CPT code 90853 is used to bill group therapy. When you provide a psychotherapy service to a group of people who otherwise are not related to each other and were not previously acquainted, that is group therapy, and 90853 is the code for it. This guide covers the full code description, current reimbursement, modifiers, documentation requirements, and the practical billing mechanics: units, multiple insurers, prior authorization, government programs, private pay versus insurance, co-facilitators, and the mistakes that trigger denials.
CPT codes are numbers used to reimburse specific mental health services. They are essential for billing, for ensuring the accuracy of services reported, and for receiving reimbursement from third-party payors. Billing the correct CPT code is necessary for a mental health clinician, and CPT codes help ensure accurate documentation of the services you provide. Psychotherapists must know a variety of CPT codes to bill specific services, because psychotherapy services encompass many different therapeutic settings. The CPT code 90853 is used to denote group therapy, which differs from individual therapy, couples therapy, family therapy, or an intake assessment.
If you run groups, the billing and the documentation are the parts that eat your evenings. Mentalyc handles both: its AI Note Taker recommends the correct CPT codes based on session content and duration, which reduces billing errors without a manual lookup, and it generates group therapy notes for the session as a whole plus a separate individual progress note for every participant, automatically, with no manual splitting or copy-paste between records. You can try the AI Note Taker for free and keep reading for the full billing breakdown.
What is the 90853 code?
The 90853 CPT code signifies group therapy: a therapist and at least two participants working on a theme in a therapeutic setting. According to the Centers for Medicare & Medicaid Services, it is recommended for billing purposes to have no more than 10 participants in a group if you are billing Medicaid or Medicare [1].
Spend less time writing, more time with clients.
The CPT code 90853 can be billed no more than once per day. The therapist must be trained to lead a group, because psychotherapy services are being performed. Social workers, counselors, psychologists, substance use counselors, psychiatrists, and marriage and family therapists are examples of trained mental health professionals who can lead a group.
The 90853 code is specifically designed for group psychotherapy and covers sessions with multiple participants led by one or more qualified mental health professionals. You cannot just use your individual therapy code (90837 or 90834) and hope for the best, because insurance companies are particular about how the group code is used.
Who is licensed to bill 90853?
Any independently licensed mental health professional trained to run a group can bill 90853. In practice that includes Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Mental Health Counselors (LMHC), Licensed Marriage and Family Therapists (LMFT), Clinical Psychologists (PhD or PsyD), and Psychiatrists (MD). Your reimbursement can vary by licensure level and payer.
How is 90853 different from 90849 and 97150?
90853 is general group psychotherapy; 90849 is multiple-family group psychotherapy; 97150 is group activity or therapeutic-procedure billing used mainly in physical and occupational therapy, not psychotherapy. Bill 90849 only when you are treating two or more families together, and note that Medicare does not cover 90849, so it is rare and should not be billed unless specifically authorized. If you are doing mental health group therapy, 90853 is almost always the correct code, not 97150.
What is group therapy?
Group therapy is one healthcare provider treating several patients at the same time. An overview of group therapy on PubMed reports it can be effective for conditions such as [2]:
- Attention deficit hyperactivity disorder (ADHD)
- Post-traumatic stress disorder (PTSD)
- Emotional trauma
- Anxiety
- Depression
- Substance use
Other group topics or presenting problems may be helpful for clients. Groups help providers treat similar issues at once, and group members can receive more support for the problems for which they seek help. Group therapy usually focuses on one topic or particular topics of interest to the group members.
There are also many different kinds of groups. Some are focused on skill-building, while others are educational groups about a specific condition. See types of group topics for examples. Either way, to bill the 90853 CPT code, therapy is being provided to a group of two or more people. According to Medicare standards, the maximum number of participants allowed in a group is ten.
What are the benefits of group therapy for patients?
The essential advantage of group therapy is being able to help multiple clients at once, and there are real clinical benefits for the patients too. Research indicates that some potential benefits include [3]:
- Fostering connection and group cohesion
- Fostering secure attachments with others
- Feelings of belonging
- Fostering trust with others
- Learning to regulate emotions
- Being more open to differing perspectives
- Fostering a sense of well-being among marginalized groups
- Helping group members develop a sense of hope
- Helping group members practice gratitude
- Learning how to forgive
- Developing accountability
- Cultivating humility among group members
While not all of these outcomes occur within every group, group therapy can help individuals with personal growth and help members relate to others in healthy ways.
Is there a time limit for group therapy to bill 90853?
No, there is no time limit for group therapy, which differs from CPT codes that are time-restricted. You can only bill the code once per day for group therapy. Many people keep their groups between 45 and 60 minutes, but you can run a group longer than that. You can also bill group therapy and individual therapy on the same day, as long as you use accurate codes for the different services and do not bill them at the same time.
