Billing 90853 isn’t as straightforward as it looks. When it’s billed incorrectly, it doesn’t just create claim denials and wasted dollars, it risks slowing down care delivery and putting providers under unnecessary scrutiny.

1. MUE Limits

We’ve reviewed claims where 8–12 units of 90853 were billed on the same patient, same day. In reality:

– In a practitioner’s office, the MUE is 1 unit per patient, per date of service.

– In an outpatient setting (like IOP), the MUE is 4 units — and even then, it must be clinically justified.

Going past these limits almost always raises a compliance flag.

2. Revenue Code Misalignment

Revenue codes tell the story of the service. If they don’t line up, the claim is confusing at best — and fraudulent at worst.

– 0915: Group psychotherapy (90853)

– 0906 + H0015: Intensive outpatient programs (per diem, alcohol and/or drug therapies)

– Submitting both together can look like double billing.

3. System Edits That Miss the Mark

Many claims systems only edit at the revenue code level. That means the CPT-specific MUE checks for 90853 never fire. The result: incorrect payments slip through unnoticed until an audit.

When coding doesn’t align with policy, two things happen:

– Money gets wasted. Millions of dollars in inappropriate spend that could have gone toward real care.

– Patient care takes a backseat. Providers and payers are forced to spend time fixing errors instead of focusing on treatment.

This is about keeping healthcare resources where they belong: with the patient.

KEY REMINDERS: 

– Follow the MUE: 1 in an office, 4 in outpatient, and always document.

– Map revenue codes correctly.

– Avoid stacking 90853 on top of IOP per diem codes.

– Strengthen system edits to check both revenue and CPT/HCPCS codes.

 By Michelle Messick 

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Jeanmarie Loria, CEO of Advize Health | 407.583.7379 | jloria@advizehealth.com