CPT Code 90853: Group Therapy Guide [2024 Reimbursement Rate]

GUIDE

As a mental health professional, understanding CPT codes is crucial for accurate billing and optimal reimbursement. This comprehensive guide focuses on CPT code 90853, which is essential for billing group psychotherapy sessions. For a comprehensive guide to all CPT codes with cheat sheet and examples, refer here.

What is CPT Code 90853?

CPT code 90853 is defined as:

"Group psychotherapy (other than of a multiple-family group)"

This CPT code is used for billing group psychotherapy sessions where a trained mental health professional provides psychotherapy services to multiple patients in a group setting. It's an essential code for healthcare providers offering group therapy as part of their mental health services.

Who Can Use CPT Code 90853?

CPT code 90853 can be used by a variety of mental health professionals, including:

  • Licensed Clinical Social Workers (LCSW)

  • Licensed Professional Counselors (LPC)

  • Licensed Marriage and Family Therapists (LMFT)

  • Clinical Psychologists

  • Psychiatrists

Any qualified mental health professional providing group psychotherapy services can use this code, provided they meet the necessary licensing and credentialing requirements.

Group Therapy Session Requirements

When billing CPT code 90853, it's important to understand the specific requirements:

  • Group size: Typically, groups should have at least 2 members and no more than 12 members. Some insurance companies may have specific limits, so it's essential to verify with each payer.

  • Session length: While there's no strict time requirement for 90853, group therapy sessions typically last 60-90 minutes.

  • Frequency: 90853 can be billed once per day per patient.

  • Focus: The group must be focused on therapeutic goals, not simply socialization or activities.

It's crucial to note that 90853 is for general group psychotherapy and not for multiple family group psychotherapy, which has its own code (90849).

Participation of Family Members

While CPT code 90853 is primarily used for group psychotherapy with unrelated individuals, there are instances where family members might be involved:

  1. Mixed Groups: Some group therapy sessions may include a mix of unrelated individuals and family members of patients. In these cases, 90853 can still be used as long as the primary focus is on general group psychotherapy rather than family-specific issues.

  2. Support for Individual Therapy: Family members might occasionally participate in a group session to better understand and support the patient's treatment. This can still be billed under 90853 if the family member's participation is secondary to the group's therapeutic goals.

  3. Transition from Family Therapy: Patients who have participated in family therapy (billed under 90847) might transition to group therapy (90853) as part of their treatment plan. In such cases, it's important to clearly document the shift in therapeutic focus from family dynamics to general group psychotherapy.

It's crucial to note that if the primary focus of the group is on family dynamics or if multiple families are treated together, the more appropriate code would be 90849 (Multiple-family group psychotherapy) rather than 90853.

When family members are involved in group sessions billed under 90853, be sure to document:

  • The relationship of the family member to the patient

  • The reason for the family member's participation

  • How the family member's presence contributes to the group's therapeutic goals

By incorporating family members thoughtfully into group therapy sessions, practitioners can enhance the support system for patients while still appropriately using CPT code 90853 for billing.

Documentation Requirements

Proper documentation is essential when billing CPT code 90853. Your clinical notes should include:

  1. Date, start time, and end time of the session

  2. Number of participants in the group

  3. General theme or topic of the group session

  4. Therapeutic interventions used

  5. Each patient's participation and response to the group process

  6. Progress towards individual treatment goals

  7. Plan for future sessions

Example documentation snippet:

"90-minute group psychotherapy session (2:00 PM - 3:30 PM) with 8 participants focusing on coping strategies for anxiety. Used cognitive-behavioral techniques and mindfulness exercises. Jane Doe actively participated, sharing her recent success in using deep breathing to manage a panic attack. Plan to continue weekly sessions, focusing on building a toolbox of coping skills."

Remember, while the group has a common focus, your documentation should reflect each individual's participation and progress.

Automating Therapy Notes with AI

With the advancement of technology, many mental health professionals are turning to AI Therapy Note tools like Supanote to automate their documentation. These tools automate the creation of progress notes, reducing the time spent on paperwork and allowing more focus on patient care.

