CPT code 90853 is the billing code for group psychotherapy, one of the most cost-effective treatment modalities in mental health care. When billed correctly, group therapy can significantly increase your practice revenue while providing evidence-based care to more patients. The key is understanding the per-patient billing model, documentation requirements, and payer-specific rules that govern this code.
This comprehensive guide covers everything you need to know about CPT 90853: group size requirements, time considerations, per-patient reimbursement, co-facilitator billing, and strategies to avoid the common mistakes that lead to denials and audits.
What Is CPT 90853?
CPT 90853 is the billing code for group psychotherapy sessions where a therapist provides treatment to multiple patients simultaneously. The American Medical Association defines this code as:
"Group psychotherapy (other than of a multiple-family group)."
Note: This code is billed separately for each patient in the group. Family group therapy uses a different code (90849).
The critical distinction with 90853 is that you bill it for each patient who attends the group session. If you run a group with 8 patients, you submit 8 separate claims using 90853, one for each participant. This per-patient model is what makes group therapy financially viable for practices.
Key Facts About 90853
- Billing Model: Per patient, not per group session
- Minimum Group Size: 2 patients (though most payers expect 3 or more)
- Maximum Group Size: No CPT limit, but clinical guidelines suggest 8-12 patients
- Session Type: Group therapy only (not family or couples)
- Time Requirement: No specific time in CPT definition, but typically 45-90 minutes
- Provider Types: Billable by psychologists, clinical social workers, licensed counselors, and other qualified mental health professionals
Group Size Requirements
Understanding group size requirements is essential for proper 90853 billing. While CPT guidelines provide some flexibility, payers often have their own rules about what constitutes a valid group.
Minimum Size Requirements
- CPT Guidelines: 2 or more unrelated patients
- Medicare: Generally requires 2+ patients
- Most Commercial Payers: Expect 3+ patients
- Medicaid: Varies by state (check local rules)
- Best Practice: Plan for 6-10 patients per group
What Happens If Patients Cancel?
- Down to 2 patients: Still billable as 90853
- Down to 1 patient: Cannot bill 90853
- Option for 1 patient: Convert to individual session (90834/90837)
- Documentation: Note original group size and cancellations
- Prevention: Overbook groups by 20-30% to account for no-shows
Important: The "Unrelated Patients" Rule
Group therapy under 90853 must involve unrelated individuals. If you are treating family members together, use 90849 (multiple-family group psychotherapy) or 90847 (family therapy with patient present) instead. Billing 90853 for family members in the same session can result in claim denials and compliance issues.
Optimal Group Size for Clinical and Financial Success
While you can technically bill 90853 with just 2 patients, the economics of group therapy favor larger groups. Here is how group size affects your practice:
| Group Size | Revenue per Session | Clinical Dynamics | Recommendation |
|---|---|---|---|
| 2-3 patients | $64-114 | Limited group dynamics | Consider individual therapy |
| 4-6 patients | $128-228 | Good interaction potential | Viable for specialized groups |
| 7-10 patients | $266-380 | Optimal group dynamics | Recommended sweet spot |
| 11-15 patients | $418-570 | May limit individual attention | Consider co-facilitator |
Time Requirements for Group Therapy
Unlike individual psychotherapy codes (90832, 90834, 90837), CPT 90853 does not specify a time requirement. However, this does not mean time is irrelevant. Payers and auditors expect group sessions to be of sufficient duration to provide meaningful therapeutic benefit.
Documentation Tip: Always Record Session Duration
Even though 90853 is not time-based, document your group session start and end times. This protects you during audits and demonstrates that sufficient therapeutic time was provided. Many payers will deny claims for groups that appear unusually short (under 30 minutes).
