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Wiki 90853 minimum number of participants?

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10
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Gilbert, AZ
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If you schedule group therapy 90853 but only one person shows up and they end up essentially having a 1 on 1 session, can you bill 90837?
 
Has it been determined if we can bill 99417 with 90833, 36, 38 on the same DOS due to the excludes note in Encoder?
You cannot bill 99417 and the add on psychotherapy codes 90833/90836/90838. 99417 can only be used with outpatient E&M codes when billing based on time. If you add on psychotherapy to your E&M service, you have to level the E&M based on medical decision making.
 
Yes, you should bill individual. Group requires 3 or more participants.
Do you have a reference that states that it requires 3 participants? We used to follow a minimum of 4 participants, but I cannot find a reference of this anywhere now. I do see that Medicare does not allow for more than 12 participants.
 
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