CurrentPremera BluecrossPolicy N/A

Group psychotherapy (CPT 90853) unit limitation

This payment policy establishes the Plan's unit limitation for professional billing of group psychotherapy (CPT 90853) and applies to services billed to Premera Blue Cross and affiliated plans; it governs unit allowances per member, per date of service, per provider.

Policy Summary

PayerPremera Bluecross

PolicyGroup psychotherapy (CPT 90853) unit limitation

Policy CodePolicy N/A

Change TypeAnnual reviewno material changes

Effective DateAug 4, 2025

Next Review DateN/A

Key ActionLimit billing of CPT 90853 to one unit per date of service per member per provider on professional claims (CMS-1500/837P).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1maximum allowed per date of service per member per provider for CPT 90853

Professionalbilling form scope (CMS-1500 / 837P)

Hospitals / ATFs / Residentialprovider types subject to one-unit limit

Payment Integrity Oversightgovernance

Coverage Criteria

Unit limit for 90853

Billing limitation for professional claims

CPT 90853 (Group psychotherapy) is limited to one unit per date of service per member per provider on professional claims regardless of session length.

This unit limitation applies to professional services billed by alcohol treatment facilities, hospitals, and behavioral health residential facilities when submitted on a professional claim (CMS-1500/837P).

Violations of this policy may result in auditing, monitoring, contractual penalties, corrective action up to and including contract termination, unless a provider or employer group contract specifies otherwise (exceptions may be made per contract).

Coding

Group psychotherapyCPTCovered

90853

Group psychotherapy (other than of a multiple-family group)

Policy Summary

PayerPremera Bluecross

PolicyGroup psychotherapy (CPT 90853) unit limitation

Policy CodePolicy N/A

Change TypeAnnual reviewno material changes

Effective DateAug 4, 2025

Next Review DateN/A

Key ActionLimit billing of CPT 90853 to one unit per date of service per member per provider on professional claims (CMS-1500/837P).

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Actions and Billing Rules

Billing Rule

Limit CPT 90853 to one unit per date of service on professional claims

Limit billing of CPT code 90853 to one unit per date of service per member per provider on professional claims (CMS-1500/837P); applies regardless of session length and includes professional services billed by alcohol treatment facilities, hospitals, and behavioral health residential facilities.

Applies to all Premera Blue Cross, Premera Blue Cross Blue Shield of Alaska, LifeWise Health Plan of Washington, LifeWise Assurance Company and Premera Blue Cross.
Violations may result in increased auditing, monitoring, contractual penalties, or termination of contract; disciplinary actions up to corrective action may be taken.

OpenPayer

Group psychotherapy (CPT 90853) unit limitation

Coverage Criteria

Coding

Provider Actions and Billing Rules

Definitions