Medical Billing Forum

Coding => Coding => Topic started by: TammyL on January 08, 2013, 08:32:46 PM

Title: Group Therapy
Post by: TammyL on January 08, 2013, 08:32:46 PM
I have a client who  is a  psychlogists has started substance abuse group therapy what codes do I use to bill the insurance companys and how do I bill would it be on a HCFA 1500
Title: Re: Group Theraphy
Post by: James B on January 09, 2013, 07:54:08 AM
The Dr. who I work for bills SA groups as 90853, although this probably just changed with the new mental health billing system (I haven't billed any 2013 appointments, yet). What you need is whatever code replaced that one. Actually, I just looked it up and it appears that code has been retained.

This is for a psychiatrist, I imagine it may be different for other types of therapists.

Hope that helps.

-James
Title: Re: Group Therapy
Post by: rdmoore2003 on January 10, 2013, 08:53:44 AM
group therapy codes did stay the same.  90853 would be billed.   if it is a professional charge, you would use cms 1500 form, if facility use UB94
Title: Re: Group Therapy
Post by: TammyL on January 10, 2013, 05:50:42 PM
Okay do I bill each patient seperate with the CPT code 90853 to there insurance companies even though it was a group. Never billed group therapy so this is all new to me. Thanks
Title: Re: Group Therapy
Post by: supertaz93 on January 10, 2013, 07:31:51 PM
Okay do I bill each patient seperate with the CPT code 90853 to there insurance companies even though it was a group. Never billed group therapy so this is all new to me. Thanks

Yes, the reimbursement rate for this code is much lower than other psych codes for this reason.
Title: Re: Group Therapy
Post by: Nettie on February 04, 2013, 02:46:43 PM
My problem is how to bill for example: 90834 w/ (2) 90853. Before I billed as 90806 mod 59, 90853 mod 76 and the final 90853 w/ no mod. Doesn't work with 90834's...
Someone said no mod on 90834 but now add 59mod to 1st group then 76 to 2nd.
Does this sound right? HELP!
Title: Re: Group Therapy
Post by: rdmoore2003 on February 06, 2013, 09:28:08 AM
I dont use modifiers, since our specialty with insurances will not cover different services in same day.
Title: Re: Group Therapy
Post by: jessika1803 on March 05, 2013, 12:44:07 PM
ok so I'm having an issue with billing a 90853 for 3 units (30 minutes per unit) to blue cross. what is did before was bill the 90853 with a quantity of 3. Now they're saying I'm not billing it right to get paid for the 3 units. Can anyone help me? This is for Mental Health billed on a HCFA 1500. Thanks
Title: Re: Group Therapy
Post by: PMRNC on March 05, 2013, 12:52:56 PM
90853 is NOT a timed /unit cpt code. You can only bill one 90853 per date of service. 
Title: Re: Group Therapy
Post by: jessika1803 on March 05, 2013, 02:37:06 PM
do you have any suggestions for a group therapy session that is 90 minutes long?
Title: Re: Group Therapy
Post by: PMRNC on March 05, 2013, 02:53:55 PM
There really is no option.. 90853 is not going to get paid by units and only reimbursed by CPT which most carriers base on 60 min.  I have my providers shorten their sessions. You can try adding a modifier but I don't think it will fly. You could also try to obtain authorization for a 90 min session PER patient. I've done that but again, they won't reimburse over the maximum for the CPT code 90853
Title: Re: Group Therapy
Post by: rdmoore2003 on March 06, 2013, 09:53:11 AM
There really is no option.. 90853 is not going to get paid by units and only reimbursed by CPT which most carriers base on 60 min.  I have my providers shorten their sessions. You can try adding a modifier but I don't think it will fly. You could also try to obtain authorization for a 90 min session PER patient. I've done that but again, they won't reimburse over the maximum for the CPT code 90853

Exactly what Linda said.