Behavioral Health is revising the description of Group Psychotherapy and adding Multiple Family Group Psychotherapy to the Behavioral Health Manual

 

The South Carolina Department of Health and Human Services (SCDHHS) is implementing the following changes and clarifications effective December 1, 2013 to the Group Psychotherapy code and adding Multiple Family Group Psychotherapy code as outlined below:

Procedure code 90853 – Group Psychotherapy

Description of service: Group Psychotherapy is a method of treatment in which several beneficiaries with similar problems meet face-to-face in a group with a clinician. The focus of Group Psychotherapy is to assist beneficiaries with solving emotional difficulties and to encourage the personal development of beneficiaries in the group.

Group Psychotherapy requires one professional and no more than eight beneficiaries in the group.  Beneficiaries in excess of the allowed ratio should not be present during the delivery of the service. The ratio count applies to all beneficiaries receiving services by a provider regardless of whether or not the beneficiary is Medicaid eligible.

Note - The following are not changing: medical necessity criteria, staff qualifications, service documentation and staff to beneficiary ratio, billing frequency, service documentation, modifiers, and rates. 

Effective December 1, 2013, Medicaid will no longer reimburse for other services listed as a component of Group Psychotherapy.  Multiple Family Group

Psychotherapy services will no longer be part of Group Psychotherapy and will be listed as a separate service with specific coverage and credential criteria. 

Procedure code 90849 - Multiple Family Group Psychotherapy

Description of services: Multiple Family Group Psychotherapy treatment will allow beneficiaries and their families with similar issues to meet face-to-face in a group with a clinician. The group’s focus is to assist the beneficiary and their family members in resolving emotional difficulties, encourage personal development and ways to improve and manage their functioning skills.

Multiple Family Group Psychotherapy requires one professional and a minimum of 2 family units (a minimum of 4 individuals) and a maximum of up to eight individuals which includes the beneficiaries and their families.  Beneficiaries in excess of the allowed ratio should not be present during the delivery of the service. The ratio count applies to all beneficiaries receiving services by a provider regardless of whether or not the beneficiary is Medicaid eligible.

PROCEDURE CODE

MODIFIER

STAFF DESCRIPTION

FREQUENCY

UNITS

90849

AH

HO

Clinical Psychologist

Master’s level Staff

Encounter = 1 unit

8 units/month

 

This bulletin affects the policy for fee-for-service and the Medical Home Networks (MHNs).  Please contact the appropriate Managed Care Organizations (MCOs) for their coverage policy.

For a complete copy of these policy changes, please refer to the most current version of the Rehabilitative Behavioral Health Services, Local Education Agencies, License Independent Practitioners Rehabilitative Services, and the Community Mental Health Services manual located on the SCDHHS website at www.scdhhs.gov .  If you have questions regarding this bulletin, please call the Provider Service Center at (888) 289-0709. 

Thank you for your continued support of the South Carolina Healthy Connections Medicaid Program.

Report Fraud