Extended Group therapy Code?


Denver, CO
Best answers
Hello, I just started a new job at a Behavioral Health Organization. I have been trying to help them improve upon their coding. One thing I haven't been able to find, is a good code to use for 2 hour group therapy session. It is not family members, groups are around 10 people, and they are run/facilitated by a credentialed Behavioral Health Provider.

We use 90853, and before I got here they tried adding +99354 in the past, but I can't find an example of it ever getting paid.

Does anyone have any advice, or can tell me if there is anything that can be done? Looking at the guidelines in the book, it never says anything about how long the session should last for, so I was questioning whether we could even use an add on code if it even exists. And while I know I can use +99354 for 90837, nowhere does it say that 99354 can be used in conjunction with 90853.

One thing I noticed was on AAPC coder, in the Lay Terms section, it says that sessions should last between 45-60mins. Anyways, any advice or tips would be greatly appreciated. Also, if anyone has any good information/sources for Behavioral Health Coding specifically Substance Use Disorder (Alcohol and Opioid {outpatient: induction, detox, buprenorphine and Vivtrol}) Psychotherapy, Group Therapy and pharmacological management. That would really help me lots.




True Blue
Clovis, CA
Best answers
Also, be aware of insurance restrictions on groups. For instance, Medicare requires that groups target a specific problem, whether that's depression or panic or something else; they require that it be led by a psychiatrist or psychologist (or if led by another qualified mental health professional, but have a followup visit with a psychiatrist), and the participants are limited to 10 patients. This is Noridian Medicare, but I do not know if it is MAC-specific.