How many units do you bill for a 90-minute group session?
One unit. Group therapy billing is based on the session, not the duration or the number of participants. Whether your group runs 60 minutes or two hours, and whether you have three people or 12, you bill one unit of 90853 per participant per session.
Reimbursement for group therapy
Group therapy reimbursement is typically lower than individual, couples, or family therapy sessions, and the exact rate depends on the payer and the state you are in. Medicare rates are set annually in the Physician Fee Schedule and change each year [1][4]:
| Year | Medicare 90853 rate (national, non-facility) |
|---|---|
| 2026 | $30.39 |
| 2025 | $28.14 |
| 2024 | $27.18 |
| 2023 | $26.77 |
| 2022 | $29.87 |
Commercial payers generally pay more than Medicare for 90853, but the amount is set in your individual contract. Other reimbursement rates depend on your licensure, the state in which group therapy is conducted, and the payer source.
How do you maximize revenue from group therapy sessions?
Start by reading your own contracts, because most therapists do not know their group therapy rates and the 90853 rate is often buried in the fine print. Take an afternoon to review your contracts, specifically looking for 90853 rates. You might discover you have been accepting lower reimbursement than you are entitled to.
When do you need prior authorization for group therapy?
Sometimes, and it is inconsistent, so check every time. Some insurance companies require prior authorization for group therapy, others do not, and not all plans treat 90853 as a routine outpatient service. Rather than guessing, develop a standard practice of checking authorization requirements for every new group member.
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Pro tip: When seeking prior authorization, explain how group therapy explicitly addresses the client’s diagnosis and treatment goals in ways that individual therapy alone cannot.
How do you handle multiple insurance companies in one group session?
Run a separate billing process for each member, because your group will likely have different insurance companies, copays, deductibles, and prior authorization requirements. One approach is to set up separate billing profiles for each insurance type and batch billing by payer (Monday is Blue Cross day, Tuesday is Aetna day, and so on). It is more efficient than juggling eight different requirements at once.
Modifiers and add-on codes for group therapy
The most common add-on for group therapy is 90785 for interactive complexity, which you can bill alongside 90853 when specific factors have made communication unusually difficult. Interactive complexity means factors that have complicated patient service delivery. The Centers for Medicare and Medicaid Services outlines what counts, and it can be billed when [5]:
- There are high levels of maladaptive communication that complicate the delivery of services
- The emotions of a caregiver interfere with the plan of treatment
- There is an event that prompts a mandated report, or disclosure of an event that prompts a mandated report
- Physical devices are needed to deliver services because services are not delivered in the patient’s first language
CMS emphasizes that interactive complexity should not be billed solely for translation or interpretation services, as this can violate federal law.
If you conduct an individual session with a client you also saw in group, use the same-day billing modifier appropriate to that payer, and call ahead to confirm it. Two other add-on codes apply when you run groups outside normal hours: 99050 for services provided outside regularly scheduled office hours, and 99051 for services during regularly scheduled evening, weekend, or holiday hours.
Who handles different government insurance programs?
Government programs are more predictable than commercial insurers once you learn each one’s rules.
Medicaid. Every state does it differently, so what works in California might get a denial in Texas. Most states cover group therapy under Medicaid, but requirements vary widely. Connect with your state’s Medicaid provider relations department early. Rates are typically lower than commercial insurance, but payment is usually reliable once you get the process right.
Medicare. More consistent across states but still fairly restrictive. Medicare covers groups of 2 to 10 participants and requires detailed documentation showing individual therapeutic value within the group setting. You cannot just write “participated in group therapy,” you need to show individual benefits and progress.
When should you choose private pay vs. insurance billing?
Choose based on which trade-off fits the group. Private pay means simpler billing, no prior authorizations, no claims denials, and complete clinical flexibility. Insurance means accessibility for clients who cannot afford $75 to $100 per session out of pocket, plus predictable revenue once you understand the process. Many successful practices use both: private-pay groups for specialized populations and insurance-based groups for broader accessibility. What matters most is being intentional about which groups you run under which model.
What documentation is required for group therapy?
You must document what the group was about, the interventions used, and each individual participant’s response, because group documentation differs from individual or couples therapy. You do not need to write a novel for each person, but you need evidence that each person was present, participated appropriately, and that the session addressed their individual treatment goals within the group context. For government payers, you need to establish why group therapy is clinically appropriate for each individual in even more detail, and each client’s claim should carry their own specific diagnosis even when the group topic is shared.
