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Mental health professionals use CPT Code 90853 when billing for group psychotherapy with unrelated patients. As of 2025, billing will also require documented proof of medical necessity and compliance with guidelines set forth by the payer. Knowledge of what is being reimbursed, the regulation of telehealth, and the recognition of red flags minimizes the risk of denials and maximizes the likelihood that billing for group therapy will be correct and sustainable.
Behavioral Health Services continue to expand in 2025 and group psychotherapy remains one of the most utilized treatment types in the field. Mental health conditions such as depression, anxiety, substance use disorders, trauma, and mood disorders are being treated with group psychotherapy. CPT Code 90853 is the main code that is used to document group psychotherapy sessions conducted by qualified mental health professionals. Although the code itself looks simple, correct billing for the code involves numerous elements. The following blog explores what CPT Code 90853 means, its most common rules and what are the most common pitfalls that providers should avoid.
What is CPT Code 90853?
CPT Code 90853 is used in reference to psychotherapy group services conducted by a licensed mental health professional for more than two, and for some payers, more than three, separate, and/or unrelated participants, in one, and for some payers, one clinical session. The service involves some sort of therapeutic interaction with emotional functioning and coping, problematic behavior and psychological wellbeing. Unlike individual psychotherapy, group psychotherapy is more structured in a clinical-driven discussion and therapeutic techniques that might be beneficial to particular individual treatment goals. This code does not include family therapy sessions, educational classes, support groups, or peer-led meetings that do not include active psychotherapy. For CPT 90853 to apply, the clinician needs to be delivering the therapy, not just supervising the group or leading a discussion. Sessions last around 45 to 60 minutes.
Who Can Bill CPT 90853?
Qualified mental health professionals can bill CPT 90853. This includes psychiatrists, psychologists, licensed clinical social workers, licensed professional counselors, and other behavioral health providers who hold the appropriate credentials defined by the payer. The provider must be operating within the limits of their license, and the payer’s credentialing requirements must be satisfied. In some cases, services can be provided by clinicians in training, but billing must occur under the supervising provider’s credentials, if allowed by payer policy. So, when it comes to supervision, credentialing, and incident-to billing, each insurer’s policy must be understood to prevent compliance issues.
Requirements for Utilizing CPT 90853
CPT 90853 can only be used when there are two or more individuals in a structured psychotherapy session. Each participant must have a distinct mental health diagnosis and individual treatment plan that justifies their need for attending a therapy group. The clinical group setting must be warranted. This means that it is directed toward improving the participant’s diagnosis and objectives. The therapist has to run the session, use active therapeutic techniques, and deal with pertinent clinical matters. Simply watching, doing fun stuff, or just talking about clinical things does not qualify as psychotherapy, and these things should not be billed under CPT 90853.
New Documentation Requirements for 2025
The therapist documentation constitutes the basis for the CPT 90853 billing compliance. Each group session note must include the date of service, the time the session started and ended, the length of the session, and the type of therapy. The therapist must indicate what the session focused on. This can include the development of different coping skills, prevention of relapse, managing of emotions, or the processing of trauma.
Participating and responding to treatments thoroughly should be noted individually for each patient. Each note should demonstrate how a patient participated in the session. Explain the clinical issues that were addressed and how it fits the patient’s treatment plan. They should be noted on their individual progress and clinical observations. Using the same wording for several patients is a significant compliance risk and typically causes payer review. Every note must show that the patient requires the services medically. Documentation should be provided that demonstrates the reason the specific patient is using group psychotherapy and how it helps the patient achieve their treatment goals. A claim can be done correctly and without medical necessity it can still be denied. .Rules on Time, Units, and Frequency
One unit of CPT code 90853 can be billed for each patient, each day. This code represents group psychotherapy services, regardless of how many people participated in the psychotherapy group. If patients are in different group sessions on the same day, notes must reflect that the sessions were different and, in that, focus on different therapeutic goals. Even that does not guarantee that payers will reimburse the claim. Usually, there is no limit to the size of a group, but most insurance companies and other professional organizations consider group size to be around six to ten participants. If groups become too large, and there is a lack of attention given to individual participants, that could compromise the quality of the therapy being provided. .
