 90865 covers

Narcosynthesis involves medication producing an altered, relaxed state while a clinician conducts a focused psychiatric interview or therapeutic work. A psychiatrist typically performs the service, using the induced state to facilitate communication or discussion of material that may be difficult to address in an ordinary interview. CMS recorded a small number of office services for this code in 2024 and no facility services.

Select 90865 when the documented service is specifically medication-assisted psychiatric work in an induced state, rather than ordinary psychotherapy, psychoanalysis, or hypnotherapy. The record should identify the medication-assisted method, its psychiatric purpose, and the interview or treatment performed. Under the Medicare Physician Fee Schedule, payment valuation includes clinician work, practice expense, and malpractice expense; the supplied CMS data show separate office and facility practice-expense inputs for this code.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 90865 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

90865 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 90865 rate is calculated

Each of 90865’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 90865

90865 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

90865 compared with similar codes

How to choose

90880Hypnotherapy

90880 is for hypnotherapy. Use 90865 when psychiatric interview or treatment is conducted in a medication-induced state.

90845Psychoanalysis

90845 represents psychoanalysis, not an interview or treatment conducted in a medication-induced state.

90870Electroconvulsive therapy

90870 is electroconvulsive therapy. It describes an electrical treatment procedure, not medication-assisted psychiatric interviewing.

Codes related to 90865

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates