In recent years, there’s been a major demand for mental health services and group psychotherapy in particular has proven itself to be one of the most effective and cost-effective treatments available. While no one disputes the advantages of group therapy to patients, it can be something of a quagmire for mental health clinicians and those who submit the super bill.
That’s when CPT Code 90853 comes into play. It’s easy to save your practice time, avoid billing errors, and increase your earning potential when you understand and use this code correctly.
To simplify your billing process, let’s learn more about CPT Code 90853.
CPT Code 90853: Taking a Closer Look
CPT Code 90853 is used for group psychotherapy sessions that do not involve multiple families. This code also may be used to bill for therapeutic intervention in which a mental health professional serves as a facilitator, leading a group through Guided Discussion, problem-solving techniques or emotional support.
In a nutshell, here is the 90853 CPT code description:
• It is group therapy for improving mental health and for working on particular emotional or psychological problems.
• Sessions consist of 4-10 participants led by a facilitator.
• This code does not include multi-family (conjoint) services or individual psychotherapy.
Differentiating CPT 90853
It’s important to distinguish CPT Code 90853 from other psychotherapy codes. For example:
• CPT Code for Multiple Family Group Psychotherapy is group therapy with many family members, in which case, a separate code is billed.
• If performed face-to-face with the beneficiary, CPT Code 90834 is appropriate for individual therapy.
In other words, the CPT code 90853 description is specifically for sessions not involving the sharing of personal information among unrelated people in group therapy.
Who Can Use CPT Code 90853?
You may be wondering in whose name CPT Code 90853 get billed?
Here’s a list:
• From Mental Health professionals:
- Psychiatrists
- Psychologists
- Certified Therapists and Counsellors
• Clinics & Group Practices:
- Group therapy for behavioural health clinics
- Group psychotherapy sessions
This group of professionals and facilities can be sure that they are billing for group therapy correctly by adding CPT 90853 to their billing.
CPT 90853 Billing and Documentation Guidelines
Accurate billing of CPT Code 90853 requires sticking to specific documentation and payer requirements.
Key Requirements for Billing:
Document Attendance:
Preserve the number of attenders at the patient’s attendance, indicating the one in the session.
Session Details:
o Record the subject or purpose of the session.
o Discuss, at a minimum, the therapist’s role and the therapeutic interventions employed.
o Keep a record of how long the session lasted (start and end times).
Therapeutic Outcome:
Provide an update on patient involvement, status, and care plans.
Payer-Specific Requirements:
Got that point across on 90853 billing – there may be different rules for that at insurance plans. Be sure to check with the payer if any modifiers or additional information is necessary before submitting claims.
And proper documentation is needed not just to stay in compliance, but also to reduce claim denials and increase reimbursements.
Reimbursement of CPT Code 90853
Having a good understanding of the 90853 rate is essential for revenue tracking.
Average Reimbursement:
Your reimbursement rates for CPT code 90853 will depend on the following:
• Geography: Prices can be higher in rural vs. urban areas.
• Insurance: There are differences per payer.
• Length of Session: In some cases, the period a payer believes it takes to deliver a service is part of its calculus for reimbursing that service.
Maximizing Reimbursement:
• Verify the documentation complies with the criteria for each claim submitted to the payer.
• Monitor payor patterns when it comes to reimbursing amounts for group therapy billing CPT codes.
Also, while monitoring your reimbursement trends, by paying attention to reimbursement patterns, you can pinpoint and fix any possible revenue leaks in your billing.
What Not to do When Billing 90853
Errors can cause denials, delays, or even legal problems.
Here are a few common errors to avoid when billing CPT Code 90853:
Incorrect Use of Modifiers:
Failing to append modifiers as dictated by the payer.
Insufficient Documentation:
They left out important details, such as duration of the session, whether the patient received treatment, and what the goal of the therapy was.
Non-Qualified Services Billing:
Not complying with CPT 90853.
It is necessary to train staff extensively and to conduct periodic audits in order to eliminate such errors.
Related CPT Codes
CPT 90853 is the cornerstone for group psychotherapy billing, but there are other codes that one should know:
• CPT Code for Multiple Family Group Psychotherapy (90853 GT)
Applies to families that attend group therapy (i.e., when the family is focusing on some aspect of family dynamics).
• CPT Code Family Psychotherapy with Patient Present:
For family therapy sessions with patient participation.
• Weight Loss CPT Code:
Implications for Behavioural Health SlM I) lUTION Provides guidance for behavioural health professionals providing a weight management program with a mental health component.