Payer-Specific Time Expectations
- Medicare: No specific time requirement, but expects clinically appropriate duration
- Medicaid: Many states require minimum 45 minutes for reimbursement
- Blue Cross Blue Shield: Some plans specify 45-60 minute minimum
- United Healthcare: Generally expects sessions comparable to industry standards
- Intensive Outpatient Programs (IOP): Often require 3-hour group blocks
Understanding the Per-Patient Billing Model
The per-patient billing model is what makes group therapy financially attractive. Unlike individual therapy where one session equals one claim, a single group session generates multiple claims. Here is how it works:
How Per-Patient Billing Works
- ✓ You run one 90-minute group session
- ✓ 8 patients attend the group
- ✓ You submit 8 separate claims for 90853
- ✓ Each claim is processed individually
- ✓ Reimbursement: 8 x $38 = $304 per session
Revenue Comparison: Group vs Individual
- ● Individual (90834): $102 per 45-min session
- ● Group (90853 x 8): $304 per 90-min session
- ● Hourly rate individual: ~$136/hour
- ● Hourly rate group: ~$203/hour
- ✓ Revenue increase: 49% higher per hour
Medicare vs Commercial Reimbursement Rates
Reimbursement for 90853 varies by payer, geographic location, and provider credentials. Because 90853 is billed per patient, even modest rate differences can significantly impact your group therapy revenue.
2024-2025 Medicare Rates
Commercial Insurance Rates
Commercial payers typically reimburse 100-130% of Medicare rates for 90853:
- Blue Cross Blue Shield: $38-52 per patient average
- Aetna: $35-48 per patient average
- United Healthcare: $36-50 per patient average
- Cigna: $34-46 per patient average
Maximizing Group Therapy Revenue
When negotiating payer contracts, do not overlook 90853. A $5 increase in your contracted rate across 10 weekly groups with 8 patients each adds up to $20,800 annually. Group therapy rates are often more negotiable than individual therapy codes because payers recognize the cost-efficiency.
Documentation Requirements (Per Patient)
Group therapy documentation requires a balance: you need individual notes for each patient while also capturing the group dynamics. This is where many practices struggle and where audit risk increases.
90853 Documentation Checklist (Per Patient)
The Individual Note Requirement
A common compliance error is writing one group note and copying it for all patients. This approach fails audits. Each patient needs an individualized note that demonstrates:
- How they specifically participated in the group
- Their individual response to the group content
- Progress toward their personal treatment goals
- Any clinical observations unique to that patient
Sample Documentation Structure
Group Session Note for [Patient Name]
Date: [Date] | Time: 2:00 PM - 3:30 PM (90 minutes)
Group Type: DBT Skills Training Group
Patients Present: 8
Session Topic: Distress tolerance skills, specifically TIPP technique and radical acceptance
Patient Participation: [Patient] actively engaged in discussion of applying TIPP technique to recent work stressor. Shared example of using temperature change during panic symptoms with positive outcome. Asked clarifying questions about radical acceptance and how it differs from approval.
Mental Status: Alert and oriented, appropriate affect, engaged in group process, no safety concerns
Progress: Demonstrating increased skill utilization outside of sessions. Reports 60% reduction in panic frequency since starting group. Treatment goal progress on track.
Plan: Continue weekly DBT group. Assign between-session practice of radical acceptance for minor daily frustrations.
Co-Facilitator Billing for Group Therapy
Many group therapy programs use co-facilitators, especially for larger groups or specialized treatments like DBT. Understanding how to bill when two therapists lead a group is essential for proper reimbursement.
When Both Facilitators Can Bill
- Different patients: Each bills for different group members
- Distinct roles: Clearly defined, non-overlapping responsibilities
- Separate documentation: Each maintains independent notes
- Medical necessity: Two facilitators are clinically required
- Prior authorization: Some payers require approval
When Only One Facilitator Bills
- Trainee present: Unlicensed co-facilitator cannot bill
- Supervision: One therapist supervising another
- Payer restriction: Some plans only pay one provider
- Same patients: Cannot double-bill for same patient
- Observation only: Second therapist not actively treating
Co-Facilitator Best Practice
When using co-facilitators, divide the patient roster before the group begins. Each facilitator should be the "primary" for their assigned patients, document for those patients specifically, and bill only for their assigned group members. This creates clear accountability and prevents duplicate billing issues.
