What Is CPT Code 90853 for Group Psychotherapy?
Decode CPT 90853. Learn about this essential billing code for group psychotherapy and how it impacts understanding service details, costs, and insurance coverage.
Current Procedural Terminology (CPT) codes provide a standardized language for healthcare professionals to describe medical services and procedures. These five-digit codes are essential for accurate reporting and efficient processing of claims by both public and private insurance programs. CPT code 90853 specifically identifies a type of mental health service: group psychotherapy. This code enables billing and reimbursement for therapeutic interventions delivered in a group setting, allowing providers to account for care provided to multiple patients simultaneously.
Understanding CPT Code 90853
CPT code 90853 is defined as “group psychotherapy (other than of a multiple-family group).” This designation means the code is used for billing group therapy sessions where a trained mental health professional guides a group of unrelated individuals through psychotherapy services. It is distinct from codes used for individual therapy sessions, such as 90832, 90834, or 90837, and also from codes for multiple-family group psychotherapy (90849) where the focus is on family dynamics rather than general group interaction.
This code is utilized by a range of licensed mental health professionals, including licensed clinical social workers (LCSW), licensed professional counselors (LPC), licensed marriage and family therapists (LMFT), clinical psychologists, and psychiatrists. This code allows providers to bill multiple clients for a single group therapy session. Proper documentation, including the date, start and end times, number of participants, and therapeutic interventions used, is required for accurate billing and to support the medical necessity of the service.
Defining Group Psychotherapy Services
Group psychotherapy involves one or more qualified therapists leading a small group of individuals to address shared mental health concerns or therapeutic goals. These sessions typically include between three and twelve participants, though some insurance companies may have specific limits. The usual duration for a group therapy session ranges from 45 to 90 minutes, with 60 to 90 minutes being common.
Group psychotherapy centers on therapeutic goals, not just socialization. Participants engage in discussions, share experiences, and offer mutual support under therapist guidance. This collaborative environment helps individuals build coping skills, enhance communication, and develop emotional resilience. Group therapy can encompass various therapeutic approaches, such as Cognitive Behavioral Group Therapy or Dialectical Behavior Therapy (DBT) skills groups, focusing on specific problems like anxiety, depression, or substance abuse.
Navigating Costs and Coverage
Understanding the financial aspects of group psychotherapy services billed under CPT code 90853 involves considering provider fees, geographic location, and insurance plan details. Costs for group therapy vary significantly, with reimbursement rates for CPT 90853 ranging from $25 to $100 per patient per session, depending on region and insurance provider. Medicare reimbursement for this code, for instance, has been around $27.18 to $32 per patient per session.
Patients should contact their insurance provider to verify coverage for CPT code 90853, as prior authorization may be required. Inquiries should focus on understanding co-pays, deductibles, and whether the service falls under mental health benefits. Ascertain if the provider is “in-network,” meaning they have a contract with the insurance company for pre-negotiated rates, which generally results in lower out-of-pocket costs. An “out-of-network” provider does not have such a contract, potentially leading to higher out-of-pocket expenses, though some plans may offer partial coverage.