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
CPT Code 90853
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
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
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