90853 – Psychotherapy Service
CPT code 90853 represents a distinct mental or behavioral health service, including evaluation, therapy, or care coordination.
What is CPT
90853
?
90853 is a CPT code utilized for group psychotherapy sessions, characterized by the engagement of multiple individuals in a collaborative therapeutic environment. This entry delves into the clinical rationale behind this code, the documentation requirements that providers must adhere to, and the considerations necessary for successful billing from various payers. It is crucial for providers to ensure that clinical notes reflect evidence-based practices, document specific treatment objectives, detail the interventions employed, and track the measurable progress of each participant in the session. In instances where the service is billed based on time, providers should meticulously log the start and stop times to substantiate the billed duration.
Documentation Tips
Effective documentation is essential for the successful billing of group psychotherapy services. Providers should document the start and stop times for each session to support time-based billing. It is also important to record the type of therapeutic modality utilized, such as Cognitive Behavioral Therapy (CBT) or Dialectical Behavior Therapy (DBT), as well as the clinical focus of the session. Detailed notes should capture patient responses, outlining their engagement and progress toward treatment goals. For sessions utilizing assessment instruments, ensure that copies of completed tools are retained in the patient’s record. In the case of telehealth sessions, it is imperative to document patient consent for treatment and specify the platform used for the session. Employing a consistent structure, such as SOAP (Subjective, Objective, Assessment, Plan) or DAP (Data, Assessment, Plan), will enhance audit readiness and ensure compliance with payer requirements.
At a Glance
- Service Type: Group Psychotherapy
- Use Case: Therapeutic Sessions Involving Multiple Patients
- Typical Setting: Outpatient clinic or telehealth (subject to payer guidelines)
- Billing Unit: Per session (frequency may vary by payer)
- Common Pairings: 90791, 96127, and other relevant psychotherapy codes
Billing Examples
For example, a clinician may facilitate a group therapy session focused on coping mechanisms for anxiety, utilizing CBT techniques. During the session, progress notes would detail specific interventions applied, such as guided discussions on anxiety triggers, and document the group members' feedback and progress towards their individual treatment goals. If a session runs longer than the typical duration, the clinician should ensure to bill using the appropriate time-based psychotherapy code that accurately reflects the actual face-to-face interaction time with the group.
Compliance Guidelines
- Confirm payer coverage and authorization requirements before billing to prevent claim denials.
- Document medical necessity clearly, ensuring that services provided are directly linked to ICD-10 diagnoses.
- Utilize appropriate modifiers, such as 95 for telehealth services, in accordance with payer guidelines.
- Avoid upcoding; always select the code that accurately corresponds to the documented time and service level provided.
- Conduct regular audits of billing practices and documentation to minimize claim denials and improve the quality of clinical records.
Common ICD-10 Codes
Helpful links for mental health billing and documentation
- F32.0
- F41.1
- F33.1
- F43.10
- F41.9
- F34.1
Additional Resources
Helpful links for mental health billing and documentation
Related CPT Codes
Helpful links for mental health billing and documentation
Got questions? We’ve got answers.
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Q1: What is the primary purpose of CPT code 90853?
A: CPT code 90853 is specifically designated for billing group psychotherapy sessions, where multiple patients participate in therapeutic activities simultaneously. Accurate documentation must substantiate the billed service.
Q2: Is it permissible to bill this code for telehealth sessions?
A: Yes, many payers allow billing for telehealth services as long as the session is synchronous, and proper consent is documented along with any necessary modifiers. Always verify the specifics of payer policy.
Q3: What type of documentation might payers require for this code?
A: Payers typically request documentation that includes session timing, therapeutic modalities or instruments utilized, patient responses, and a clear linkage to a covered ICD-10 diagnosis.
Q4: Can CPT code 90853 be billed alongside other services?
A: Yes, when billing multiple services, it is essential to document the distinct time and rationale for each service. Adhere to add-on codes or evaluation and management (E/M) separation rules where applicable.
Q5: What are common reasons for claim denials associated with this code?
A: Common denial reasons include incomplete documentation of session times, insufficient evidence of medical necessity, incorrect use of modifiers, or exceeding frequency limits set by payers.
