If you’re a therapist, you know that group therapy can be a powerful way to help clients heal, grow, and connect. But when it comes to billing and getting paid for those sessions, things can get tricky. That’s where CPT codes come in.
Today, we’re focusing on CPT code 90853, the code used for group therapy sessions. This guide will cover everything you need to know, from who can use it to what types of therapy it covers. You’ll also find billing and documentation tips, reimbursement rates, and answers to some of the most common questions about this code.
CPT code 90853 is the billing code used for group psychotherapy sessions. These are therapeutic sessions where a licensed clinician works with multiple clients in a group setting to address shared mental health concerns, symptoms, or diagnoses. Unlike individual therapy, the focus in group therapy is on group dynamics and shared experiences.
This code is specific to group therapy and doesn’t include family therapy sessions, which fall under different codes like 90846 or 90847. Sessions billed under 90853 typically last between 45 and 60 minutes.
Not every health provider is eligible to bill for CPT code 90853. To use this code, you must be a licensed professional authorized to provide group therapy. This includes:
Before billing, check with your state licensing board and the insurance providers you work with, as regulations and requirements can vary.
Group therapy can take many forms, and CPT 90853 covers a wide range of therapeutic approaches. Some examples include:
It’s worth noting that multiple-family therapy sessions are not billed under 90853. For those, you’ll need to use CPT code 90849. For example, a group therapy session for multiple sets of couples who’ve been affected by child loss would be considered a multiple-family therapy session.
Additionally, there are some support groups that have no licensed facilitator – for example, 12-step groups for substance use are often peer-led. Remember that only qualified health providers can bill CPT code 90853. You can’t bill this code for a peer-led group.
Billing for group therapy requires careful documentation to meet insurance requirements. Here’s what to include when billing for CPT code 90853:
Every insurance provider has its own requirements, so it’s a good idea to check with them ahead of time to avoid denied claims.
The reimbursement rate for CPT code 90853 depends on several factors, including your license type, location, and the insurance provider. Medicare reimburses this code at around $27 to $32 per client. You should bill 90853 for each client who participates in group, with a maximum of 10 clients per group.
Since reimbursement rates vary, it’s always a good idea to contact the insurance companies you work with for up-to-date information.
Even though group therapy billing isn’t as complex as some other services, there are still a few common pitfalls. Here’s how to avoid them:
| Mistake | What to Do Instead |
|---|---|
| Using 90853 for multiple-family therapy | Use CPT code 90849 for multiple-family group therapy sessions. |
| Forgetting to document individual progress | Include detailed notes not just about how the group did as a whole, but about each client’s engagement and progress in the session. |
| Billing 90853 with individual therapy codes | If a client attends both group and individual therapy on the same day, make sure each session is documented as separate and distinct. |
| Only billing for one participant | You should bill 90853 for each participant in the group therapy session, with a maximum of 10 clients per session. |
Yes, but only if the sessions are truly distinct. If a client has both group therapy (90853) and individual therapy (90834) on the same day, the documentation needs to show that the services were separate and necessary. If you’re billing both in one day, you may also need to use the modifier -59 for the second session. Some insurance plans may not allow this combination, so check with the payer first.
Make sure the session is conducted with multiple clients and focuses on therapeutic interventions for the group. Document the session’s purpose, structure, and individual progress for each participant. Most importantly, ensure that group therapy is medically necessary for each client.
Group therapy sessions billed under 90853 typically last between 45 and 60 minutes. However, the exact duration may depend on the needs of the group and the clinical goals. Unfortunately, 90853 isn’t a time-based code, so you may not get paid for extended time even if your group therapy session runs over an hour.
The main difference is the type of group:
To bill for group therapy, use CPT code 90853. Make sure you document the session thoroughly, including the start and end times, the group’s focus, the methods used, and each client’s progress. Verify the billing requirements with the insurance provider to ensure everything is in order.
Understanding how to bill for group therapy using CPT code 90853 is an important part of running a mental health practice. While the process can feel overwhelming, having clear documentation and knowing what’s covered under the code can make it much simpler.
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