Medical Billing Forum

Billing => Facility Billing => Topic started by: rb2007 on April 20, 2016, 12:27:04 PM

Title: Group Size
Post by: rb2007 on April 20, 2016, 12:27:04 PM
Regarding Mental Health and Substance Abuse, is there a specific number of members that must be attending a group, in order to bill services under group codes?  90853 standard group?
 H0015/0906 Intensive Outpatient Program?
Title: Re: Group Size
Post by: Michele on April 22, 2016, 01:54:09 PM
I don't see a specific number.  According to the American Psychological Association group sessions are between five and 15 patients.
Title: Re: Group Size
Post by: tinaraynor on April 22, 2016, 02:35:48 PM
When I initially read your question, I immediately answered to myself  "more than 2, less than 15, per Medicare". But when I tried to find that in writing I was not able to. But I used that standard when I billed MH services for years.

What I did currently find is several insurance carriers define group size differently, some saying more than 2, less than 10, less than 12, less than 15, etc. It's a good question... and may be best answered by payer of the billed group service.
Title: Re: Group Size
Post by: Ypmb16 on July 31, 2016, 09:53:46 AM
Each insurer has different rules. But it's irrelevant for billing.
Title: Re: Group Size
Post by: PMRNC on August 02, 2016, 09:18:52 AM
Quote
Each insurer has different rules. But it's irrelevant for billing.

I was going to say same thing.. makes no difference really unless they all have the same insurance plan and that would be freaky !!