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CMS Transmittals




90849
Quick jump to procedure code: Printer Friendly Version
90863

Procedure Category: Medicine
Procedure Subcategory: Psychiatry

90853: GROUP PSYCHOTHERAPY

CPT® 90853: Group psychotherapy (other than of a multiple-family group)



--

CPT copyright 2017 American Medical Association. All rights reserved.


2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

Global Non-Facility Fee
Global Facility Fee
$ 26.64
$ 25.20
2018 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2018D Unadjusted OPPS Payment $ 71.94
2018 APC Code: 5822
Level 2 Health and Behavior Services

2018 OPPS Status Indicator: Q3

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
11.9%
F20.9
Schizophrenia, unspecified
885
9.5%
F32.9
Major depressive disorder, single episode, unspecified
881
6.1%
F33.1
Major depressive disorder, recurrent, moderate
885
4.6%
F25.0
Schizoaffective disorder, bipolar type
885
4.3%
F33.2
Major depressive disorder, recurrent severe without psychotic features
885
4.1%
F20.0
Paranoid schizophrenia
885
4.0%
F25.9
Schizoaffective disorder, unspecified
885
3.0%
F41.1
Generalized anxiety disorder
880
2.5%
F33.3
Major depressive disorder, recurrent, severe with psychotic symptoms
885
2.4%
F11.20
Opioid dependence, uncomplicated
894-897

