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90865 CPT Code: What Medical Billers Need to Know in 2025

Stanley Efrem

Jul 14, 2025

CPT code 90865 stands out as one of psychiatry's most specialized billing procedures. This distinct code encompasses two key elements: intravenous administration of tranquilizer drugs and interviews conducted under their influence. Medical professionals use these specifically for psychiatric diagnostic and therapeutic purposes.

Accurate reimbursement in psychiatry depends on your grasp of narcosynthesis reporting details. The code 90865 differs from standard mental health procedures because it doesn't follow time-based billing. This adds complexity to the entire billing process. The procedure, which experts call an Amytal interview, requires slow intravenous infusion of either a barbiturate or benzodiazepine that helps suppress patient's inhibitions.

The CPT coding system has become the standard language across the United States. Medical professionals need to understand how this code fits within this broader framework. This piece offers a complete walkthrough of the 90865 CPT code for 2025. You'll learn about documentation requirements, common billing mistakes to avoid, and essential compliance considerations.

Understanding the 90865 CPT Code

Narcosynthesis blends pharmacology with psychotherapy in mental health practice. This section explains the unique aspects of CPT code 90865 and its role in psychiatric billing.

What is 90865 used for?

Medical professionals use the 90865 CPT code for narcosynthesis, a specialized psychiatric diagnostic and therapeutic technique. The procedure helps patients discuss psychological material they can't express in their normal conscious state. Healthcare providers use this approach to:

Reveal hidden memories or emotions that affect mental health
Break down barriers when patients discuss sensitive topics [2]
Tap into unconscious material needed for treatment

Patients who don't respond well to standard therapy often find narcosynthesis a helpful alternative. The procedure opens new paths toward emotional healing and psychological relief.

90865 CPT code description and context

The process starts with a slow intravenous infusion of a narcotic substance. Doctors typically use sodium amobarbital (Amytal) or a benzodiazepine [3]. These medications create a hypnotic state that reduces inhibitions [4].

The healthcare provider manages the drug administration and watches the patient's responses carefully. They use this enhanced access to unconscious material to guide their therapeutic work. The 90865 code, billed per session, covers both drug administration and the interview that follows.

Note that 90865 only covers the procedure. Providers must bill the drug separately using J0300 (Injection, amobarbital, up to 125 mg) [5].

How it fits into psychiatry CPT codes

The 90865 code belongs to "Other Psychiatric Services or Procedures" [4]. This sets it apart from standard diagnostic evaluations, psychotherapy, and related psychiatric services.

Psychiatric CPT codes cover several types of care:

General and special diagnostic services
Various therapeutic services
Specialized procedures like narcosynthesis [6]

The 90865 code works as a standalone procedure with specific billing limits. Correct Coding Initiative (CCI) rules don't allow providers to bill this code with psychodiagnostic evaluations (90791, 90792) or any Evaluation and Management codes [5].

Most insurance companies pay for this procedure [3]. This makes it a practical billing option for qualified providers who offer this specialized service.

Billing Rules and Restrictions for 90865

Providers need a solid understanding of specific billing rules that govern CPT code 90865 to get reimbursed for narcosynthesis. These rules greatly affect how they can report this specialized procedure.

Not a time-based code: what that means

The 90865 CPT code is different from many psychiatric services because it doesn't depend on session duration. Your clinician will report just one unit of 90865 per patient per calendar date [7], whatever time they spend conducting the narcosynthesis interview. This code is different from psychotherapy codes that specify time ranges (such as 30, 45, or 60 minutes). The reimbursement stays the same whether the procedure takes 30 minutes or two hours.

Can 90865 be billed with E/M or psychotherapy codes?

The short answer is no. CPT code 90865 has strict bundling restrictions with several other services:

You can't report 90865 with psychodiagnostic evaluation codes (90791, 90792) [7]
Practitioners can't bill E/M services with narcosynthesis on the same date [8]
The code doesn't allow reporting with psychotherapy codes (90832-90838) [7]
Crisis psychotherapy codes (90839, 90840) can't be billed with 90865 [7]

Facilities can separately report E/M codes and narcosynthesis if they perform them at separate patient encounters on the same service date [8].

Common CCI edits and bundling issues

The Correct Coding Initiative (CCI) enforces several important bundling rules for 90865. These edits carry a modifier indicator of "0," which means you can't override the bundling restrictions with modifiers [7]. Here's what this means:

You may only report crisis psychotherapy if both narcosynthesis and crisis therapy happen on the same day [7]
The code 90865 faces bundling with most psychiatry codes used in clinical practice [9]
You must report 90865 and not the psychotherapy code when choosing between them [9]

Narcosynthesis serves as a detailed service that has elements of evaluation and management that would otherwise need separate reporting with other psychiatric services.

Documentation and Compliance Essentials

Proper documentation of the 90865 CPT code just needs careful attention to detail. Improper record-keeping remains one of the top reasons for claim denials. Your thorough documentation will serve both clinical and compliance purposes.

Medical necessity and prior authorization

Most payers want prior authorization before performing narcosynthesis [10]. Your documentation must clearly show why this specialized procedure is required. The notes should state something like "the patient had difficulty verbalizing psychiatric problems without the aid of the drug" [11]. Medical records should explain why standard psychotherapy approaches didn't work for the patient's needs. Medicare and commercial insurers might have different documentation requirements to establish medical necessity [12].

Who can perform 90865?

