Please note that this article contains information that is only relevant to American clinics.
PTs, OTs, and SLPs across America have some uncertainty about whether they’ll be able to submit claims for group therapy sessions to their patients’ insurance carriers. The truth is that you are allowed to bill for group therapy sessions, but you just need to be sure to provide the correct documentation. In this article, we’re going to discuss how your clinic can get paid for offering group therapy sessions.
We’ll start by defining group therapy. A recent article from Gawenda Seminars and Consulting stated that “group therapy involves 2 or more patients being treated by one therapist or assistant.” The article went on to further explain that the therapist or assistant must be in constant attendance of all patients, however, there doesn’t need to be direct one-on-one contact during the entire session. This definition applies to all physical therapy, speech therapy, and occupational therapy settings.
Click here to read our article about defining one-on-one therapy for Medicare patients.
Now, it’s important to note that group therapy is an untimed CPT code. This means that each individual patient in the group is going to be charged for one unit of the group therapy code (CPT 97150 for PTs and OTs and CPT 92508 for SLPs), regardless of how much time was spent in the session.
If you’ll also be billing for individual therapy CPT codes on the same day as a group therapy session, you must use a special modifier to indicate that they were a component of the group therapy session. The specific code to use is modifier 59. That said, your daily progress notes and clinical documentation will need to show the specific times that each patient received their individual treatment.
Gawenda Seminars and Consulting also reminded us that certain payors do not cover group therapy sessions. If you have doubts about whether your patients’ group therapy session will be covered, then don’t hesitate to contact their insurance carrier for more information.
We hope you found this article helpful. Be sure to check out the Gawenda Seminars and Consulting website and learn more about the benefits of becoming a Gold Member.