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

90853 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 90853

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for 90853
Denied Codes (1)
Effective
Modifier
Accepted (2)
0362T BHV ID SUPRT ASSMT EA 15 MIN
10/01/2014 No
0373T ADAPT BHV TX EA 15 MIN
10/01/2014 No
36591 DRAW BLOOD OFF VENOUS DEVICE
10/01/2015 No
36592 COLLECT BLOOD FROM PICC
10/01/2015 No
36640 INSERTION CATHETER ARTERY
01/01/1996 Yes
90832 PSYTX W PT 30 MINUTES
10/01/2014 Yes
90833 PSYTX W PT W E/M 30 MIN
10/01/2014 Yes
90834 PSYTX W PT 45 MINUTES
10/01/2014 Yes
90836 PSYTX W PT W E/M 45 MIN
10/01/2014 Yes
90837 PSYTX W PT 60 MINUTES
10/01/2014 Yes
90838 PSYTX W PT W E/M 60 MIN
10/01/2014 Yes
90845 PSYCHOANALYSIS
10/30/2000 Yes
90846 FAMILY PSYTX W/O PT 50 MIN
10/30/2000 Yes
90847 FAMILY PSYTX W/PT 50 MIN
10/30/2000 Yes
90849 MULTIPLE FAMILY GROUP PSYTX
10/30/2000 Yes
90865 NARCOSYNTHESIS
10/30/2000 Yes
90870 ELECTROCONVULSIVE THERAPY
10/30/2000 Yes
96116 NUBHVL XM PHYS/QHP 1ST HR
01/01/2006 Yes
96127 BRIEF EMOTIONAL/BEHAV ASSMT
01/01/2015 No
96150 ASSESS HLTH/BEHAVE INIT
01/01/2002 No
96151 ASSESS HLTH/BEHAVE SUBSEQ
01/01/2002 No
96152 INTERVENE HLTH/BEHAVE INDIV
01/01/2002 No
96153 INTERVENE HLTH/BEHAVE GROUP
01/01/2002 No
96154 INTERV HLTH/BEHAV FAM W/PT
01/01/2002 No
96155 INTERV HLTH/BEHAV FAM NO PT
01/01/2014 No
97151 BHV ID ASSMT BY PHYS/QHP
01/01/2019 No
97152 BHV ID SUPRT ASSMT BY 1 TECH
01/01/2019 No
97153 ADAPTIVE BEHAVIOR TX BY TECH
01/01/2019 No
97154 GRP ADAPT BHV TX BY TECH
01/01/2019 No
97155 ADAPT BEHAVIOR TX PHYS/QHP
01/01/2019 No
97156 FAM ADAPT BHV TX GDN PHY/QHP
01/01/2019 No
97157 MULT FAM ADAPT BHV TX GDN
01/01/2019 No
97802 MEDICAL NUTRITION INDIV IN
01/01/2002 No
97803 MED NUTRITION INDIV SUBSEQ
01/01/2002 No
97804 MEDICAL NUTRITION GROUP
01/01/2002 No
99201 OFFICE/OUTPATIENT VISIT NEW
01/01/2002 Yes
99202 OFFICE/OUTPATIENT VISIT NEW
01/01/2002 Yes
99203 OFFICE/OUTPATIENT VISIT NEW
01/01/2002 Yes
99204 OFFICE/OUTPATIENT VISIT NEW
01/01/2002 Yes
99205 OFFICE/OUTPATIENT VISIT NEW
01/01/2002 Yes
99211 OFFICE/OUTPATIENT VISIT EST
01/01/2002 Yes
99212 OFFICE/OUTPATIENT VISIT EST
01/01/2002 Yes
99213 OFFICE/OUTPATIENT VISIT EST
01/01/2002 Yes
99214 OFFICE/OUTPATIENT VISIT EST
01/01/2002 Yes
99215 OFFICE/OUTPATIENT VISIT EST
01/01/2002 Yes
99217 OBSERVATION CARE DISCHARGE
01/01/2002 Yes
99218 INITIAL OBSERVATION CARE
01/01/2002 Yes
99219 INITIAL OBSERVATION CARE
01/01/2002 Yes
99220 INITIAL OBSERVATION CARE
01/01/2002 Yes
99221 INITIAL HOSPITAL CARE
01/01/2002 Yes
99222 INITIAL HOSPITAL CARE
01/01/2002 Yes
99223 INITIAL HOSPITAL CARE
01/01/2002 Yes
99224 SUBSEQUENT OBSERVATION CARE
01/01/2011 Yes
99225 SUBSEQUENT OBSERVATION CARE
01/01/2011 Yes
99226 SUBSEQUENT OBSERVATION CARE
01/01/2011 Yes
99231 SUBSEQUENT HOSPITAL CARE
01/01/2002 Yes
99232 SUBSEQUENT HOSPITAL CARE
01/01/2002 Yes
99233 SUBSEQUENT HOSPITAL CARE
01/01/2002 Yes
99234 OBSERV/HOSP SAME DATE
01/01/2002 Yes
99235 OBSERV/HOSP SAME DATE
01/01/2002 Yes
99236 OBSERV/HOSP SAME DATE
01/01/2002 Yes
99238 HOSPITAL DISCHARGE DAY
01/01/2002 Yes
99239 HOSPITAL DISCHARGE DAY
01/01/2002 Yes
99281 EMERGENCY DEPT VISIT
01/01/2002 Yes
99282 EMERGENCY DEPT VISIT
01/01/2002 Yes
99283 EMERGENCY DEPT VISIT
01/01/2002 Yes
99284 EMERGENCY DEPT VISIT
01/01/2002 Yes
99285 EMERGENCY DEPT VISIT
01/01/2002 Yes
99291 CRITICAL CARE FIRST HOUR
01/01/2002 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99292 CRITICAL CARE ADDL 30 MIN
01/01/2002 Yes
99307 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99308 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99309 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99310 NURSING FAC CARE SUBSEQ
01/01/2006 Yes
99315 NURSING FAC DISCHARGE DAY
01/01/2002 Yes
99316 NURSING FAC DISCHARGE DAY
01/01/2002 Yes
99318 ANNUAL NURSING FAC ASSESSMNT
01/01/2006 Yes
99324 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99325 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99326 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99327 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99328 DOMICIL/R-HOME VISIT NEW PAT
01/01/2006 Yes
99334 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99335 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99336 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99337 DOMICIL/R-HOME VISIT EST PAT
01/01/2006 Yes
99341 HOME VISIT NEW PATIENT
01/01/2002 Yes
99342 HOME VISIT NEW PATIENT
01/01/2002 Yes
99343 HOME VISIT NEW PATIENT
01/01/2002 Yes
99344 HOME VISIT NEW PATIENT
01/01/2002 Yes
99345 HOME VISIT NEW PATIENT
01/01/2002 Yes
99347 HOME VISIT EST PATIENT
01/01/2002 Yes
99348 HOME VISIT EST PATIENT
01/01/2002 Yes
99349 HOME VISIT EST PATIENT
01/01/2002 Yes
99350 HOME VISIT EST PATIENT
01/01/2002 Yes
99354 PROLONG E&M/PSYCTX SERV O/P
01/01/2002 Yes
99355 PROLONG E&M/PSYCTX SERV O/P
01/01/2002 Yes
99356 PROLONGED SERVICE INPATIENT
01/01/2002 Yes
99357 PROLONGED SERVICE INPATIENT
01/01/2002 Yes
99358 PROLONG SERVICE W/O CONTACT
07/01/2017 Yes
99359 PROLONG SERV W/O CONTACT ADD
07/01/2017 Yes
99408 AUDIT/DAST 15-30 MIN
04/01/2011 No
99409 AUDIT/DAST OVER 30 MIN
04/01/2011 No
99415 PROLONG CLINCL STAFF SVC
01/01/2016 Yes
99416 PROLONG CLINCL STAFF SVC ADD
01/01/2016 Yes
99483 ASSMT & CARE PLN PT COG IMP
01/01/2018 Yes
99497 ADVNCD CARE PLAN 30 MIN
01/01/2016 Yes
99605 MTMS BY PHARM NP 15 MIN
01/01/2008 Yes
99606 MTMS BY PHARM EST 15 MIN
01/01/2008 Yes
G0176 Opps/php;activity therapy
01/01/2002 Yes
G0177 Opps/php; train & educ serv
01/01/2002 Yes
G0270 Mnt subs tx for change dx
07/01/2003 No
G0271 Group mnt 2 or more 30 mins
07/01/2003 No
G0380 Lev 1 hosp type b ed visit
10/01/2008 Yes
G0381 Lev 2 hosp type b ed visit
10/01/2008 Yes
G0382 Lev 3 hosp type b ed visit
10/01/2008 Yes
G0383 Lev 4 hosp type b ed visit
10/01/2008 Yes
G0384 Lev 5 hosp type b ed visit
10/01/2008 Yes
G0396 Alcohol/subs interv 15-30mn
04/01/2011 Yes
G0397 Alcohol/subs interv >30 min
04/01/2011 Yes
G0406 Inpt/tele follow up 15
07/01/2010 Yes
G0407 Inpt/tele follow up 25
07/01/2010 Yes
G0408 Inpt/tele follow up 35
07/01/2010 Yes
G0425 Inpt/ed teleconsult30
07/01/2010 Yes
G0426 Inpt/ed teleconsult50
07/01/2010 Yes
G0427 Inpt/ed teleconsult70
07/01/2010 Yes
G0442 Annual alcohol screen 15 min
07/01/2012 Yes
G0443 Brief alcohol misuse counsel
07/01/2012 Yes
G0444 Depression screen annual
07/01/2012 Yes
G0445 High inten beh couns std 30m
07/01/2012 Yes
G0446 Intens behave ther cardio dx
07/01/2012 Yes
G0447 Behavior counsel obesity 15m
07/01/2012 Yes
G0459 Telehealth inpt pharm mgmt
10/01/2013 No
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0473 Group behave couns 2-10
07/01/2015 Yes
G0508 Crit care telehea consult 60
07/01/2017 Yes
G0509 Crit care telehea consult 50
07/01/2017 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 90853.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 90853