Medicare and CPT Codes 90853
Medicare pays less than individual codes for CPT 90853, but that is not expected to change as the average for 2025 is expected to range from the 20’s to 30’s per participant and will vary based on location and practice. Facility rates will also differ from the non-facility rates. Patients will make you money, but make sure that you are meeting the quality of standards required.
Commercial Insurers Reimbursement
Many commercial insurance companies offer CPT 90853 and less than Medicare. Most of the time, commercial insurance will offer more than 1 Medicare for services provided. Most commercial insurances apply limits to insurance such as no more than five services and a prior auth is required, decreasing the number of services to the individual. If the company documentation is not followed, then the company will not pay for services, even if the company loses money on the insurance.
Telehealth and CPT 90853
As payers continue to cover CPT 90853 provided via approved telehealth platforms, telehealth group psychotherapy continues to be utilized in 2025. While telehealth group psychotherapy continues to be utilized in 2025, payers cover CPT 90853 provided via approved telehealth platforms. Each provider may have different requirements related to modifiers, place of service, and telehealth technologies. Telehealth participants should be documented, and fidelity to the telehealth security and privacy standards should be confirmed. Since not all telehealth group therapy payers cover telehealth group therapy, it is important to verify telehealth group therapy eligibility.
Common Red Flags in CPT 90853 Billing
Insufficient and generic documentation is one of the most serious red flags. Notes that are not individualized and lack a medical justification are likely to be denied or recouped. Payers are likely to watch for the misuse of citation psychotherapy codes. Please note that CPT 90853 is not applicable for support groups, skills classes that do not include therapy, or social activities. Incorrect or missing telehealth modifiers are a common problem. A lack of adequate documentation may result in an increase in the telehealth group therapy provider’s claims being audited. Telehealth group therapy is an activity that takes place via the internet, and the participants may reside in different states or countries. Each state in the United States has its own laws and regulations pertaining to telehealth. It is important for telehealth group therapy providers to be aware of these regulations to avoid legal issues.
Best Practices for Compliant Billing
Before starting practices, one must confirm coverage, prior authorization, and number of sessions for group therapy. Keeping processes clear at the front end reduces denials further along in the process. Documenting individual therapy should be emphasized in training with clinicians, and clarify the expectations most frequently after group therapy. Templates are great, but they should be designed to include custom patient information. To find and report patterns with different payers, billing teams should review denied claims and stay on top of new policy updates. Internal audits can help reinforce compliance and capture issues in the early stages, along with retrospective reviews.
Ethical Considerations
The cost of care, peer support, and experience normalization are all valuable benefits of group therapy, but it is not appropriate for all patients. Providers must consider patient preferences and whether someone is clinically appropriate for group therapy. Financial incentive should not be the driving force in clinical decision making. Ethically speaking, along with compliance, it is concerning to provide group therapy because it is more profitable, when it is not clinically indicated.
Conclusion
TCPT Code 90853 is still important to billing behavioral health services in 2025. Billing is not just about the right code; group psychotherapy must be appropriate, well-documented, and payer rules followed. Knowing the rules of reimbursement, compliance, and red flags, keeps revenue, and quality patient care in focus. Correct use of CPT 90853 helps practices improve the availability of mental health care while being ethical and financially viable.
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For CPT code 90853, a qualified mental health professional engages in group psychotherapy with two or more unrelated patients in a therapeutic setting.
No, CPT 90853 should be used strictly for psychotherapy. This code cannot be used for educational classes, peer support groups, or recreational activities. These are not billable separately.
There is usually only one unit per patient per day that is billable for most payers unless separate, distinct sessions are documented and deemed medically necessary.
When claims for CPT 90853 are denied, the most common reason is a lack of generic documentation that does not show medical necessity and the participation of the patient.