Coding guidelines state that only a qualified psychiatrist can perform and bill for narcosynthesis [4]. This code differs from other mental health procedures and cannot be used by clinical psychologists, licensed clinical social workers, or nurse practitioners. Medical records must confirm that an authorized provider performed the procedure [4].

What to include in clinical notes

Your 90865 procedure documentation must include:

The specific pharmacological agent administered (e.g., sodium amobarbital)
Exact dosage of the medication used
Whether the technique was effective or non-effective
Treatment recommendations
Detailed reasons for choosing narcosynthesis as the appropriate intervention [11]

Clinical notes should cover the patient's response to the procedure and how the gathered information will shape the treatment plan. These elements are crucial for both medical practice and potential audits.

Reporting the drug supply separately (J0300)

You must report the medication used during narcosynthesis separately from the procedure code. Use HCPCS code J0300 (Injection, amobarbital, up to 125 mg) for amobarbital [4]. This separation of procedure from drug supply will give you appropriate reimbursement for both components and helps maintain billing compliance.

Real-World Scenarios and Coding Tips

The practical application of narcosynthesis billing knowledge helps bridge the gap between coding guidelines and clinical practice. Let's get into how this specialized procedure works day to day.

Example: Narcosynthesis for trauma disclosure

To name just one example, see this scenario: A psychiatrist treats a 35-year-old female patient for depression. The patient receives anti-depressants and regular psychotherapy. The psychiatrist suspects the patient withholds critical information and decides to perform an amytal interview. During this narcosynthesis session, they find the patient's condition stems from childhood sexual abuse by a relative. An abusive relationship later made it worse.

The psychiatrist handled medication management in the same session. You should report only 90865 for the narcosynthesis. The evaluation and management component bundles into the procedure code. You should not report an E/M code separately for the medication review.

When to use modifiers like 59

Modifier 59 (Distinct procedural service) matters most when narcosynthesis happens among other family or group therapy services. The psychiatrist might perform both family psychotherapy and narcosynthesis on the same date. You can report both procedures by adding modifier 59 to code 90865.

This modifier works with several psychiatry-related services that are the foundations of "column 2" codes with 90865:

Family psychotherapy without patient present (90846)
Family psychotherapy with patient present (90847)
Multiple-family group psychotherapy (90849)
Group psychotherapy (90853)
Electroconvulsive therapy (90870)
Hypnotherapy (90880)

Avoiding denials and audit triggers

Your documentation must clearly show medical necessity to prevent claim rejections. State why the patient needed narcosynthesis (e.g., "patient had difficulty verbalizing psychiatric problems without pharmacological assistance"). Records should include the specific medication used, exact dosage given, and the technique's effectiveness.

Claims often face audits due to weak justification for the procedure, missing details about the pharmacological agent, or lack of clinical outcome documentation. It also raises red flags when the code gets used for services that don't truly involve narcosynthesis.

Note that narcosynthesis documentation should demonstrate the diagnostic reasoning behind this specialized approach. It must also show how the information will shape the treatment plan going forward.

Conclusion

Medical billers working with psychiatric providers need to understand CPT code 90865 for narcosynthesis procedures. This specialized code differs from other psychiatric services because of its unique billing requirements and restrictions. Narcosynthesis billing doesn't follow time-based considerations but requires strict adherence to bundling rules.

Your claims for this procedure need solid documentation. Records must show medical necessity, list the specific medication used, and identify the qualified psychiatrist who performed the service. On top of that, it helps to bill the drug supply separately with J0300 for amobarbital.

Problems are systemic when practitioners try to report other services with narcosynthesis. You should know the CCI edits that stop simultaneous billing with psychodiagnostic evaluations or E/M services. While 90865 has many restrictions, you can still report certain family and group therapy services on the same date by using modifier 59 correctly.

Billers who become skilled at narcosynthesis coding will improve reimbursement rates by a lot and reduce denials. This procedure stands as one of psychiatry's most specialized interventions. A full picture of its billing requirements will affect your organization's financial success directly. This knowledge about CPT code 90865 lets you handle narcosynthesis claims confidently through 2025 and beyond.

FAQs

What is CPT code 90865 used for in psychiatric practice?

CPT code 90865 is used for narcosynthesis, a specialized psychiatric technique involving the intravenous administration of tranquilizer drugs to conduct interviews for diagnostic and therapeutic purposes. It helps patients access and discuss psychological material they may not be able to verbalize in a fully conscious state.

Can CPT code 90865 be billed with other psychiatric services?

No, CPT code 90865 cannot be billed with most other psychiatric services. It faces strict bundling restrictions and cannot be reported alongside psychodiagnostic evaluation codes, E/M services, or psychotherapy codes on the same date of service by the same provider.

Who is qualified to perform and bill for narcosynthesis (CPT 90865)?

Only a qualified psychiatrist can perform and bill for narcosynthesis using CPT code 90865. Unlike some other mental health procedures, this code cannot be used by other mental health professionals such as clinical psychologists, licensed clinical social workers, or nurse practitioners.

What documentation is required for billing CPT code 90865?

Documentation for CPT code 90865 must include the specific pharmacological agent administered, exact dosage, effectiveness of the technique, treatment recommendations, and detailed reasons for choosing narcosynthesis. It should also establish medical necessity and confirm that a qualified psychiatrist performed the procedure.

How is the medication used in narcosynthesis billed?

The medication used in narcosynthesis, typically amobarbital, is billed separately from the procedure code. For amobarbital, use HCPCS code J0300 (Injection, amobarbital, up to 125 mg) in addition to the 90865 CPT code for the narcosynthesis procedure itself.