Wiki 90853 minimum number of participants?

[jillmoore1355]

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?

 

[msbernards]

Yes, you should bill individual. Group requires 3 or more participants.

 

[jillmoore1355]

Thank you so very much; I greatly appreciate your feedback!

 

[Amynoelle]

We use add on codes for the extra time. What do we use now that those are not used 2023. Ex. 90837 add on codes 99354 99355

 

[lgardner]

We use add on codes for the extra time. What do we use now that those are not used 2023. Ex. 90837 add on codes 99354 99355

per EncoderPro, both of these deleted codes have a note stating "to report, see [99417]".

hope this helps.

 

[Amynoelle]

Thank you so much! I

 

[Amynoelle]

I need to know for the Psychology practice. That will not work for us. Thank you though

 

[lgardner]

okay. I don't code psych, but...

I pulled up 99417 on EncoderPro and there is an excludes note:

Psychotherapy services (90833, 90836, 90838)

maybe these are what you are looking for?

 

[CINDYLARSON]

Has it been determined if we can bill 99417 with 90833, 36, 38 on the same DOS due to the excludes note in Encoder?

 

[ebembene]

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.

 

[ebembene]

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.