Group therapy sessions are no exception to the rule that accurate billing is fundamental to any successful mental health practice.
Learning how to bill for mental health services using CPT code 90853 can help you maintain the smooth operation of your clinic, guarantee prompt reimbursement, and prevent expensive mistakes.
Definition of CPT Code 90853
CPT code 90853 is used by medical billers to submit insurance claims for group therapy services. This code covers therapeutic sessions involving multiple patients, typically lasting 45 to 60 minutes.
Group psychotherapy involves interpersonal interactions and support among several participants.
Group therapy sessions often focus on addressing specific mental health issues, building skills, and exploring solutions for challenges like anxiety, depression, substance abuse, chronic pain, grief, panic disorders, or obesity.
According to Medicare guidelines, sessions shouldn’t exceed 10 patients or participants. Often, sessions include anywhere from 6 to 10 clients.
Authorization and Limits for CPT Code 90853
Not all insurance plans classify group therapy as a routine outpatient mental health service, meaning prior authorization may be required for billing under CPT code 90853.
To avoid claim denials, obtain authorization during your eligibility and benefits verification call. Be sure to confirm whether group therapy is covered and inquire about any service limits specific to the client’s plan.
If you’re uncertain about coverage, ask directly if CPT code 90853 is included in the client’s benefits.
Differences between 90853 vs. 90849
While similar, there’s an important distinction between CPT codes 90853 and 90849:
- 90853: Used for group therapy sessions.
- 90849: Reserved for multiple-family group therapy.
Medicare does not cover CPT code 90849, as it is an uncommon treatment approach. It is recommended to bill 90849 only when explicitly authorized.
Is CPT Code 90853 Covered by Medicare?
Yes, CPT code 90853 can be covered by Medicare. However, it must be submitted alongside evaluation and management (E/M) services performed by a qualified provider, such as a medical doctor (MD) or a non-physician practitioner (NPP).
Who Can Bill for CPT Code 90853?
Group therapy sessions billed under 90853 must be conducted by licensed mental health professionals.
The following practitioners are eligible:
- Licensed Clinical Social Workers (LCSWs)
- Licensed Professional Counselors (LPCs)
- Licensed Mental Health Counselors (LMHCs)
- Licensed Marriage and Family Therapists (LMFTs)
- Clinical Psychologists (PhD or PsyD)
- Psychiatrists (MD)
Add-On Codes for Group Therapy Billing
When billing for group therapy sessions, two commonly used add-on CPT codes can enhance your claims:
- CPT Code 99050: Used for services provided outside of regular office hours or on days when the office is typically closed.
- CPT Code 99051: Applied for services rendered during regularly scheduled evening, weekend, or holiday office hours.
CPT Code 90853 Reimbursement Rate for 2024
The Medicare reimbursement rate for CPT Code 90853 is confirmed at $27.18 per session for 2024. This rate can vary slightly depending on the location and other factors such as the type of payer (e.g., private insurance or Medicaid).
Medicaid and private insurance often have different reimbursement structures, with Medicaid rates usually lower and private insurers potentially offering rates between $30 and $50 per participant per session.
