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  5. /Case rate
CPT 90863

PHARMACOLOGIC MGMT W/PSYTX

Reported by 21 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$0

Average

$1.7k

Median

$27

High

$19.7k

Hospitals reporting this code

#HospitalLocationApproximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price.
1The Finley HospitalDubuque, IA$45$45——$45$45
2Trinity Medical CenterRock Island, IL$45$45——$45$45
3Unity HealthcareMuscatine, IA$45$45——$45$45
4Hca Florida Orange Park HospitalMIDDLEBURG, FL$15k$15k——$40$15k
5Florida Coast Medical and Surgical Center, Inc.Port St. Lucie, FL$0$0$0—$0$86
6Sanford Fargo Medical CenterFargo, ND$24$24$1—$22$41
7Sanford Medical Center BismarckBismarck, ND$25$24$1—$23$25
8Sanford Bemidji Medical CenterBemidji, MN$24$24$1—$23$41
9Sanford USD Medical CenterSioux Falls, SD$24$24$1—$22$41
10Sanford Aberdeen Medical CenterAberdeen, SD$24$24$1—$22$25
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