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Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 08-2026-05)
Effective date
May 8, 2026
Identified
Aug 18, 2026
Summary
Aetna considers behavioral health group psychotherapy medically necessary when all listed criteria are met. The criteria include a documented DSM-5-TR diagnosis, a documented treatment plan from a physician or licensed behavioral health professional within the past 90 days, and a group of no more than 12 participants led by a clinician licensed to deliver psychotherapy. Coverage may vary according to the member's benefit plan.
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What to do
Action · 7 steps
01Already effective 2026-05-08: Billing team: Before billing CPT 90849 or 90853, confirm the group was ordered by a physician or an independently licensed behavioral health professional, and that the member has a documented DSM-5-TR diagnosis appropriate for group treatment.
02Confirm the diagnosis is one of the listed ICD-10 codes and that a documented treatment plan from a physician or licensed behavioral health professional exists within the past 90 days.
03Confirm the group does not exceed 12 participants and is led by a clinician licensed to deliver psychotherapy within scope of practice.
04Confirm the documentation includes the expected frequency and number of sessions, the date, duration and type of service, the therapeutic goals and interventions, the member's participation and progress toward treatment plan objectives, and the provider's signature and credentials.
05Use HCPCS C7903 only for group psychotherapy provided remotely by hospital staff when the patient is at home and there is no associated professional service.
06Do not bill group psychotherapy for the diagnoses the policy lists as temporarily inappropriate for group treatment, including F02.C11 through F02.C18, F03.C11 through F03.C18, F06.0, F71, F72, F80.1, F80.2 and R47.01 through R47.02.
07Check the member's benefit plan, because coverage may vary by plan.
Codes mentioned
9084990853C7903F06.4F07.0F07.9F10.10F19.99F21F32.0F32.AF33.0F33.9F34.0F34.1F40.00F40.9F41.0F41.9F43.10F43.12F43.20F43.29F43.81F43.89F44.81F45.21F51.5F60.0F60.9F68.10F68.AF69F93.0F94.0F94.9F02.C11F02.C18F03.C11F03.C18F06.0F71F72F80.1F80.2R47.01R47.02
Original notice
Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 08-2026-05)
aetna.com · Always check the source before changing claims.
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Related policy hubs
Aetna policiesPsychiatryCode 90849Code 90853Code C7903Code F06.4Code F07.0Code F07.9Code F10.10Code F19.99Code F21Code F32.0Code F32.ACode F33.0Code F33.9Code F34.0Code F34.1Code F40.00Code F40.9Code F41.0Code F41.9Code F43.10Code F43.12Code F43.20Code F43.29Code F43.81Code F43.89Code F44.81Code F45.21Code F51.5Code F60.0Code F60.9Code F68.10Code F68.ACode F69Code F93.0Code F94.0Code F94.9Code F02.C11Code F02.C18Code F03.C11Code F03.C18Code F06.0Code F71Code F72Code F80.1Code F80.2Code R47.01Code R47.02