How to use CPT code 90836
Code 90836 represents an add-on for 38-52 minutes of psychotherapy with an E/M code.
Here’s how to properly document and bill group therapy sessions.
Even if individual therapy may be the crux of your practice, you may facilitate therapy in group settings from time to time. Just as you’ll need particular skills to lead a group of clients, it’s also important to learn about how to properly document and bill these sessions. Understanding the CPT codes commonly involved with group psychotherapy is the first step.
Below, learn more about billing group psychotherapy with CPT code 90853.
Group therapy codes are used when you’re providing psychotherapy to a group of individuals who don’t have a previous relationship. These individuals typically share experiences, symptoms, or diagnoses. For example, you could use a group therapy code when you’re facilitating a small group of clients who have depression, but not for a couples or family therapy session.
CPT code 90853 is used for group psychotherapy, which is when a therapist facilitates therapy with several clients who share an experience, symptom, or diagnosis. Group psychotherapy typically includes at least three clients and one psychotherapist.
Additionally, CPT code 90849 is used for multiple family group psychotherapy, which is a blend of group therapy and family therapy. However, it’s uncommon and is typically only used in higher levels of care.
Along with being complete and legible, group therapy documentation should include:
Further, each client should have their own treatment plan, with unique goals. Unlike with couples therapy, which is typically billed as one unit, each participant in group therapy needs their own individual record and documentation outlining how they participated in the group.
Headway group therapy sessions are usually conducted for a minimum of 45 minutes. Your therapy may vary according to factors such as your insurance contract, the therapy modality you’re using, and how often you meet as a group. You may need to use an add-on code if your group session is longer than 45 minutes.
When coordinating sessions, keep in mind some groups opt to meet on an open-ended basis, while others meet for a particular number of weeks before terminating. Insurance companies may limit the number of sessions covered, so this is something to take into account when setting clients up in a group.
Reimbursement rates vary widely depending on your contract with the payer. Typically, these group therapy codes are flat rates, so you need to meet the minimum time element to bill the agreed-upon, contracted amount.
This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.
Code 90836 represents an add-on for 38-52 minutes of psychotherapy with an E/M code.
Code 90838 represents an add-on for at least 53 minutes of psychotherapy with an E/M code.
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