Insurance Coverage
Learn whether your plan covers clinical men’s group therapy (CPT 90853)
*This is general information, each insurance plan is unique, and coverage varies depending on the provider, plan, state, and other factors. Be sure to check with your insurance provider for specific details.
What’s Covered
Group psychotherapy → licensed clinician, diagnosis, treatment goals, notes, insurance billing.
Men's groups typically refer to support or therapy groups tailored to men's mental health needs, such as addressing stress, relationships, anger, substance use, or societal pressures like masculinity norms. These can include peer-led support sessions or professionally facilitated group therapy. Coverage under medical insurance (health insurance plans) varies by provider, plan type, location, and whether the group qualifies as a "medically necessary" behavioral health service. Under the Affordable Care Act (ACA) and the Mental Health Parity and Addiction Equity Act (MHPAEA), most U.S. health plans must cover mental health services on par with physical health benefits, including outpatient group therapy. However, non-clinical peer support groups (e.g., informal meetups) are often not covered.
Key Factors Influencing Coverage
Plan Type:
- Employer-Sponsored Group Plans: Often include robust mental health benefits, such as Employee AssistancePrograms (EAPs) that may cover initial group sessions at no cost. These are common for men's issues like work-related stress or substance use.
- Individual/Marketplace Plans (ACA): Required to cover essential health benefits, including mental health outpatient services like group therapy. Preventive screenings (e.g., for depression) are often free.
- Medicaid/Medicare: Varies by state; Medicaid frequently covers group therapy for diagnosed conditions, while Medicare Part B covers outpatient mental health (including groups) after a deductible.
- Provider Credentials: Coverage requires licensed professionals (e.g., psychologists, licensed clinical social workers, or counselors). Peer-led groups without a therapist typically aren't reimbursable.
- Diagnosis Requirement: Many plans need a formal mental health diagnosis (e.g., anxiety, depression) for claims to be approved. Sessions must be deemed "medically necessary" by the insurer.
Session Limits and Costs: Plans may cap sessions (e.g., 20–30 per year) or require copays ($20–$50 per session for groups, often lower than individual therapy). Telehealth group sessions are widely covered post-COVID.
What’s Not Covered
Peer-led circle / growth / connection / spiritual work → usually self-pay, though sometimes subsidized by grants, philanthropy, or employers.
Non-therapeutic groups (e.g., hobby-based meetups) or those outside the insurer's network aren't covered. Some plans limit coverage for men's-specific groups if not tied to a diagnosis.
