Billing code 90865: Drug-assisted sessionMedicare rate & RVUs in Oregon
Reports a psychiatric interview or therapeutic session conducted in a medication-induced state to facilitate communication or access to difficult material.
Medicare pays $169.10–$179.02 for 90865 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
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 in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $179.02 | $116.68 |
| Rest Of Oregon | $169.10 | $113.21 |
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.
How the rate is built · 90865
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.84Practice expense 2.14Malpractice 0.13
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 90865
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$170.68
The facility rate would be $114.57 (+$56.11). In a facility, the facility bills its own costs separately.
90865 compared with similar codes
Compare codes
90865 vs 90880 vs 90845 vs 90870: national Medicare rates
Swap in your local Medicare rate.
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.
90865 billing questions
How is 90865 different from ordinary psychotherapy?
The defining feature is psychiatric interview or therapeutic work conducted in a medication-induced state. A conventional psychotherapy session without that method is not narcosynthesis.
What documentation supports reporting 90865?
Document the medication-assisted method, the psychiatric purpose, and the interview or therapeutic work performed. A note describing only routine counseling does not establish this service.
Does 90865 require a primary-code pairing?
The supplied CMS facts do not identify 90865 as an add-on code or specify a required primary-code pairing.
Can a separate psychotherapy service be reported for the same encounter?
The record should distinguish any separately reported psychotherapy from the medication-assisted interview or treatment. Do not use a psychotherapy code to represent the narcosynthesis service itself.
Is 90865 selected by session length?
The supplied code facts do not specify a time threshold. Choose it based on the medication-induced method and psychiatric service documented, not a psychotherapy time interval.
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
Show the CMS file lines behind this rate
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