Quick Tips: Group Therapy Billing

I often get a lot of questions around group therapy and how to bill/what counts and doesn’t count as group psychotherapy. I’ll be honest, I don’t run groups in my private practice and haven’t personally billed for it. I did some research on what CMS/Medicare says about the good ol’ 90853 CPT code. 

Group therapy sessions are often oriented around a specific mental health problem, skills, and solutions for that problem, such as anxiety, depression, obesity, panic disorder, loss of a family member, substance abuse, or chronic pain.

What can not be billed as group therapy?

Medicare does not include the following services as part of coding CPT Code 90853:

• Teaching grooming skills
• Monitoring daily living activities
• Recreational therapy (dance, art, play)
• Eating together
• Excursions
• Social interaction
• Travel time
• Self-help materials
• Report preparation

How long is a typical group therapy session?

Technically 90853 is not time based but oftentimes providers meet with groups for 45 to 60 minutes.  (Source) (Source)

Is there a maximum number of clients or minimum required for a group?

According to Medicare guidelines, sessions are not to exceed 10 patients or participants max. Often, sessions are 6 to 10 clients.  (Source)

Because 90853 is not time based, a maximum of one unit per day may be billed for CPT code 90853. 

As always, check with each insurance payer to make sure they cover 90853 before you bill it. Reimbursement rates would vary based on payer and region.