Back to Top Skip to main content

Health.mil: the official website of the Military Health System (MHS) and the Defense Health Agency (DHA)

Utility Navigation Links

TRICARE Policy Manual 6010.63-M, April 2021
Medicine
Chapter 7
Section 3.12
Psychotropic Pharmacologic Management
Issue Date:  December 5, 1984
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  
1.0  DESCRIPTION
Pharmacologic management, including prescription and review of medication, when performed with or without psychotherapy services.
2.0  POLICY
2.1  In 2013, the American Medical Association (AMA) made significant revisions to the Current Procedural Terminology (CPT) codes regarding behavioral health services. Beginning January 1, 2013, psychotropic pharmacologic management services can be billed in one of two ways depending on the type of provider and the services being rendered:
2.1.1  Physicians and certified psychiatric nurse specialists permitted to utilize Evaluation and Management (E/M) codes providing psychotropic pharmacologic management with or without psychotherapy services should use the appropriate E/M code as described in the current CPT manual.
2.1.2  Prescribing psychologists providing psychotropic pharmacologic management in conjunction with psychotherapy services (when the psychologist is authorized to prescribe in their state; for example, New Mexico and Louisiana) should use CPT code 90863 as an add-on code to the primary psychotherapy service as described in the current CPT manual. Other providers (i.e., physicians or Certified Psychiatric Nurse Specialists [CPNSs]) should not utilize this CPT code. See also 32 CFR 199.2 and Chapter 11, Section 3.7, regarding TRICARE’s definition of CPNS.
2.2  The allowable charge for psychotropic pharmacologic management shall be based on the CHAMPUS Maximum Allowable Charge (CMAC) methodology.
3.0  EFFECTIVE DATES
3.1  January 1, 2013.
3.2  Removal of quantitative limits on mental health care, October 3, 2016.
- END -

Utility Navigation Links

DoD Seal

tricare.mil is the official website of the Defense Health Agency (DHA) a component of the Military Health System

TRICARE is a registered trademark of the Department of Defense (DoD), DHA. All rights reserved.

CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.

If you have a question regarding TRICARE benefits, please go to the TRICARE Contact Us page page.
If you need help with technical/operational issues, please go to the TRICARE Manuals Online Help page.

The appearance of hyperlinks to external websites does not constitute endorsement by the DHA of these websites or the information, products or services contained therein. For other than authorized government activities, the DHA does not exercise any editorial control over the information you may find at other locations. Such links are provided consistent with the stated purpose of this DoD website.

v4.12.8657.14950

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.