CPT 90853Mental Health

Group psychotherapy

CPT code 90853 covers group psychotherapy sessions where a licensed mental health provider conducts therapeutic treatment with multiple patients at the same time, typically 4-10 individuals who meet together to work through emotional or behavioral issues.

Showing rates for

National Average

Base Medicare rate

$28.14

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.65

PE RVU (NF)

0.2

MP RVU

0.02

Total RVU

0.87

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

Loading bundling edits…

Billing tips

Document exact start and stop times for each group session, as some payers require minimum duration of 45-60 minutes for 90853 reimbursement
Impact: Prevents denials for insufficient session length; approximately 15-20% of group therapy claims are challenged on time documentation
Maintain a detailed attendance roster with each participant's name, diagnosis, and signature to prove multiple patients attended the same session
Impact: Critical audit defense; absence of group attendance documentation is the #1 reason for recoupment during post-payment audits
Bill 90853 once per group session regardless of number of participants, not once per patient (unlike individual therapy codes)
Impact: Prevents fraud allegations and overpayment; billing per patient instead of per group could result in 400-800% overpayment penalties
Verify payer-specific group size requirements before billing; most require minimum 2-3 patients and maximum 10-12 patients per group
Impact: Groups outside payer parameters may be denied entirely or downcoded; verify contracts as requirements vary widely
For Medicare, ensure rendering provider has active enrollment and billing privileges for 90853; not all non-physician practitioners can independently bill
Impact: Claims from non-credentialed providers auto-deny; affects $24.26-$28.14 per session plus potential incident-to billing opportunities
When billing family groups with identified patient, consider whether 90847 (family psychotherapy with patient present) is more appropriate and better reimbursed
90847 reimburses at approximately $97-115 versus $24.26-$28.14 for 90853, representing 245-309% higher payment when applicable

Live Field Datano reports yet

Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.

Working with CPT 90853?

Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.

Help build the field knowledge

MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.

Related actions

Frequently asked questions

How much does Medicare pay for CPT code 90853 in 2025?

Medicare pays $28.14 for 90853 in non-facility settings and $24.26 in facility settings based on the 2025 national average. Actual payment may vary by geographic locality due to GPCI adjustments. The total RVU is 0.87 with a work RVU of 0.65.

Do I bill CPT 90853 once per group or once per patient?

Bill 90853 once per group session, not per patient. This is a common billing error that leads to significant overpayments and fraud allegations. Each provider bills one unit of 90853 for conducting the group, regardless of whether 2 or 10 patients attended.

What is the minimum group size required to bill CPT 90853?

CPT does not specify a minimum, but most payers require at least 2-3 patients for true group therapy. Medicare and many commercial payers will deny 90853 if only one patient attended, as this constitutes individual therapy (codes 90832-90838). Always verify specific payer policies as requirements vary.

Can CPT 90853 be billed with an E/M code on the same day?

Generally no, unless the E/M service is for a completely separate problem and meets modifier 25 requirements. Most payers consider group psychotherapy and E/M services on the same day to be part of the same encounter. Some payers allow this combination in specific circumstances with proper documentation and modifiers.

How long does a group therapy session need to be to bill 90853?

CPT does not specify a time requirement for 90853, but most payers require 45-60 minutes minimum. Some Medicare MACs and commercial payers have specific time thresholds in their policies. Document exact start and stop times, as sessions under 45 minutes may be denied or require different coding.

Is CPT 90853 covered for telehealth?

Yes, Medicare and most payers have covered 90853 via telehealth since the COVID-19 public health emergency, and many have made this permanent. Use modifier 95 or GT to indicate telehealth delivery. The 2025 Medicare rate with telehealth is $24.26 (facility rate). Verify individual payer telehealth policies as requirements vary.

What is the difference between CPT 90853 and 90849?

CPT 90849 (multiple-family group psychotherapy) involves therapy with multiple families together, while 90853 is traditional group psychotherapy with multiple individual patients. Code 90849 is used when working with family units collectively, not individuals in a group. The distinction affects reimbursement and medical necessity documentation requirements.