Essential documentation elements include:
- Individual assessment of participation
- Specific therapeutic interventions used
- Progress toward individual goals within the group context
- Plan for continued treatment
There are specific guidelines about what does not count as group therapy. Under Medicare standards, the following are excluded:
- Monitoring daily living activities
- Teaching hygiene or grooming skills
- Taking the time to prepare reports
- Recreational therapy that includes play, art, or dance
- Eating meals together
- Outings with group members
- Social interaction
- Travel time to a location
- Providing the group with self-help materials
If you provide groups, the topic must relate to therapy or treat presenting issues. If it does not, you may not receive reimbursement for the groups you provide.
Documenting group therapy accurately also matters for tracking the progress of the participants, not just for billing. If you run groups multiple times a week you may have the same participants returning, and developing therapeutic rapport over time can help members become more engaged and get more out of group sessions. Good documentation lets you assess engagement over time, see which topics landed and which were difficult to treat, and get paid on time. This is exactly the work Mentalyc automates: a shared group section plus an individual response for each member, generated together rather than copy-pasted, with the individual-therapy progress note workflow extended to the group setting. The AI Treatment Planner keeps each member’s goals connected from session to session.
How do you bill when you have co-facilitators?
Both therapists can bill for all group members, but only one therapist per member per session, so the common assumption that co-facilitators each bill half the group is wrong. Decide upfront who each group member’s primary therapist will be, split billing responsibility accordingly, and document that co-facilitation was clinically necessary. Both therapists should document, but the notes should complement each other rather than duplicate.
What are common group therapy billing mistakes to avoid?
This is where theory meets practice, and where most denials originate.
The “absent member” trap. Bill for whoever attended, not for the roster. If your group of eight has six show up, you bill six. The part that gets people in trouble is the attendance policy: if someone shows up 10 minutes late, or leaves early, do they count? Define attendance as being present for at least 50% of the session, and communicate that policy to clients and insurers upfront, because some companies will audit for it.
Co-payment confusion. Check each client’s benefits specifically for group therapy copays, because the group copay is often different from the individual session copay. Some plans use the same copay for both, others do not, and some have different copay structures for different group types (process groups versus skills groups, for example).
The “group rate” miscalculation. Group reimbursement rates are typically 60 to 70% of individual rates, so the per-group math is not your individual rate times the group size:
| Individual rate | Group rate (about 60–70%) | Group size | Per group | |
|---|---|---|---|---|
| The trap (what people expect) | $150 | n/a | 8 | $1,200 |
| Reality | $150 | $100 | 8 | $800 |
That is still good money, but not the windfall some people expect. Plan your group size and business model accordingly.
The bottom line
CPT code 90853 bills group therapy: a psychotherapy service for a group of people who otherwise are not related to each other and were not previously acquainted. Reimbursement is lower than for individual therapy, you bill one unit per participant per day regardless of session length, and you can also bill individual therapy on the same day with the right same-day modifier.
When communication within the group is unusually difficult, the interactive complexity modifier (90785) can apply, but never solely for translation or interpretation. There are limits on what counts: hygiene or grooming groups, socialization, meal times, and transportation are not group therapy, and there is no time limit on group therapy. Properly capturing and documenting the service helps you get paid on time and, as with any CPT code, helps you accurately describe what you provided. Because a group can include up to ten participants, you must document each individual’s response to the interventions for reimbursement.
The practical reality is more art than science: Blue Cross does one thing, Aetna does another, and California has different rules than Texas. Master the basics first (the right code, one unit per participant, individual documentation, and a clear attendance policy) and the organization comes later. Mentalyc can take most of the trial and error off your plate by recommending the correct CPT codes from the session content and generating both the group note and each member’s individual progress note automatically, so you run group therapy sessions and actually get paid without the headaches. View pricing to find the plan that fits your practice.
Frequently Asked Questions
References
1. Centers for Medicare & Medicaid Services. (2022). Billing and Coding: Psychiatry and Psychology Services (A57480). https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480
2. Malhotra A, et al. (2022). Group Therapy. StatPearls / NCBI. https://www.ncbi.nlm.nih.gov/books/NBK549812/
3. Marmarosh C, et al. (2022). New Horizons in Group Psychotherapy Research and Practice from Third Wave Positive Psychology: A Practice-Friendly Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9893048/
4. American Psychological Association Services. (2026). Medicare changes coming in 2026 (CY2026 Physician Fee Schedule, 90853 rates). https://www.apaservices.org/practice/reimbursement/government
5. American Psychiatric Association / AACAP. (2012). Interactive Complexity. https://www.psychiatry.org/getmedia/86779486-e341-4793-81b0-3f065f2c914c/APA-AACP-CPT-Interactive-Complexity.pdf
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