Co-Facilitator Billing Example
Scenario: Dr. Smith and Ms. Johnson co-facilitate a 12-person DBT group
Arrangement: Dr. Smith is primary for 6 patients; Ms. Johnson is primary for 6 patients
Billing: Dr. Smith submits 6 claims for 90853; Ms. Johnson submits 6 claims for 90853
Documentation: Each writes individual notes for their assigned patients only
Result: 12 total claims submitted, no duplication, clear audit trail
Interactive Complexity (90785) with Group Therapy
CPT 90785 is an add-on code for interactive complexity that can sometimes be used with group therapy. However, its application to 90853 is limited and requires specific circumstances.
When 90785 May Apply to Group Therapy
- Communication barriers: Patient requires interpreter services during group
- Third-party involvement: Case manager, guardian, or other party participates
- Emotional complexity: Maladaptive communication significantly complicates treatment
- Threat to self or others: Requires additional intervention during group
Caution: Limited Applicability
Most payers do not reimburse 90785 when billed with 90853. The add-on is primarily designed for individual therapy scenarios. Before billing 90785 with group therapy, verify payer policy. Medicare generally does not pay this combination, and many commercial payers follow suit.
Payer-Specific Rules for Group Therapy
Each payer has unique policies for group therapy coverage that can affect your billing success. Knowing these rules prevents denials and ensures proper reimbursement.
| Payer | Min Group Size | Time Requirements | Special Rules |
|---|---|---|---|
| Medicare | 2 patients | No minimum specified | Individual documentation required |
| Medicaid | Varies by state | Often 45+ minutes | Check state-specific manuals |
| BCBS | 3-4 patients typical | 45-60 minutes expected | May limit frequency per week |
| United Healthcare | 3 patients typical | No specific requirement | Prior auth for some plans |
| Aetna | 2-3 patients | 45+ minutes preferred | Document group size in notes |
| Cigna | 3 patients typical | No specific requirement | May audit high-volume providers |
Common Denial Reasons and Prevention
Group therapy claims have a higher denial rate than individual therapy, often due to documentation issues or payer-specific rule violations. Here are the most common reasons for 90853 denials:
Identical Documentation Across Patients
Prevention: Write individualized notes for each patient. Use templates that prompt for patient-specific content. Never copy-paste the same note for all group members.
Group Size Not Documented
Prevention: Always record the number of patients present in each note. Some payers require this for claim processing, and auditors look for it.
Below Minimum Group Size
Prevention: If your group drops to 1 patient, do not bill 90853. Convert to individual therapy code or reschedule. Document the situation clearly.
Missing or Invalid Diagnosis Codes
Prevention: Ensure each patient has a valid ICD-10 code that supports group therapy. The diagnosis must be on file and linked to the claim.
Frequency Limits Exceeded
Prevention: Know payer limits on group therapy frequency. Some plans allow only 1-2 group sessions per week. Obtain prior authorization when needed.
Billing for Family Members in Same Group
Prevention: Use 90849 for multi-family groups or 90847 for family therapy. Code 90853 is for unrelated individuals only.
Real-World Billing Scenarios
Let us walk through common group therapy situations and how to handle billing correctly:
Scenario A: Standard DBT Skills Group
Situation: A therapist runs a weekly 90-minute DBT skills group with 10 enrolled patients. This week, 8 patients attend.
Correct Billing: Submit 8 separate claims for 90853, one for each patient who attended.
Documentation: Write 8 individual notes documenting each patient's participation and skill acquisition.
Revenue: 8 x $38 = $304 (Medicare rate example)
Scenario B: Group Falls Below Minimum Size
Situation: A process group scheduled with 6 patients has 5 cancellations, leaving only 1 patient.
Correct Approach: Do not bill 90853. Instead, offer the patient an individual session and bill 90834 or 90837 based on time.
Documentation: Note that the group was cancelled due to insufficient attendance, and an individual session was provided instead.
