Michelle Posted Fri 22nd of May, 2020 16:30:17 PM
Hello I was wondering if billing a 90853 for group therapy what specific restrictions are there? What license level does the provider need to have? Can this be billed by a supervising provider?
SuperCoder Answered Tue 26th of May, 2020 08:22:51 AM
Thanks for your question.
Group psychotherapy is provided to a group of people who are normally not acquainted with each other but might be sharing similar kinds of psychological issues. The psychotherapist selects a group of patients who are not members of the same family, involving no more than 12 participants, and leads the group therapy session for 45 to 60 minutes.
Group therapy, since it involves psychotherapy, must be led by a person who is licensed or otherwise authorized by the state in which he or she practices to perform this service. This will usually mean a psychiatrist, psychologist, clinical social worker, clinical nurse specialist, or other person authorized by the state to perform this service. Registered nurses with special training may also be considered eligible for coverage. For Medicare coverage, group therapy does not include: socialization, music therapy, recreational activities, art classes, excursions, sensory stimulation or eating together, cognitive stimulation, or motion therapy, etc.
Use code 90853 in conjunction with 90785 for the specified patient when group psychotherapy includes interactive complexity)
Do not report 90853 in conjunction with adaptive behavior assessment and treatment codes such as 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, and with 0362T and 0373T.
The supervising physician (or other qualified healthcare professional) is usually a primary care physician directing the behavioral healthcare manager and overseeing the patient’s care. The psychiatric provider makes recommendations on diagnosis and treatment conversed through the behavioral health manager. Beyond this non-face-to-face work, any additional services performed, such as evaluation and management codes or psychiatric diagnostic codes, are separately reported.
Hope this helps.