How to Bill for Group Therapy with CPT Code 90853?
Introduction
Group therapy is a powerful tool for mental health treatment, offering support, shared experiences, and cost-effectiveness for patients. As a mental health provider, accurately billing for group therapy sessions ensures you receive proper reimbursement and can continue offering this valuable service. This article explains the specifics of billing for group therapy using CPT code 90853.
Understanding CPT Code 90853
CPT code 90853 stands for “Psychotherapy, group, multiple patient; per hour.” This code is used to bill for general group psychotherapy sessions, where a therapist facilitates a group discussion focused on mental health concerns.
Key Points for Billing with CPT Code 90853
Here are crucial aspects to remember when billing for group therapy with CPT code 90853:
- Group Size: The recommended group size for billing with CPT code 90853 is typically between 2 and 10 participants (check with your payer for specific guidelines).
- Session Duration: Billing with CPT code 90853 is based on time units, often 15 minutes. A typical group therapy session might last 50 minutes (4 units).
- Documentation: Maintain clear and detailed documentation for each group session. This should include the date, time, duration, participants’ names, diagnosis codes, and a summary of the group discussion.
- Verification of Benefits: Always verify your patients’ insurance benefits before providing services. This ensures they have coverage for group therapy and CPT code 90853 specifically.
- Pre-Authorization: Certain insurance plans might require pre-authorization for group therapy services. Confirm this requirement with the insurance company before starting treatment.
Modifiers for CPT Code 90853
In some situations, you might need to use additional modifiers with CPT code 90853 to accurately reflect the service provided. Here are a few common examples:
- 90791: Used for the initial group psychotherapy session where an assessment and treatment plan are established.
- 59: Used to indicate prolonged services if the group session exceeds the typical timeframe.
- 25: Used for limited psychotherapy services if the session is shorter than the typical timeframe.
Important Considerations
- One CPT Code per Day: You can only bill one CPT code 90853 per day, even if you see the same patient for individual therapy on the same day. Different modifiers might be required for individual services on the same day.
- Diagnosis Codes: Always include appropriate diagnosis codes (ICD-10) for each group member on the claim form. These codes reflect the mental health conditions being addressed in the group therapy session.
- Out-of-Network Billing: If you are out-of-network with a patient’s insurance, you might need to collect payment directly from them and submit the claim yourself.
Benefits of Using a Mental Health Billing Service
Billing for mental health services, including group therapy with CPT code 90853, can be complex and time-consuming. Partnering with a reputable mental health billing service offers several advantages:
- Expertise: Billing services have a deep understanding of insurance regulations and coding requirements, ensuring accurate and optimized claims submission.
- Efficiency: They streamline the billing process, freeing up your valuable time to focus on patient care.
- Faster Reimbursement: Billing services can expedite the claims process, leading to faster reimbursement for your services.
- Reduced Errors: They minimize the risk of errors that can lead to claim denials and delays in payment.
To conclude,
Understanding how to bill for group therapy with CPT code 90853 is essential for mental health providers. This article provides a foundation for accurate billing, but it’s always recommended to consult with your insurance provider or a billing specialist for specific requirements.
PrimeCare MBS, a leading mental health billing service, can assist you with navigating the complexities of billing for group therapy and other mental health services. Contact us today to learn more about our services and how we can help your practice thrive.
CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved. The use of CPT code 90853 is subject to AMA guidelines and regulations.
