Category: #reimbursement

This update will apply to any dos of Jan 1, 2026 and thereafter.

This update does not apply to SUD services/ providers that are certified as Article 32.

29-I providers are also excluded from the concurrent prior authorization requirenments.

Services affected:

Family Psychotherapy – CPT Code 90847

Group Psychotherapy – CPT Code 90853   

FidelisCare members have 30 visits per code/per calendar year.*

*Calendar year is defined as Jan 1st to Dec 31st

After the initial 30 visits the provider will have to submit a concurrent authorization request using the Family and Group Psychotherapy Form along with additional required information: (partial list)

1.Member and provider information, such as Member Full Name, ID and Date of Birth, Provider ID/TIN and Servicing Address
2. Type of service requested & CPT codes (Family Psychotherapy 90847 or Group Psychotherapy 90853)
3. First service date
4. Duration and intensity of requested services
5. Clinical goals, objectives, and rationale
6. Place of service (e.g. office)

7. A treatment plan with measurable goals
8. Recent progress notes
9. Recent psychiatric evaluation/biopsychosocial

In addition, please include the following:

1. How well does the individual cope with adversity, use supports, and community resources? 

2. Treatment & Recovery History

3. Engagement in Services and Recovery Status: Is member engaged in treatment?

How soon should the providers submit the concurrent authorization request?

Up to 30 days in advance of the 30th visit.

For a full list of required information please visit click here for FAQs.

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