The 90849 CPT code belongs to the family of CPT codes for mental health. Proper understanding and usage of this code ensures compliance, accurate claims processing, and streamlined workflows for healthcare providers.
Professionals can provide efficient care while upholding the required administrative standards by following the requirements related to the 90849 CPT code.
90849 CPT Code
The 90849 CPT code refers to multiple-family group psychotherapy, a session where families with similar challenges meet with a clinician.
These sessions, typically involving up to eight participants, aim to address emotional issues, promote personal growth, and improve functional skills.
Difference Between 90849 CPT Code and 90853 CPT Code
Both 90849 CPT code and 90853 CPT code are used for group psychotherapy but have key differences:
- 90849: Specific to multiple-family group psychotherapy, where family members participate.
- 90853: General group psychotherapy for individual patients, not family-specific.
Documentation Requirement
You need to create proper documentation when billing for these sessions:
- Include a session description unique to each participant.
- Document the absence of any family members, specifying the reasons and duration.
- Provide a covered diagnosis when applicable for both 90849 and 90853 sessions.
Creating accurate and detailed records ensures compliance and supports claims processing.
How to Bill the 90849 CPT Code?
Getting reimbursed for group psychotherapy services varies by insurance plan and region. For instance, CPT code 90849 is typically not covered by Medicare, while codes 90849 and 90853 may be covered by Minnesota Health Care Programs (MHCP), and 90853 may be reimbursed by Excellus.
However, commercial insurance companies generally do not reimburse for group psychotherapy, so it’s important to have a policy in place clarifying that clients are responsible for charges not covered by insurance (ideally documented in the Consent for Services form).
Each participant in a group psychotherapy session requires individualized documentation, including details about the session and how it supports the patient’s treatment goals. For the 90849 CPT code, remember to document when a family member is not present, including the reason for their absence and the duration.
For both 90849 and 90853, include patient identification and, whenever possible, a covered diagnosis to support the medical necessity of the service.
