Fee for Support Groups?

agrebiner

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Hi there!

My provider (LCSW) wants to start doing a support group. And as far as cost I am a bit concerned/confused.

Is she allowed to:

1. Charge self-pay patients $20
2. Bill insurance for $40

And for a support group would that be considered 90853?

Please help! Definitely want to follow the rules!!
 
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You are required to charge the same fee for all patients; that's part of the Anti-Kickback Statute.

There is a difference between a support group and group therapy.
Support groups are essentially a group of people who meet on a routine basis to discuss issues/situations/etc and provide mutual support to one-another.
Group therapy, on the other hand, must be led by a licensed facilitator who supports and promotes group discussion while simultaneously providing psychotherapy. This means the facilitator will provide guidance during the discussion, tools, education, etc to the patients to assist them in overcoming their problem/issue/condition, rather than relying on the participates to help each other.
It's basically like a study group versus an educational class led by an instructor.

Group therapy requires the facilitator/provider to maintain individual charts and documentation for each patient. The documentation should meet the same standards as with individual therapy, describing the work the provider performed.
 

kerryann

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I believe you can use CPT code 90849 for family support groups. I am not sure if this is what you mean but this might help.
Per CPT Assistant March 2010: CPT code 90849, Multiple-family group psychotherapy, is used when multiple families meet, typically in hospitals and drug treatment centers, to share experiences, give and receive support, acquire insight, and develop new ways of coping or behaving under the direction of co-leaders, who foster therapeutic interaction and maintain a safe and supportive environment for patients being treated. Code 90849 should be reported separately for each family group present (eg, if three multiple-group families were present, code 90849 would be reported three times, once for each identified patient within each family group).
 
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