How To Use CPT Code 90853

CPT 90853 describes the procedure for group psychotherapy, excluding multiple-family groups. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90853?

CPT 90853 can be used to describe the procedure of group psychotherapy, where a trained therapist conducts a therapy session for a group of individuals who are not members of the same family. The session typically lasts for 45 to 60 minutes and allows participants to discuss and explore personal and group dynamics in a therapeutic setting.

2. Official Description

The official description of CPT code 90853 is: ‘Group psychotherapy (other than of a multiple-family group).’ It is important to note that CPT code 90853 should be used in conjunction with CPT code 90785 when group psychotherapy includes interactive complexity. Additionally, it should not be reported with CPT codes 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, or 0373T.

3. Procedure

1. A trained therapist selects a group of individuals who are not members of the same family.
2. The therapist leads a therapy session for the group, lasting between 45 and 60 minutes.
3. During the session, personal and group dynamics are discussed and explored, allowing for emotional catharsis, instruction, insight, and support.
4. The therapist facilitates the sharing of problems, issues, and thoughts among the group members, while the group provides feedback, support, criticism, and shares their own experiences.
5. The therapy session helps individuals relate to others, overcome personal shortcomings, and improve behavior, self-esteem, interpersonal relations, social interactions, and adaptability.

4. Qualifying circumstances

CPT 90853 is appropriate for individuals who require group psychotherapy and are not members of the same family. The therapy session should involve no more than 12 participants. The therapist conducting the session must be licensed or authorized by the state to perform this service, which may include psychiatrists, psychologists, clinical social workers, clinical nurse specialists, or other qualified professionals. Medicare coverage for group therapy does not include socialization, music therapy, recreational activities, art classes, excursions, sensory stimulation, eating together, cognitive stimulation, or motion therapy.

5. When to use CPT code 90853

CPT code 90853 should be used when conducting group psychotherapy sessions that meet the qualifying circumstances mentioned above. It should not be used for multiple-family groups or in conjunction with certain other CPT codes, as listed in the official description.

6. Documentation requirements

To support a claim for CPT 90853, the therapist must document the following information:

• Details of the therapy session, including the date, start and end time, and duration of the session.
• Number of participants in the group.
• Topics discussed and explored during the session.
• Progress made by the participants and any additional sessions scheduled.
• Signature of the therapist conducting the session.

7. Billing guidelines

When billing for CPT 90853, ensure that the therapy session meets the qualifying circumstances and is conducted by a licensed or authorized therapist. It is important to follow the guidelines provided by the payer regarding the use of CPT code 90853 in conjunction with other codes. Additionally, consider any specific tips or requirements for reporting CPT code 90853. For example, Medicare coverage for group therapy excludes certain activities and therapies.

8. Historical information

CPT 90853 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A clinical social worker conducting a group therapy session for individuals struggling with anxiety disorders.
2. A psychologist leading a therapy session for a group of individuals dealing with grief and loss.
3. A psychiatrist facilitating a therapy session for individuals with mood disorders.
4. A clinical nurse specialist conducting a group therapy session for individuals with substance use disorders.
5. A licensed therapist leading a therapy session for individuals with eating disorders.
6. A clinical psychologist facilitating a therapy session for individuals with post-traumatic stress disorder.
7. A clinical social worker conducting a group therapy session for individuals with personality disorders.
8. A psychiatrist leading a therapy session for individuals with attention-deficit/hyperactivity disorder.
9. A clinical nurse specialist facilitating a therapy session for individuals with obsessive-compulsive disorder.
10. A licensed therapist conducting a group therapy session for individuals with phobias.