Denied Codes (1)
Effective
Modifier
Accepted (2)
90791 PSYCH DIAGNOSTIC EVALUATION
01/01/2013 No
90792 PSYCH DIAG EVAL W/MED SRVCS
01/01/2013 No
90839 PSYTX CRISIS INITIAL 60 MIN
01/01/2013 No
90840 PSYTX CRISIS EA ADDL 30 MIN
01/01/2013 No
90867 TCRANIAL MAGN STIM TX PLAN
01/01/2011 Yes
90868 TCRANIAL MAGN STIM TX DELI
01/01/2011 Yes
90869 TCRAN MAGN STIM REDETEMINE
01/01/2012 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
90880 HYPNOTHERAPY
10/30/2000 No
90901 BIOFEEDBACK TRAIN ANY METH
10/30/2000 Yes
90911 BIOFEEDBACK PERI/URO/RECTAL
10/30/2000 Yes
G0337 Hospice evaluation preelecti
01/01/2005 Yes
G0409 Corf related serv 15 mins ea
01/01/2010 Yes
G0410 Grp psych partial hosp 45-50
01/01/2010 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 90853.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for 90853


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 5 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: CMS Policy Nature of Service/Procedure Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   90853 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
LATISHA BRABOY -DETROIT,MI 13,422
JAIME MEDVENE -ENCINO,CA 12,223
AHMED DAMTEW -DALTON,GA 11,223
FRANCIS BUTLER -CLEARWATER,FL 10,944
TAMIKA PENNAMON -FARMINGTON HILLS,MI 10,763

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 90853*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 1,178,736
Total Services Denied 2017: 172,140 (14.6%)
National Charges Submitted 2017: $ 77,842,828.88
National Charges Allowed 2017: $ 22,304,865.80
National Average (No Modifier) Fee Submitted 2017: $ 69.23
National Average (No Modifier) Fee Allowed 2017: $ 22.31


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Licensed clinical social worker 670,031 56.8% $ 58.49 109,651 16.4%
Clinical psychologist 276,012 23.4% $ 67.83 23,261 8.4%
Psychiatry 152,025 12.9% $ 98.01 18,735 12.3%
Nurse practitioner 22,523 1.9% $ 80.20 3,263 14.5%
Family practice 14,238 1.2% $ 48.15 1,618 11.4%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 696,282 59.1% $ 62.79 104,516 15.0%
Community mental health center 96,266 8.2% $ 90.07 13,930 14.5%
On Campus-Outpatient Hospital 78,814 6.7% $ 92.39 15,964 20.3%
Nursing facility 70,573 6.0% $ 46.29 4,791 6.8%
Skilled nursing facility 40,157 3.4% $ 47.94 2,763 6.9%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 919,187 78.0% $ 69.23 116,515 12.7%
AJ 107,308 9.1% $ 56.96 10,111 9.4%
59 - Distinct Procedural Service 73,438 6.2% $ 37.86 20,922 28.5%
AH 41,466 3.5% $ 51.53 3,545 8.5%
GY 9,231 0.8% $ 95.62 9,231 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

CMS Transmittals Referencing "90853"
Issue DateTransmittalTitle
2018-03-21 R4006CP April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1
2018-03-02 R3989CP April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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12/17/2018 01:10:22 34.228.30.69

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