Prevention: Overbook groups and confirm attendance 24 hours in advance.
Scenario C: Co-Facilitated Intensive Group
Situation: Two licensed therapists co-facilitate a 3-hour trauma processing group with 12 patients in an IOP setting.
Correct Billing: Divide patients between facilitators (6 each). Each therapist bills 90853 for their 6 assigned patients.
Documentation: Each therapist documents only for their assigned patients, noting their co-facilitator role.
Revenue: 12 x $38 = $456 total (split between two providers)
Scenario D: Telehealth Group Therapy
Situation: A therapist conducts a 60-minute anxiety management group via video platform with 7 patients.
Correct Billing: Submit 7 claims for 90853 with modifier -95 (or -GT per payer preference)
Place of Service: Use POS 02 (Telehealth) or POS 10 (Telehealth in Patient Home)
Documentation: Note that session was conducted via HIPAA-compliant video platform.
Frequently Asked Questions
Can I bill 90853 and 90834 for the same patient on the same day? ▼
Generally yes, if clinically appropriate and the sessions are distinct. For example, a patient might attend a morning process group (90853) and have an individual therapy session (90834) in the afternoon. Document each session separately and ensure medical necessity for both. Some payers may require modifier -59 on the second service to indicate a distinct session.
Is there a maximum number of patients for billing 90853? ▼
CPT does not specify a maximum group size for 90853. However, clinical guidelines typically recommend 8-12 patients for optimal therapeutic dynamics. Larger groups may face payer scrutiny regarding whether meaningful individual treatment occurred. If your groups regularly exceed 15 patients, consider adding a co-facilitator and documenting the clinical rationale for the larger size.
Can a patient attend multiple groups per week? ▼
Yes, patients can attend multiple group sessions per week when clinically indicated. This is common in intensive outpatient programs (IOP) and partial hospitalization programs (PHP). Bill 90853 for each group attended. However, verify payer-specific frequency limits, as some commercial plans cap weekly group therapy at 2-3 sessions unless prior authorization is obtained.
Do I need separate treatment plans for group therapy patients? ▼
Each patient in group therapy should have an individualized treatment plan that includes group therapy as a treatment modality. The plan should specify what goals group therapy addresses and how it complements other services. You do not need a separate "group-specific" treatment plan, but group participation should be documented within each patient's overall plan.
What if a patient leaves the group session early? ▼
If a patient attends a meaningful portion of the group (generally 50% or more), you can still bill 90853. Document the early departure and reason. If a patient attends only briefly (less than 15-20 minutes of a 60-minute group), consider whether billing is appropriate. When in doubt, document thoroughly and use clinical judgment about whether therapeutic benefit was provided.
Can I bill 90853 for psychoeducational groups? ▼
Yes, if the group includes therapeutic elements beyond pure education. A group that teaches coping skills, includes processing time, and addresses individual patient needs qualifies as group psychotherapy. However, a purely educational class (like a lecture on depression without therapeutic interaction) may not meet the definition. The key is that therapeutic interventions and group processing must be part of the session.
How do I handle patients with different insurance in the same group? ▼
Each patient is billed to their respective insurance. Having patients with Medicare, Medicaid, and various commercial plans in the same group is perfectly acceptable. Submit claims to each payer individually. Be aware that reimbursement rates will vary, and some payers may have specific documentation requirements. Your billing system should track each patient's coverage and submit claims accordingly.
Key Takeaways
Master CPT 90853 Group Therapy Billing
Group therapy under CPT 90853 represents one of the most efficient and clinically effective treatment modalities in mental health care. By understanding the per-patient billing model, maintaining proper documentation, and navigating payer-specific requirements, you can build a thriving group therapy program that serves more patients while improving your practice's financial health.
The key to success is treating each group member as an individual within the group context. Your documentation should reflect each patient's unique participation, progress, and treatment needs. When you approach group therapy billing with this mindset, you will naturally avoid the common pitfalls that lead to denials and audits.
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TheraFocus Team
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The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.