How is Group Therapy Billed? Everything You Need to Know

Do you offer group therapy sessions that deal with distinct mental health concerns, skills, and solutions for issues like anxiety, depression, grief, substance abuse, etc? Are you confused about how to bill for it? Not to worry, you can still feel good about offering a place for your clients to meet with like-minded people seeking treatment and support. Below, you’ll simply find the information and support you need to bill appropriately and routinely.

Let’s Start with a Point of Clarification:  Psychoeducation vs. Psychotherapy

To bill correctly, you need to know the difference between psychoeducation and psychotherapy. Why? There is a significant difference between group psychotherapy and group psychoeducational services in the billing world. Legally, you can only bill for psychotherapy sessions. Otherwise, you can charge a self-pay rate for the group and dispense with using insurance at all.

To get a clear idea of what your practice is offering with regards to group work, let’s look at the differences:

Group psychotherapy treats mental health problems via an assessment of some type. That assessment defines both the problem and the treatment goals you specified to help the group progress. The goals are specifically related to the mental health issue that has been identified. Group psychotherapy providers may include a licensed mental health therapist, such as a psychologist, social worker, counselor, etc.

Group psychoeducation is education provided to a person with mental health challenges and the loved ones available to help manage their condition best. The mental health assessment, in this case, does not need to be performed by the psychoeducation provider. Group psychoeducation may educate members regarding a variety of topics, including mental health, communication skills. Psychoeducation is helpful guidance, not particular treatment, The group leader may be a wide variety of experts not just a licensed mental health professional.

Be Sure To Use the Correct CPT Codes

Defining 90849 and 90853

Your practice’s group offerings will use one of two billing codes: 90849  or 90853. They are the codes used when treating clients with similar issues together, in a group format. To qualify for use of those codes,  the session must employ psychotherapy within the group.

So, you might wonder, “which code is used at what time?” Good question. The two group therapy codes are distinguished by patient type.

  •  90849 for multiple-family group psychotherapy. These sessions have only family members in attendance.
  • 90853 for general group psychotherapy. These will have individual clients in attendance together.
 

photo of women at computer learning about group therapy billingWhat Does the Group Therapy Billing Process Include?

Reimbursement for group psychotherapy is insurance-dependent, varying by the plan and your region, so be sure to check with payers to determine if they cover code 90853. Because many insurers don’t cover group psychotherapy, it’s a good idea to make your clients aware as early as possible. You may want to establish a policy alerting clients that they are responsible for all uncovered charges on their consent forms to ensure you receive payment.

Also, be aware that the members in your group psychotherapy sessions need individual documentation. Describing each session and the way it contributed to treatment goals is important.

Medicare policies require that sessions do not exceed 10 participants and do not allow for the following services under CPT Code 90853:

  • Group meals
  • Social interaction
  • Grooming instruction
  • Travel time and outings
  • Observation of daily activities
  • Dissemination of self-help materials
  • Preparation of reports and other information
  • Dance, art, play, or other recreational therapies

One unit per day may be billed for CPT code 90853.

**Special Note: If you are teaching these above-listed services. This is considered a psychoeducation group and you can charge a self-pay rate for the group. Have your clients sign an insurance opt-out form just to be safe. Email me if you would like a copy of my opt-out template.

More 90849 or 90853 Coding guidelines to keep in mind

  •  Coded 90853 is not time-based like some other CPT codes.
  • documentation must identify each client and include the covered diagnosis. This determines medical service.
  • take care to document excluded family members, reasons for missing appointments, and the length of absence when using 90849.
  • group family counseling does not include staff supervision or therapy.
  • You may use the interactive complexity add-on code (90785) with code 90853.
  • check for insurer-specific guidelines.

Now, Let’s Take the Next Step

You know the value of group therapy. Hopefully, you also recognize now that you can offer it and get the fair compensation you deserve. If you find you still need a bit of support, don’t worry. I’m here to help and to connect you with other therapists who are improving their billing knowledge too. Please reach out now. Get started now to get the guidance you need.

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