← Back to list
Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 2026-08-20)
Effective date
May 8, 2026
Identified
Oct 4, 2026
Summary
Aetna considers behavioral health group psychotherapy medically necessary when all of the listed criteria are met. Covered CPT codes are 90849 (multiple-family group psychotherapy) and 90853 (group psychotherapy other than multiple-family), and HCPCS C7903 covers group psychotherapy provided remotely by hospital staff licensed under applicable state law when the patient is in their home and there is no associated professional service. Group size must not exceed 12 participants.
Get alerts when payers change rules like this one
We check Aetna and other payers every day and email you when a change matches your specialty and state.
Get Aetna alertsPolicy Monitoring is free. No card required.
What to do
Action · 11 steps
01Already effective 2026-05-08: Billing team: Bill CPT 90849 or 90853 for behavioral health group psychotherapy only when all of these are met.
02The service is ordered by a physician or independently licensed behavioral health professional.
03The member has a documented DSM-5-TR diagnosis that is appropriate for group-based intervention and results in clinically significant functional impairment.
04A documented treatment plan performed by a physician or licensed behavioral health professional exists within the past 90 days.
05The member can participate safely in a structured group and has sufficient cognitive capacity.
06The therapy is conducted by a clinician licensed to deliver psychotherapy within scope of practice, and the group has no more than 12 participants.
07Documentation must include 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 signature and credentials of the provider.
08Unlicensed or provisionally licensed clinicians may conduct the group only under direct supervision, meaning a licensed behavioral health professional is physically present on-site and immediately accessible.
09Students and trainees may conduct group psychotherapy only under formal, ongoing supervision by a licensed mental health professional.
10Support groups without a trained therapist, educational classes only, activity-based groups without therapeutic processing, coordination or planning meetings, and social gatherings should not be billed under the group therapy code.
11Check the member's benefit plan for coverage details.
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.AF69F93.0F94.0F94.9
Original notice
Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 2026-08-20)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Behavioral Health: Group Psychotherapy (CPB 1100, reviewed 08-2026-05)MediumEffective May 8, 2026 · Behavioral HealthKetamine for the Treatment of Depression and Other Selected Indications (CPB 0938, reviewed 2025-12-30)MediumNo effective date · Medical PolicyQuantitative EEG (Brain Mapping) (CPB 0221, reviewed 2026-04-14)MediumNo effective date · Medical PolicyChronic Pain Rehabilitation Programs (CPB 0237, reviewed 2026-04-23)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list
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 F94.9