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90853 CPT Code | Group Psychotherapy | Description & Billing Guidelines

CPT code 90853 can be reported for group psychotherapy procedures, according to the American Medical Association (AMA). Individuals are treated in the context of group psychotherapy alongside strangers who experience similar emotional challenges. Below you can find the code description and billing guidelines for the 90853 CPT code for group psychotherapy.

What Is Group Psychotherapy?

Group psychotherapy is described by CPT 90853 and describes psychotherapy administered in a group setting with no more than 10-12 participants, generally facilitated by a trained therapist who also provides therapy to each group’s patients.

Sessions of group psychotherapy typically last for 45-60 minutes. For emotional release, knowledge, wisdom, and support, therapists can be investigated group dynamics at the level of the individual patient.

Group psychotherapy can be opposed to multiple-family group psychotherapy. To gain from psychotherapy, one should have the mental capacity to have a meaningful conversation with the therapist.

Due to the therapeutic nature of group therapy, its facilitator should be a professional and hold a valid license or other authorization to practice in their state. 

For example, a clinical psychologist, clinical social worker, clinical nurse specialist, or psychiatrist are state-licensed medical professionals who may provide this service.

Is CPT Code 90853 Time Based?

The psychotherapist can report 45 to 60 minutes for psychotherapy treatment in a group session with CPT 90853.

Psychotherapists often meet with groups for longer than 45-60 minutes. CPT code 90853 is officially not time-based. However, because CPT code 90853 is categorized as a time-based session, it is limited to be billed one unit daily.

How Many Members Are Allowed In A Group For The 90853 CPT Code?

Twelve general patients are allowed to attend for CPT code 90853. Individuals and groups can be analyzed their relationships and gain insight into themselves while releasing pent-up emotions in a secure environment created by therapeutic activities.

What Is CPT 90853?

Individual pathology within a group is evaluated by interactions between group members using the CPT code 90853. When striving to enhance the attitudes and actions of individuals, all of the group’s strengths can be examined.

CPT code 90853 can be used for addressing a specific mental health condition and developing coping mechanisms and skills. Examples of such conditions are anxiety, depression, obesity, panic disorder, grief, substance abuse, and chronic pain.

Medicare can not include the following symptoms for billing procedures under CPT Code 90853:

  • Education about personal hygiene.
  • Maintaining tabs on regular happenings.
  • Therapy via Play (dance, art, play).
  • Community mealtimes.
  • Informing stakeholders by drafting reports.

Each insurance provider can be differed due to the variation in their billing guidelines. Therefore, it is essential to inquire whether or not your preferred therapy method can be covered for group therapy services throughout the eligibility and benefits verification process. 

Can Nurses Use The 90853 CPT Code?

Per Medicare rules, nurse practitioners cannot use procedure code 90853.

Who Can Use CPT 90853?

The following certified mental health professionals are allowed to report group therapy sessions:

  • Licensed Clinical Social Workers (LCSW)
  • Licensed Professional Counselors (LPC)
  • Licensed Mental Health Counselors (LMHC)
  • Licensed Marriage and Family Therapist (LMFT)
  • Experts in psychological therapy (Ph.D. or PsyD)

The following condition should be met for CPT 90853:

  • Twelve people can attend a group session at once.
  • This code can only be billed once per day.
  • If you decide to move a client from group treatment to individual therapy, you can use the proper same-day billing claim for that insurance company. 
  • Each client’s diagnosis should be distinct, even if the conversation should be concerned with the same issue. 

90853 CPT Code Description

Group psychotherapy is the best treatment for some people and conditions because it can be used to help them feel supported and accountable to others with similar problems.

The 90853 CPT code for group therapy is officially described by CPT’s manual as: “Group psychotherapy (other than of a multiple-family group).”

Report CPT 90853 for individual pathology in a group based on how people interact in a group session.

Under the CPT code 90853, a group psychotherapy session can be accommodated with twelve individuals. The group session should typically be between 45 and 60 minutes.

All participants can be grouped together when trying to change their thoughts and actions.

Why Do People Need Group Psychotherapy?

Group psychotherapy can be useful because it provides a safe space where patients share their experiences and hold one another accountable.

In addition, group therapists recommend yoga, meditation, physical activity, and mindfulness as ways to care for oneself.

Who Is Allowed To Use Group Psychotherapy?

Only adults are allowed for group therapy; younger members, such as children and teenagers, should also be included.

CPT codes 90849 and 90853 can be considered group general and family group psychotherapy. These codes describe which participants can be eligible to join the session. 

For example, the client’s immediate family should be welcome to join multiple-family group psychotherapy sessions for CPT 90849, while at general group psychotherapy sessions for the CPT code 90853, only the clients themselves will be present.

Documentation

Each person attending a group psychotherapy session should have a written record detailing what went on during the session.

In addition, whenever a family member cannot participate in a session, it is essential to document their absence for CPT code 90853 and explain why they were absent and how long they were missing.

A suitably covered diagnosis can be included when filling out forms for CPT codes 90849 and 90853.

Collaborative patient care involving multiple healthcare professionals is the norm. Psychologists, psychiatrists, nurses, and social workers utilize the same CPT codes when billing for psychotherapy services.

When a non-physician provider performs a service, the supervising physician can make a document for psychotherapy session guidelines in the medical records.

When a non-physician provider provides services to a medical doctor, they must follow incident-to requirements to be reimbursed for such services under the doctor’s NPI.

Therefore, disclose the following information for the implication of the CPT code 90853.

  • All documentation entries can be included the identity of the practitioner who provided the service and the co-signature or readable name and credentials (MD, DO, NP, PA, etc.) of the supervising physician.
  •  The physician’s involvement in the entry body is briefly supervised. The intensity of participation needs to be commensurate with the severity of the patient’s condition.
  • Services are rendered outside the requested time frame (the initial visit, for example). It establishes communication between the two service providers.

If a patient is involved in multiple groups at once, and their payer has approved this as part of their treatment plan, various claims for the same day can be submitted.

What Is The Reimbursement Rate For CPT Code 90853?

In 2022, the reimbursement rate for CPT Code 90853 is $29.87.

Most commercial reimbursement plans do not cover the cost of group psychotherapy. 

It is essential to have a policy that holds clients accountable for out-of-pocket expenses (ideally on the Consent for Services form). 

It is necessary to keep detailed notes on each group psychotherapy session, outlining what was covered and how the patient progressed toward their goals.

CPT code 90853 should be updated to reflect if any general member is absent from a session, the reason for their absence, and how long it lasted. The correct covered diagnosis can be listed for reimbursement purposes in the case of CPT 90849 and CPT 90853.

 Example

When several patients get an appointment for a psychotherapy session to reduce their tension, the professional psychotherapist decides to arrange a general therapy session for twelve patients.

All these patients have symptoms of depression. Therefore this is a general therapy session (the same issue can be discussed in the session). Report CPT code 90853

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