Billing in group therapy involves understanding specific CPT codes, insurance requirements, and reimbursement structures unique to group treatment modalities.
Picture this: You have just finished leading your first therapy group. Eight participants had significant engagement, and everyone left feeling hopeful. You’re riding high on that “this is why I became a therapist” feeling until you sit down to handle the billing. Suddenly, you’re staring at your practice management software, wondering: Do I bill each person the full session rate? Is there a special group code? What if someone showed up late?
Unlike individual therapy billing, group therapy requires knowledge of session structure documentation, co-facilitation protocols, and varying insurance policies that can significantly impact your practice’s revenue and compliance. Most of us learned group therapy billing through trial and error and a few uncomfortable conversations with insurance companies.
This article will walk you through everything you need to know about billing for group therapy and the fundamental mechanics of advanced scenarios.
Billing Fundamentals: Getting the Basics Right
Let’s start with the fundamentals that somehow never got covered in that one required “business of therapy” class we all took. Group therapy billing operates on a completely different logic than individual sessions.
What CPT Codes Do You Use for Group Therapy?
First things first: group therapy has its own CPT code, and no, you can’t just use your individual therapy code (90837or 90834) and hope for the best. The 90853 code is specifically designed for group psychotherapy and covers sessions with multiple participants led by one or more qualified mental health professionals. Here’s what most billing guides won’t tell you: insurance companies are very particular about how you use this code.
How Many Units Do You Bill for a 90-Minute Group Session?
Have you ever asked yourself, “How many units do I bill for a 90-minute group session?” The answer is more straightforward than you think: one unit. Group therapy billing is based on the session, not the duration or number of participants. Whether your group runs 60 minutes or two hours, whether you have three people or 12, you bill one unit of 90853 per participant.
How Do You Handle Multiple Insurance Companies in One Group Session?
Here’s something that catches new group facilitators off guard: Your group members will likely have different insurance companies, copays, deductibles, and prior authorization requirements. This means you’re running multiple billing processes for every group session.
Consider This: Set up separate billing profiles for each insurance type and batch billing by the payer. Monday is Blue Cross day, Tuesday is Aetna day, etc. It’s more efficient than juggling eight different requirements simultaneously.
Insurance & Payment Strategies: Maximizing Your Revenue
Let’s talk about the elephant in the room: group therapy typically reimburses at a lower rate than individual sessions, but that doesn’t mean you should accept whatever insurance companies initially offer.
How Do You Maximize Revenue from Group Therapy Sessions?
You may be surprised how many therapists don’t know their group therapy reimbursement rates. Most insurance contracts specify rates for different services; group therapy rates are often buried in the fine print. Take an afternoon to review your contracts, specifically looking for 90853 rates. You might discover you’ve been accepting lower reimbursement than you’re entitled to.
When Do You Need Prior Authorization for Group Therapy?
Some insurance companies require prior authorization for group therapy, others don’t, and some are inconsistent. Rather than playing guessing games, develop a standard practice of checking authorization requirements for every new group member.
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Pro tip: When seeking prior authorization, explain how group therapy explicitly addresses the client’s diagnosis and treatment goals in ways that individual therapy alone cannot.
Who Handles Different Government Insurance Programs?
Government insurance programs have rules, quirks, and special ways of keeping us on our toes. But once you understand the basics, they’re more predictable than many commercial insurers.
Medicaid
Every state does it differently. What works in California might get you a denial in Texas. Most states cover group therapy under Medicaid, but requirements vary wildly. Connect with your state’s Medicaid provider relations department early. Reimbursement rates are typically lower than commercial insurance, but payment is usually reliable once you get the process right.
Medicare
More consistent across states but still pretty restrictive. Medicare covers groups of 2-10 participants and requires detailed documentation showing individual therapeutic value within the group setting. You can’t just write “participated in group therapy.” You need to show individual benefits and progress.
When Should You Choose Private Pay vs. Insurance Billing?
Private Pay Advantages: Simpler billing, no prior authorizations, no claims denials, and complete clinical flexibility. You can run groups; however, it makes clinical sense without insurance constraints.
Insurance Advantages: Accessibility for clients who can’t afford $75-100 per session out of pocket and predictable revenue once you understand the process.
The Hybrid Approach: Many successful practices offer both: private pay groups for specialized populations and insurance-based groups for broader accessibility. What matters most is being intentional about which groups you run under which model.
Avoiding Common Pitfalls
Here’s where theory meets practice, and most of us have made many mistakes (so you don’t have to).
What Documentation Is Required for Group Therapy Billing?
You need to document each participant individually, but you don’t need to write a novel. You need evidence that each person was present, participated appropriately and that the session addressed their individual treatment goals within the group context.
