CPT Code 9053 for group therapy services can be complex to bill and code accurately.
In our guide to CPT Code 90853 we’ll teach you the size, length, and services that are allowed and not allowed in group therapy billing. We’ll also let you know CPT code 90853 reimbursement rates at the end of the article.
If you’re struggling to get your group therapy sessions paid in full, consider reaching out to our billing service to help you solve your frustrations. We replace all of the calls and follow up for you. If you’re brave, carry on!
What is procedure code 90853?
90853 is a CPT code or billing code medical billers are required to use to submit insurance claims. This code describes group therapy services rendered. You’ll learn how to use this code to bill multiple clients for your large therapy sessions.
CPT Code 90853 Definition:
Group therapy sessions are often oriented around a specific mental health problem, skills, and solutions for that problem, such as anxiety, depression, obesity, panic disorder, loss of a family member, substance abuse, or chronic pain.
What is the Maximum Number of Clients per Group Therapy Session?
According to Medicare guidelines, sessions are not to exceed 10 patients or participants max. Often, sessions are 6 to 10 clients. (Source)
Group Therapy Exclusions?
Medicare does not include the following services as part of coding CPT Code 90853:
- Teaching grooming skills
- Monitoring daily living activities
- Recreational therapy (dance, art, play)
- Eating together
- Social interaction
- Travel time
- Self-help materials
- Report preparation
Each insurance company is different, so when conducting an eligibility and benefits verification, ask if your modality of therapy is covered for group therapy services.
We do this for our providers as part of our billing service.
CPT Code 90849 Definition:
Multiple-family group psychotherapy by physician directed to effects of patient’s condition on the family.
Multi-Family therapy is not covered by Medicare. (Source)
Add-On Codes for Group Therapy Billing
There are two common Add-on CPT codes you can use for group therapy billing:
CPT Code 99050 – Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed.
CPT Code 99051 – Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.
Is CPT code 90853 time based?
Because 90853 is not time based, a maximum of one unit per day may be billed for CPT code 90853.
If you’re struggling to bill 2 hour+ group therapy sessions, we might be able to help.
90853 vs 90849
While minor, it’s worth mentioning the difference between CPT Code 90853 vs 90849: 90853 is for group therapy whereas 90849 is multiple family therapy.
Medicare does not cover 90849 and it is a rare treatment modality. We do not recommend billing 90849 unless specifically authorized.
Is 90853 covered by Medicare?
According to Medicare guidelines, procedure code 90853 must be submitted with evaluation and management services by either an MD or NPP. (Source)
90853 License Level Requirements
The following licensed mental health professions are able to conduct group therapy sessions:
- Licensed Clinical Social Workers (LCSW)
- Licensed Professional Counselors (LPC)
- Licensed Mental Counselors (LMHC)
- Licensed Marriage Family Therapists (LMFT)
- Clinical Psychologists (PhD or PsyD)
- Psychiatrists (MD)
How long is a 90853 session?
Normally sessions last 45 to 60 minutes in length. (Source).
CPT Code 90853 Reimbursement Rate
Medicare 2020 CPT Code 90853 Reimbursement Rate: $28.15
If you’re struggling to get paid the appropriate amount for your group therapy sessions, we might be able to help.
90853 Authorization and Limits
Not all plans consider group therapy as a routine outpatient mental health service and will not cover 90853 billing without prior authorization.
Ensure you obtain authorization to bill for group therapy for that client during your eligibility and benefits verification phone call. Ask about limits to services as well.
If you’re struggling to find out exactly which services will be covered, when conducting your call ask specifically if CPT Code 90853 is covered. We do this as part of our billing service.
90853 Billing and Coding Recommendations
You should genuinely not exceed 10 clients per group session nor should sessions exceed a single CPT code per day.
If you do want to conduct an individual therapy session with a client you saw during group, use the same day billing modifier appropriate to that insurance company. Best to call ahead about this as well.
Each client’s diagnosis will be specific to them even if the topic of conversation is about one specific topic. Use specified diagnoses when billing your group therapy claims.