Benefits of using AI for group therapy documentation include:

  1. Consistency in note structure

  2. Time savings

  3. Improved accuracy in capturing session details

  4. Easy integration of individual responses within group context

Tools like Supanote can also write notes for group therapy sessions, which are typically hard to do documentation for. The product automatically recognizes different participants and captures the essence of the discussion. It comes with prebuilt note note templates like SOAP, DAP, GIRP, BIRP and many others. Here's a detailed guide to AI Therapy Note tools and how they work.

Reimbursement Considerations

Reimbursement rates for CPT code 90853 can vary based on several factors:

  1. Insurance provider policies

  2. Geographic location

  3. Provider credentials

  4. Specific contract terms

As of 2024, the Medicare reimbursement rate for 90853 is approximately $27.18 per patient per session. However, rates can vary significantly with private insurance companies. It's crucial to verify reimbursement rates with individual insurance companies and understand their specific policies regarding group therapy billing.

90853 vs. Other Psychotherapy Codes

Understanding how 90853 relates to other psychotherapy codes is crucial for accurate billing:

  • 90832, 90834, 90837: Used for individual therapy sessions of various lengths

  • 90847: Used for family therapy with the patient present

  • 90849: Used for multiple-family group psychotherapy

  • 90853: Used for general group psychotherapy

The main difference between 90853 and individual therapy codes is that 90853 is used when providing therapy to multiple patients simultaneously in a group setting.

Interactive Complexity and Group Therapy

In some cases, you may need to add the interactive complexity code (90785) to your group therapy sessions. Interactive complexity refers to specific communication factors that complicate the delivery of a psychiatric procedure. This might include:

  • The need to manage maladaptive communication

  • Caregiver emotions or behaviors interfering with implementation of the treatment plan

  • Evidence or disclosure of a sentinel event and the need to tailor communication to the patient's developmental stage

When billing 90785 with 90853, be sure to document the specific factors that warranted the interactive complexity code.

Group Therapy for Specific Mental Health Conditions

Group therapy can be particularly effective for a wide range of mental health conditions, including:

  • Depression

  • Anxiety disorders

  • Substance use disorders

  • Post-traumatic stress disorder (PTSD)

  • Eating disorders

  • Behavioral health issues

When forming groups, consider focusing on specific issues or diagnoses to create cohesive group dynamics. This can lead to more effective treatment as group members work through similar issues together.

Best Practices and Common Pitfalls

Best practices to ensure proper use of CPT code 90853

  1. Clearly define the therapeutic focus of each group

  2. Maintain appropriate group sizes

  3. Document individual participation and progress

  4. Regularly review and update treatment plans

  5. Stay informed about payer-specific guidelines

Common pitfalls to avoid:

  1. Using 90853 for family therapy or multiple-family groups

  2. Inadequate documentation of individual progress

  3. Exceeding recommended group sizes

  4. Billing for non-therapeutic group activities

Frequently Asked Questions

Can I bill 90853 and individual therapy on the same day?

Yes, you can bill both 90853 and an individual therapy code on the same day if they are separate, distinct services. However, check with specific payers as some may have restrictions.

How many participants are allowed in a group for billing 90853?

While there's no strict limit, most payers recommend between 2 and 12 participants. Some may have specific limits, so it's best to check with each payer.

Can 90853 be used for telehealth group sessions?

Yes, 90853 can typically be used for telehealth group sessions. Be sure to use the appropriate telehealth modifier and check with the payer for any specific telehealth billing requirements.

How does billing work if a group member leaves early or arrives late?

You can still bill 90853 for that member if they participated in a substantial portion of the session. Document the actual time of participation in your notes.

Can I use 90853 for support groups or educational groups?

90853 is specifically for therapeutic group sessions. Support groups or purely educational groups typically cannot be billed using this code.

How does reimbursement for 90853 compare to individual therapy codes?
Generally, reimbursement for 90853 is lower per patient than individual therapy codes. However, because you're treating multiple patients simultaneously, the overall reimbursement for the session can be higher.

Remember, while this guide provides general information, always consult with individual payers and stay updated on the latest billing guidelines to ensure compliance and optimal reimbursement for your group therapy services.

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