What I’ve learned: Keep individual notes focusing on specific contributions, progress toward goals, and any individual interventions you made. For government payers, you need to establish why group therapy is clinically appropriate for each individual in even more detail.
Essential documentation elements:
- Individual assessment of participation
- Specific therapeutic interventions used
- Progress toward individual goals within the group context
- Plan for continued treatment
How Do You Bill When You Have Co-Facilitators?
Most people assume that if two therapists co-facilitate a group, each bill half the members (this is wrong). Both therapists can bill for all group members, but only one therapist per member per session. For billing purposes, you need to decide upfront who each group member’s “primary” therapist will be.
Making it work: Split billing responsibility and document that co-facilitation was clinically necessary. Both therapists should document, but notes should complement each other rather than duplicate.
What Are Common Group Therapy Billing Mistakes to Avoid?
The “Absent Member” Trap:
Here’s a scenario that trips up even experienced therapists: You’re running a group of eight people, but only six show up today. Do you bill for eight or six? The answer is six. The bottom line is that you bill for whoever attended. But here’s the part that gets people in trouble: You must have a clear policy about what constitutes “attendance.” If someone shows up 10 minutes late, do they count? What about someone who leaves early?
Try This: Define attendance as being present for at least 50% of the session and communicate this policy to clients and insurance companies upfront because some companies will audit for this.
Co-Payment Confusion
Each person pays a group therapy copay, often different from their individual session copay. Check each client’s benefits specifically for group therapy copays. Some insurance plans have the same copay for individual and group therapy; others don’t. Some plans have different copay structures for various types of groups (process groups vs. skills groups, for example).
The “Group Rate” Miscalculation:
Therapists look at their session rate ($150) and their group size (eight people) and think, “Great, I’ll make $1,200 per group!” Then reality hits when they realize group therapy reimbursement rates are typically 60-70% of individual rates. The math works differently. If your rate is $150 and your group rate is $100, you’re making $800 for an 8-person group, not $1,200. This is still good money, but not the windfall some people expect. Plan your group size and business model accordingly.
Building a Practice That Works
The reality of group therapy billing is that it’s more art than science. Blue Cross does one thing, and Aetna does another. California has different rules than Texas. Most therapists just figure out what works and stick with it. Master the basics first. Organization comes later when you’re not drowning in codes. Billing well means more than just getting paid; it means you can keep offering the groups that people genuinely need. This stuff takes time to figure out. Everyone screws this up initially. I certainly did. You learn by doing it wrong a few times, and that’s okay.
Mentalyc can help you skip a lot of that trial and error. Rather than spending hours figuring out billing quirks and insurance forms, we handle that backend work so you actually get paid without the headaches.
Frequently Asked Questions
What is CPT Code 90853?
This code covers group psychotherapy sessions where you simultaneously provide clinical treatment to multiple clients. Don’t use it for support groups or educational sessions; insurance companies will reject claims that don’t meet the therapy criteria.
How Do You Track Attendance and Session Duration?
Record who attended, when the session started and ended, and clinical notes for each participant. Good documentation proves you provided the service and supports medical necessity. Telehealth groups need specific modifiers and place-of-service codes.
What Are the Most Common Billing Mistakes?
Using 90853 for non-clinical groups, poor documentation of individual treatment needs, billing for people who didn’t show up, and charging for clients who left early without adjusting the claim. These errors trigger denials and potential audits.
Resources
GetHealthie. (2024). Group therapy CPT code: A guide for providers. GetHealthie.
Headway. (n.d.). CPT code 90853: A guide to billing for group therapy. Headway.
Medisys Data Solutions. (n.d.). Group therapy billing guide. Medisys Data.
Medisys Data Solutions. (n.d.). Understanding basics of group therapy billing. Medisys Data.
My FC Billing. (n.d.). Group therapy billing. My FC Billing.
Private Practice Insurance Billing. (n.d.). How is group therapy billed? Private Practice Insurance Billing.
SessionLab. (n.d.). Co-facilitation: A practical guide to working better together. SessionLab.
Sessions Health. (2025, January 9). CPT code 90853: Everything you need to know about group therapy billing. Sessions Health.
TheraThink. (n.d.). CPT code 90853: The definitive guide for therapists. TheraThink.
TheraPlatform. (n.d.). Maximizing billing efficiencies for group practices. TheraPlatform.
TherapyNotes. (n.d.). Billing group psychotherapy with CPT codes 90849 and 90853. TherapyNotes.
Valant. (n.d.). How to maximize your reimbursement for group therapy sessions. Valant.
Workshopper. (n.d.). Co-facilitation guide: How to run workshops with a co-facilitator. Workshopper.
