Group therapy is billed differently from individual therapy — one CPT code, but a separate superbill for each participant. Understanding the billing rules for CPT 90853 prevents claim denials and helps clients with out-of-network benefits get reimbursed.
CPT 90853: Group Psychotherapy
CPT 90853 covers group psychotherapy that is not family therapy. It is billed once per participant, per session — meaning a group of 8 clients generates 8 separate claims or superbills, each using CPT 90853.
Key characteristics:
- Group size: typically 4–12 clients for insurance billing purposes
- Duration: no minimum time requirement in the code descriptor, but documentation should reflect the session length (typically 60–90 minutes)
- Facilitated by a licensed mental health professional
- Must be psychotherapy — not support groups, psychoeducation only, or skill-building without a therapeutic component
Typical Fee and Reimbursement
Private-pay fees for group therapy typically run $40–$80 per person per session. Insurance reimbursement for out-of-network group therapy is available but more difficult to obtain than for individual therapy — many plans have specific group therapy benefit language, and some explicitly exclude groups from OON reimbursement.
Before clients submit a group therapy superbill, they should call member services to confirm the plan covers OON group psychotherapy (CPT 90853).
CPT 90849: Multiple-Family Group Therapy
CPT 90849 covers multiple-family group psychotherapy — sessions where several families (not just one) meet together with a therapist. It is billed per identified patient present. This code is less commonly used in private outpatient practice and more typical in intensive outpatient or psychiatric programs.
Billing Per Participant: How It Works
- Each group member provides their own insurance information at intake
- After each session, generate a separate superbill for each participant
- Each superbill lists: CPT 90853, the participant's ICD-10 diagnosis code, date of service, and the fee for that participant
- Each participant submits their own superbill to their own insurer
Documentation for Group Therapy
Group therapy notes must be individualized — a generic group note does not satisfy payer requirements. Your notes should include:
- Group session date and duration
- Names or initials of attendees
- Therapeutic focus of the session
- Individualized observation for each participant: their engagement, progress toward treatment goals, and any clinical concerns
- Plan for continued group treatment
Why OON Reimbursement for Group Therapy Is Harder
Several factors make OON group therapy reimbursement less reliable than individual therapy:
- Some plans exclude group therapy from OON benefits entirely
- UCR rates for 90853 vary widely and can be low in some regions
- Payers may require documentation that the group is "therapeutic" versus psychoeducational
Advise clients to verify their group therapy OON benefits before committing to a group program if reimbursement is important to them.