• Billing Codes for Occupational Therapy and Reimbursement Rates:
Behavioural health also often intersects with a patient’s holistic care.
Billing Success Story
As an example of the importance of proper CPT 90853 billing, consider the following scenario:
An Illinois mental health clinic experienced a high frequency of billing denials due to incomplete documentation. After adjusting their billing practices and re-aligning their hoping frequency to the definition of CPT 90853, their denials dropped 30%, and their revenue boosted by $10K in just six months.
Correct billing is not simply about the avoidance of loss. It has the potential to impact the financial well-being of your practice positively.
While CPT 90853 focuses on group therapy involving multiple unrelated patients, therapists who provide family-based sessions with the patient present should refer to CPT Code 90847 – Family Psychotherapy Sessions with the Patient.
FAQs About CPT Code 90853 – Group Therapy Billing
Q1. Can you explain the distinction between individual and group psychotherapy codes?
The individual psychotherapy codes (e.g., CPT 90834) are reported for one-to-one therapy, and CPT 90853 is reported when therapy occurs in a group format and the group is made up of unrelated (to one another) individuals.
Q2. What is the frequency limitation for CPT Code 90853 for the same member?
Frequency is based on a treatment plan and payer protocols. Many payers will allow billing weekly, but always check with the insurance company.
Q3. What do I need to document in order to bill for CPT Code 90853?
• Patient attendance
• Subject and interventions of the session
• Duration of the session
• Progress notes
Q4. What are the billing guidelines for group therapy?
When billing for group therapy under CPT code 90853, the session must include multiple clients participating in a structured therapeutic setting facilitated by a licensed clinician (such as an LPC, LMFT, LCSW, psychologist, or psychiatrist).
Documentation should include:
- Session details (date, start and end time)
- Purpose and structure of the group
- Therapeutic interventions used
- Individual progress for each participant
- Medical necessity confirming group therapy is clinically appropriate
Only one 90853 code can be billed per client per day unless multiple, distinct sessions are documented separately. Always check payer-specific rules before submission.
Q5. What are good rules for group therapy?
Effective group therapy depends on maintaining structure, respect, and confidentiality. Common best practices include:
- Confidentiality: Members agree not to share what’s discussed outside the group.
- Respectful communication: Everyone gets equal opportunity to speak and share.
- Consistent attendance: Encourages group cohesion and therapeutic progress.
- Active participation: Clients engage in discussions and therapeutic activities.
- Clear boundaries: Facilitators establish expectations regarding behavior and privacy.
These rules help create a safe and supportive environment that fosters healing and growth.
Q6. How long is a 90853 session?
A typical CPT 90853 group therapy session lasts 45 to 60 minutes. However, this code is not time-based, meaning reimbursement does not increase for sessions longer than an hour. The focus should be on quality and structure rather than duration.
Q7. What is the difference between 90849 and 90853?
The key difference lies in who participates in the therapy session:
- CPT 90849 – Used for multiple-family group therapy, where several family units take part together.
- CPT 90853 – Used for group psychotherapy with individuals who are not part of the same family but share similar therapeutic goals.
Choosing the correct code ensures accurate billing and prevents claim denials.
Q8. What is a common challenge when selecting members for group therapy?
One of the biggest challenges is ensuring compatibility among participants. Group therapy works best when members share common issues or therapeutic goals but differ enough to offer diverse perspectives.
Therapists must consider:
- The diagnostic mix (to prevent triggering or unproductive dynamics)
- Readiness for group participation
- Communication style and emotional stability
Proper screening helps create a balanced, safe, and supportive environment for all participants.
Q9. What is the difference between group billing and individual billing?
- Group billing (CPT code 90853): You bill for each participant attending a single group session. Every client is listed separately, with the same CPT code but individualized notes.
- Individual billing (CPT 90834 or 90837): You bill for one client per session, focusing on one-on-one psychotherapy.
Group billing requires documenting both group-level interventions and individual client progress within the group.
Q10. How much does insurance reimburse for group therapy?
Reimbursement varies by payer, location, and provider credentials, but generally:
- Medicare reimburses approximately $27 to $32 per client per session.
- Private insurers may reimburse at higher rates depending on contracts and region.
Always verify current rates with the insurance provider before billing.
Q11. Can 90853 and 90834 be billed together?
Yes — but only when sessions are distinct and separately documented. If a client receives both group therapy (90853) and individual therapy (90834) on the same day:
- Clearly document two separate sessions (time, notes, and purpose).
- Add modifier -59 to indicate distinct services.
- Check payer rules first, as some insurance companies may not allow same-day billing for both codes.
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