Group psychotherapy can be an invaluable means of treating multiple patients at once, offering relief for common emotional concerns while encouraging greater connection among individuals in treatment groups. Healthcare providers need to manage billing and coding correctly for group psychotherapy treatments in order to receive payment. Group Psychotherapy CPT Code 90853 services does not fall within multi-family grouping; mental health providers treating different individuals at once with psychotherapy must use CPT number 90853. Usually, two to ten members of a group take part in each therapy session because they may all have related psychiatric issues that require treatment simultaneously.
Example: A psychotherapist working on stress management strategies with five clients over 90 minutes would bill all insurance providers using code 90853 collectively as one bill. This article provides an exhaustive guide for group billing and coding of psychotherapy in 2024, assisting providers who wish to streamline these processes with greater ease and accuracy.
Group Psychotherapy Key Characteristics:
Interactive:
Therapy relies on interactions among group members, facilitated by a psychotherapist.
Therapeutic Focus and Goals:
Focus your efforts on improving participants’ interpersonal dynamics and mental well-being.
Duration:
Therapy sessions generally last 45–60 minutes; however, their length can differ based on your therapist and individual circumstances.
Psychotherapy and Evaluation and Management (E&M) (Applying the Time Rule of Psychotherapy Session):
Patient Presence:
Patients must attend for most or even all of the duration of each session.
Distinct Reporting:
On any calendar day when providing services related to E/M and psychotherapy on the same schedule, treatments must meet specific patient histories, examinations, and medical decision-making as per CPT and E/M guidelines from 1995 or 1997.
Place of Service:
These settings include offices (POS 11), inpatient facilities (POS 21), and outpatient settings (POS 22).
Code Selection:
Select the psychotherapy code that most closely represents how long each session with your patient lasts.
Time Documentation:
Document all sessions spent in psychotherapy to ensure accurate billing.
- CPT Time Ranges:
- CPT 90832 (or + 90833): 16 to 37 minutes
- CPT 90834 (or + 90836): 38 to 52 minutes
- CPT 90837 (or + 90838): 53 minutes or longer
Minimum Session Duration:
Psychotherapy sessions lasting less than 16 minutes should not be billed as service charges.
| CPT Code | Total Duration of Psychotherapy Session | Medicare Fee 2024 |
| 90832 | 16–37 minutes | $78.23 |
| 90834 | 38–52 minutes | $103.19 |
| 90837 | 53 or more minutes | $152.12 |
| 90846, 90847 | 26 or more minutes | $97.53, $102.19 |
Psychotherapy CPT Codes and Medicare Fee 2024:
| CPT Code |
Description |
Medicare Fee 2024 |
| 90832 | Psychotherapy, 30 minutes with the patient | $78.23 |
| 90834 | Psychotherapy, 45 minutes with patient | $103.19 |
| 90837 | Psychotherapy, 60 minutes with patient | $152.12 |
| 90845 | Psychoanalysis | $97.87 |
| 90846 | Family psychotherapy (without the patient present), 50 minutes | $97.53 |
| 90847 | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | $102.19 |
| 90849 | Multiple-family group psychotherapy | $37.61 |
| 90853 | Group psychotherapy (other than of a multiple-family group) | $27.63 |
How to Utilizing the Interactive Complexity Add-on Code for Psychotherapy (CPT Code 90785):
Add-on codes designate additional services that supplement primary mental health treatments, such as diagnostic evaluation and psychotherapy sessions, offering valuable insights into areas beyond the original core service.
Add-On Code for Interactive Complexity (Code 90785):
When specific communication barriers impede the delivery of mental health services, we use CPT Code 90785 to document “interactive complexity”. By acknowledging and documenting such difficulties during billing processes, this code helps ensure they remain pertinent during billing procedures.
Criteria for Using Code 90785:
At least one of four complicating factors must be present for an interactive complexity code to work effectively during service delivery, these could include communication issues among family members or interactions between children with limited verbal skills and verbally underdeveloped adults, for instance. These complicating factors tend to surface more commonly among patients who:
- Legal guardians are involved in a patient’s care.
- Family members or interpreters are present during consultations.
- Third parties like educational institutions or law enforcement are engaged.
