CPT Code 90853: Appropriate Use
CPT Code 90853 Description
90853 CPT Code represents psychotherapy administered in a group setting, involving no more than 12 participants, facilitated by a trained therapist simultaneously providing therapy to these multiple patients. The group therapy session typically lasts 45 to 60 minutes. Personal and group dynamics are discussed and explored in a therapeutic setting allowing emotional catharsis, instruction, insight, and support.
CPT Code 90853 should also not be billed more than once per day for the same beneficiary unless he/she has participated in a separate and distinct group therapy session. In the infrequent event that a patient has a separate and distinct individual psychotherapy and group therapy session in one day, modifier 59 should be appended to the CPT code for the second session.
This code relies on the use of interactions of group members to examine the pathology of each individual within the group. In addition, the dynamics of the entire group are noted and used to modify behaviors and attitudes of the patient members. The size of the group may vary depending on the therapeutic goals of the group and/or the type of therapeutic interactions used by the therapist. The code is used to report per-session services for each group member. Most insurance plans cover this procedure.
Use 90853 in conjunction with 90785 for the specified patient when group psychotherapy includes interactive complexity. +90785, can be used with: 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90853.
CPT Code 90853 Reimbursement
|90853||$ 26.99||$ 27.83||$ 26.21|
*Reimbursement are rates taken from AMA Codemanager. Medicare 2020
In general, group psychotherapy is not reimbursed by commercial insurance companies, making it important to have a policy in place stating that clients will be liable for all charges not covered by insurance (ideally on the Consent for Services form). This ensures you’re compensated for your time.
CPT Code 90853 and 90849
The CPT codes 90853 and 90849 are used when people with similar issues or conditions are treated in a group. Whether that’s a few families trying to reconcile after a spouse cheats or individuals with depression seeking support, the session must use psychotherapy to qualify for the codes and the issue must be best treated in a group setting. What distinguishes the two codes is the type of patient: 90849 is for multiple-family group psychotherapy and 90853 is for general group psychotherapy. This affects who can attend the session. Whereas multiple-family group psychotherapy will have family members in attendance, general group psychotherapy will only have the individual clients present.
Is it possible to do codes 90837, 90847, and 90853 on the same day?
Yes, you can bill CPT codes 90837, 90847 and 90853 on the same day provided you justify the reason of having all the 3 visits on the same day. All visits should be in seperate sessions.
Each participant in the group psychotherapy session should have unique documentation, including a description of the session and how the session contributed to the patient’s treatment goals. Also, make sure for 90849 that you document when a family member is excluded from a session, including the reason why they’re missing the appointment and the length of time that they’re absent. For both 90849 and 90853, be sure that your documentation identifies the patient(s) and includes an appropriate covered diagnosis whenever possible. This helps establish medical necessity of the service.
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For accurate Mental/Behavioral Health medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate Mental/Behavioral Health medical billing and coding. To know more about our services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com