Have you ever wondered if the Current Procedural Terminology (CPT) codes you are using are correct? The right code knowledge is essential to receiving full payments and circumventing insurance audits. This is important for therapists on insurance panels and those who provide superbills to clients. Billing Group Psychotherapy with CPT Codes properly can be confusing when deciding which code is the one you should use. 

In the delivery of outpatient therapy services, there have been concerns raised regarding the appropriateness of using one-on-one codes instead of group codes. Group psychotherapy provides an excellent treatment for certain individuals and conditions, providing patients with support and accountability from others with similar issues.

While group therapy is good for clients, how to code these sessions isn’t as clear. The good news is, PsychOnline provides an educational presentation on CPT codes.

These are some facts about psychotherapies based on CPT coding for 90849 and 90853.

CPT code 90853

Billing Group Psychotherapy with CPT Codes 90853 represents psychotherapy administered to only twelve patients simultaneously in a group setting by a trained therapist. Typically, the group session lasts 45–60 minutes.

An active therapeutic setting allows individuals and groups to discuss and explore their dynamics, allowing emotional catharsis as well as instruction, support, and insight.

A 90853 code examines individual pathology within a group based on interactions between group members. Additionally, the attributes of the entire group are considered when changing the attitudes and behaviors of the participants.

Therapy groups may vary in size depending on the therapeutic goal.

CPT codes 90849

Billing Group Psychotherapy with CPT Codes 90849 designates multiple family group psychotherapy, allowing families and beneficiaries to meet a clinician with similar issues. This group therapy requires up to eight people and one professional.

Its main objective is to help the beneficiaries and their families deal with their emotional issues, improve personal growth, and learn how to manage their functioning skills.

Typically, Medicare doesn’t cover group therapy sessions to help multiple families.

 CPT codes 90849 and 90849

In a group setting, people with conditions or issues are treated using CPT codes 90849 and 90853. For the codes to apply, the meetings must use psychotherapy, and the problem must be treated in a group setting, in case it is a few families’ reconciliation or patients seeking support.

The fundamental distinction between codes is that: 90849 is a code for multiple-family group psychotherapy. In contrast, 90853 is a code for general group psychotherapy. This affects session participants because the clients attend general group psychotherapy, while multiple family group psychotherapy allows family members.

Documentation Requirement

A unique document should accompany each patient participating in a group psychotherapy session, including a session description. Additionally, ensure to document for 90849 when a family member isn’t able to attend a session, including the reason for their absence and how long they were absent.

Whenever possible, include an appropriate covered diagnosis in your documentation for 90849 and 90853.

Billing to Insurance

In 2019, 19.2% of adults were reported having received mental health treatment, including 15.8% of those taking prescription medications to manage their mental health and 9.5% of those receiving counseling in the past 12 months.

However, insurance coverage for group psychotherapy varies. Medicare does not cover 90849, but Minnesota Health Care Programs (MHCP) and Excellus cover 90853.

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