Applicable Services for Code 90785:
You can use this add-on code for interactive complexity in conjunction with other codes for diagnostic evaluations (90791), psychotherapy sessions of varying lengths (90832, 90834, and 90837), and group psychotherapy (90853). When used correctly in mental healthcare facilities, it will help with accurate billing and reimbursement.
| CPT Code |
Description |
Medicare Fee 2024 |
| 90785 | Interactive complexity
(List separately in addition to the code for primary procedure) can be reported with the appropriate primary procedure (90791, 90832, 90834, 90837, or 90853) if at least one of four specific complicating factor(s) are present. |
$14.65 |
How to Utilize the Psychotherapy for Crisis CPT Codes:
Severity and Urgency:
Report any medical issue that poses life-threatening risks or could escalate quickly due to extreme patient anxiety.
Purpose of the Service:
Treatment should focus on immediate assessment, restoring safety by mobilizing resources to address the situation, and making interventions to decrease the likelihood of mental trauma.
Billing Restrictions:
- This service cannot be billed in addition to other psychotherapy codes.
- It can only be billed once per day, emphasizing its use for acute situations only.
| CPT Code |
Description |
Medicare Fee 2024 |
| 90839 | Psychotherapy for crisis; first 60 minutes (Billed for the first 60 minutes of psychotherapy for a patient in crisis, and add-on code 90840 billed for each additional 30 minutes) |
$146.47 |
| 90840 | Psychotherapy for crisis; each additional 30 minutes (list separately in addition to code for primary service) |
$72.57 |
| G0017 | Psychotherapy for crisis furnished in an applicable site of service
(any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting) first 60 minutes |
$212.04 |
| G0018 | Psychotherapy for crisis furnished in an applicable site of service
(any place of service at which the non-facility rate for psychotherapy for crisis services applies, other than the office setting); each additional 30 minutes (List separately in addition to code for primary service) |
$105.19 |
Group Therapy Billing Authorization and Limits for CPT Code 90853:
Prior Authorization:
Before engaging in group therapy sessions, obtaining prior authorization from your insurance plan may be essential, as some may not cover CPT Code 90853 without it.
Verification Call:
Verifying benefits is vitally important. Verify the coverage of the group therapy program your client needs assistance with, along with any necessary authorizations and clearances, before calling in for verification.
Service Limits:
Find out if clients have any restrictions on session length or coverage amounts for group therapy plans.
Is 90853 covered by Medicare?
Under Medicare guidelines, CPT code 90853 must accompany evaluation and management services provided by either a doctor (MD) or non-physician physician (NPP).
When Combined with E/M Services:
- If an E/M treatment is offered the same day, and is important and identified, it is paid for alongside group therapy.
- Utilize modifier -25 along with the code E/M to indicate it’s an independent service from the psychotherapy group session.
Frequently Asked Questions (FAQ) About Billing and Coding with CPT Code 90853
Q2: Can I bill CPT code 90853 for family therapy sessions?
No. We specifically designed the CPT code 90853 to encompass group psychotherapy sessions, with the exception of family therapy, which may involve multiple family groups participating simultaneously. Family psychotherapy involving patient participation typically employs other CPT codes, like 90847, in order to facilitate its progress effectively.
Q3: Is it possible to bill individual therapy and group therapy on the same day for the same patient?
Yes, it is legal and permissible for you to charge separately for individual and group therapy sessions from one individual therapist; however, you should provide evidence to demonstrate they are separate services with distinct requirements that should not overlap or duplicate one another. Modifiers such as 25 and 59 could aid in proving that these services are sufficiently distinct from one another to warrant independent charging and avoid duplication.
Q4: What are the documentation requirements for billing CPT code 90853?
For group psychotherapy, documents must include information about each session, including time and participants, as well as an outline of the treatments provided.
How long is 90853 group psychotherapy?
Group psychotherapy sessions that fall under CPT code 90853 typically last 45–60 minutes.
What is CPT code 97150 for group therapy?
Physical therapy environments may use CPT code 97150 to facilitate group therapy sessions that include strength and functional training exercises.
What is the difference between 90853 and 90849?
General group psychotherapy sessions utilize CPT code 90853 while multi-family group therapy, often known as multi-family group therapy, uses CPT code 90849.
Can you bill for group therapy?
Yes, Group therapy sessions may incur charges. This typically uses specific CPT codes based on their therapeutic approach, such as 90853 for psychotherapy groups.
What are the billing guidelines for 90853?
CPT code 90853 denotes group psychotherapy, distinguishing it from multi-family group therapy. If a mental health professional treats multiple patients simultaneously for psychotherapy sessions using CPT code 90853, typically two to 10 patients in groups participate and suffer from any related psychiatric issues that need treating simultaneously.
Related Post:
