Wiki BILLING FOR 90849 vs 90853 - MENTAL HEALTH GROUP SESSIONS

[Suzbarrett16]

Hopefully someone can help me with billing group session participation. I have a provider that wants to host group sessions for several different families together. As an example, it would be 3 or 4 couples processing a topic that is on all of their treatment plans. Since it is a group session with psychotherapeutic modalities utilized, how do I bill each participant in group? Would I use 90849 or 90853? None of the participants have Medicare; I have seen both codes on different payer fee schedules. UHC has the only descriptor that I can find: "Optum will only reimburse for one of the family therapy codes per day and any subsequent claims for the same family, on the same date of service with the same provider will be denied. (90846, 90847, 90849)"

Has anyone used 90849 and can I bill for each individual in the group with this code?

 

[CBLENNIE]

Per EncoderPro Payer edition you can only bill 90849 once per family:

90849-Multiple family group psychotherapy provided to a patient and his/her family, as well as other patients and families, altogether. This is usually done in cases involving similar issues and often in settings of group homes, drug treatment facilities, or hospital rehabilitation centers. The session may focus on the issues of the patient's hospitalization or substance abuse problems. This code is reported once for each family group present.​

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The code would be billed under which ever family member has the mental health condition that is being addressed/treated as part of the family group psychotherapy session.