September 1, 2022
Effective with claim process dates on and after December 7, 2022, all submissions of code 90853 on a CMS-1500 paper claim or an 837P electronic claim for professional services will be processed with a maximum daily unit value of one.
Professional services billed by an alcohol/substance abuse treatment/residential treatment center, a hospital, or a behavioral health residential facility on a professional claim form will be subject to the one unit per date of service per member per provider regardless of the length of the therapy session as represented by the code 90853: group psychotherapy (other than of a multiple family group).
Per correct coding principles, code 90853 does not have a time statement like other psychotherapy codes, therefore the daily maximum unit of this code is one. All instances of this code submitted on a professional claim form, whether by a group/clinic, facility, or individual will be processed with a maximum daily unit of one on and after December 7, 2022, claim process dates.
Please review the payment policy for further details.