November 27, 2023

CPT Code 90853: Billing & Coding Overview for Group Therapy

Group therapy has become an increasingly popular option in the world of psychotherapy and healthcare, as patients can benefit from participating in sessions with others who are experiencing similar conditions. Using CPT codes for billing is essential to ensure appropriate payment for the critical work in the therapy room. With CPT code 90853, therapists can accurately code and bill for group therapy sessions, helping to ensure the continued accessibility and success of this valuable treatment option.

Harnessing CPT Codes 90853 and 90849 for Success

Before going into the details of using psychotherapy CPT codes, let's review the usage of Codes 90849 and 90853.

90849 CPT Code Description

CPT codes are an important aspect of the healthcare industry, as they provide a standardized way to bill for medical services. One such 90849 CPT code describes psychotherapy services provided to a group of patients, including family therapy sessions or support group meetings.

The code is essential for healthcare providers and patients, as it ensures that insurance companies are accurately billed for services and that patients receive the appropriate coverage for their treatment.

90853 CPT Code Description

Healthcare providers use CPT codes to report medical procedures and services rendered to patients to insurance companies. CPT code 90853 is used to bill for group psychotherapy services. It is essential to understand that this code can only be used when the group therapy session has more than two participants.

Difference Between CPT Codes 90849 and 90853

As medical professionals know, proper service documentation is crucial for efficient communication and accurate billing. It is essential to understand the difference between CPT code 90853 and 90849, both of which involve psychotherapy.

While both represent a CPT code for psychotherapy and get utilized for group therapy sessions, the composition of patient groups differs:

CPT code 90853 pertains to group therapy. The group therapy CPT code consists of three or more patients and is often used for general psychotherapy groups.

On the other hand, CPT code 90849 applies to family or couples’ psychotherapy sessions, where the group patients consist solely of family or couples. The couples therapy CPT code is used in intimate family or close-relationship group settings.

Best Practices for Applying CPT Codes in Group Therapy

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As a therapist conducting group therapy sessions, applying appropriate CPT codes is crucial to ensure proper billing and payment. The first consideration is to confirm with your client's insurance plan that these codes are covered.

Additionally, CPT code 90849 is used for family therapy, and CPT 90853 is a CPT code for group therapy with at least three patients.

By understanding the differences and requirements of each code, therapists can ensure they comply with billing standards and provide the best care for their clients.

Ensuring Patient-Centered Therapy

Ensuring patient-centered therapy in group sessions is crucial for patients and therapists. The focus of patient-centered therapy is to involve and empower the patients in their treatment process.

By emphasizing the importance of patient-centered therapy, therapists can create an environment where patients feel comfortable sharing their thoughts, feelings, and experiences with the group.

This creates a space for open dialogue, active listening, and empathy, all critical components of effective group therapy.

Utilizing the Interactive Complexity Add-on Code

90785 CPT Code Description

The interactive complexity add-on code (90785) is a valuable tool for accurately billing mental health care services. This code is used to identify and quantify additional time and effort required to manage treatment when a patient has difficulty communicating due to factors such as intellectual disability, delirium, or other issues.

By utilizing this code, mental health providers can ensure they are appropriately reimbursed for the extra time and attention required to treat patients with these complex needs. Additionally, using the interactive complexity add-on code helps enhance the transparency and accuracy of mental health billing and coding practices, ultimately benefiting providers and patients.

CPT 90853 and 90849 Coding Modifiers

It is important to limit the number of clients to no more than 10 per group session and ensure that each session is billed using a single CPT code per day.

If you wish to conduct an individual therapy session with a client who has already attended a group session, it is recommended to use the appropriate same-day billing modifier for that insurance company. It is advisable to contact the insurance company in advance to inquire about their specific requirements.

In rare cases where a patient has both individual psychotherapy and group therapy sessions in a single day, it is recommended to add modifier -59 to the CPT code for the second session, as per CMS.gov.

Keep in mind that each client will have their own unique diagnosis, even if the topic of conversation in the group session is focused on a specific issue. It is important to use specific diagnoses when billing for group therapy claims.

Navigating the Billing Process

Navigating the billing process for group therapy can be a complex and frustrating experience, especially when the varying insurance coverage comes into play. Insurance providers often have different coverage policies for group therapy, meaning there is a range of possible patient costs.

This process can be daunting, especially regarding reimbursement for a specific group therapy CPT code like 90849 and 90853. These codes can differ in reimbursement rates depending on the insurance provider, including Medicare and state-specific programs like MHCP.

Maintaining detailed documentation for each participant in group therapy sessions is essential. Keeping thorough records can save time and help you get paid for the services provided. Accurate documentation also ensures you understand what services were rendered and who received them.

Simplifying Billing with PtEverywhere

The ultimate CPT code management software, PtEverywhere!

This efficient program simplifies billing, making it easier to manage superbills and streamline your medical billing process.

With PtEverywhere, you can be confident that your billing and coding will be accurate and efficient, leaving you more time to focus on patient care.

Managing a clinical practice can be overwhelming, especially regarding billing and coding tasks. However, PtEverywhere offers a simplified solution.

By utilizing this EMR+ software, billing and coding errors are reduced, reimbursement processes are streamlined, and financial growth is maximized.

Conclusion

To run a successful practice, providing practical group therapy sessions and ensuring that your practice is financially stable is essential. One key aspect of achieving this is knowing how to use CPT code 90853 and 90849.

By understanding the importance of these codes and utilizing them correctly, clinics can provide effective group therapy sessions while maintaining financial sustainability.

As discussed in the article, mastering CPT codes 90849 and 90853 is just one way that PtEverywhere is helping healthcare professionals grow their practices and provide the best possible care for their patients.