Family therapy plays a vital role in addressing emotional, relational, and behavioral issues within family systems. For mental health professionals — whether you’re a licensed marriage and family therapist (LMFT), psychologist, clinical social worker, or counselor — family sessions can be powerful tools for healing. But billing them correctly is a different challenge altogether.
In particular, CPT codes 90846 and 90847 often create confusion among providers. What’s the real difference? When should each be used? And how can you ensure you get reimbursed — without delays or denials?
In this comprehensive guide, we’ll walk you through everything you need to know about billing family therapy sessions correctly.
If your services also include both therapy and medication oversight, it’s worth reviewing the proper use of CPT code 90863 for pharmacologic management to ensure clean claims and correct documentation — especially when billing alongside psychotherapy.
Why Family Therapy Is Covered — But Complicated
Family therapy is typically covered when it is medically necessary to treat an identified patient’s mental health condition. But here’s the key: the focus of therapy must benefit the patient, not just improve family dynamics in general.
This nuance makes documentation and proper code usage especially important. Insurers want to see how the therapy is part of the treatment plan — not just a feel-good session. That’s why billing codes like 90846 and 90847 must be used carefully.
Understanding the Codes
What is CPT Code 90846?
- Definition: Family or couples psychotherapy without the patient present
- Session Length: Typically 50 minutes
- Purpose: To educate or work with family members to support the patient’s treatment
Examples:
- A parent session about a child’s ADHD behavior plan
- Coaching a spouse on supporting a partner with PTSD
- Educating caregivers about treatment compliance for a patient with schizophrenia
Here, the patient is not in the room — but the discussion is still about their treatment plan.
For clinicians offering a wide range of assessments, managing billing across multiple codes can get complex. This advanced guide to billing psychological testing services provides deeper insights into bundling, documentation, and payer expectations.
What is CPT Code 90847?
- Definition: Family or couples psychotherapy with the patient present
- Session Length: Typically 50 minutes
- Purpose: To engage the family system in treatment directly with the patient present
Examples:
- A couple attending therapy to address conflict impacting one partner’s depression
- A teenager and parents working on boundaries and behavior strategies
- A family unit discussing trauma as part of the patient’s healing process
This code is used when the identified patient actively participates in the session.
Key Differences Between 90846 and 90847
| Criteria | 90846 | 90847 |
| Patient Present | No | Yes |
Focus of Therapy Supporting family’s role Addressing issues with patient
Common Uses Education, planning, coaching Conflict resolution, active therapy
Documentation Requirements Clear justification without patient Detailed rationale + patient benefit
Frequency Allowed Varies by payer More commonly reimbursed
Most payers do not allow both codes to be billed on the same day for the same patient — unless it’s justified (e.g., separate sessions for different purposes).
Documentation: The Make-Or-Break Factor
Incorrect documentation is one of the top reasons providers get denied for family therapy billing. Insurers want proof that the session:
- Supports the patient’s treatment plan
- Meets medical necessity criteria
- Is differentiated from general family counseling
Here’s what to include in your documentation:
- Date of service
- CPT code used
- Session participants and their relationship to the patient
- Clinical goals related to the patient
- Progress toward the treatment plan
- Any risk factors or concerns
Also, state why the patient was not present (if using 90846). For example: “Session conducted with parents only to discuss behavior modification strategies for a minor patient diagnosed with ODD. Patient excluded to allow frank discussion and improve parental response plan.”
Real-World Example: Avoiding Rejection with Proper Coding
Let’s say a therapist meets with a couple to support the wife, who is the identified patient with generalized anxiety. If the wife is in the session, code 90847 applies. If the therapist meets with the husband alone to discuss ways he can reduce triggers at home, code 90846 is more appropriate.
What happens if the therapist mistakenly bills 90847 for the husband’s solo session? That’s a red flag for most payers, and the claim is likely to be denied or flagged for audit.
Telehealth and Family Therapy: What’s Changed Since COVID?
Family therapy sessions delivered via telehealth surged during the pandemic — and insurers responded by updating coverage rules. Most now allow billing 90846 or 90847 via telehealth when clinically appropriate.
Billing Tip
Watch for Blue Cross Complete of Michigan requirements. This Medicaid HMO enforces strict rules on modifier usage and timely filing — even a missing modifier like 25 or 59 can lead to claim rejections. Visit our Michigan Billing Services to ensure clean claims and faster reimbursements.
What You Need to Know:
- Use modifier 95 or GT to indicate telehealth
- Some payers require a place of service 02 (telehealth)
- Always verify payer-specific policies
At Global Tech Billing LLC, our team tracks payer updates in real-time to help providers stay compliant and reimbursed — especially for evolving telehealth rules.
Can You Bill an Intake with Family Present?
Yes — and no. If you’re conducting an initial psychiatric evaluation, use 90791. If family members are present, document their participation but do not use 90847 at the same time.
Some therapists try to bill 90791 + 90847 for the same session. Unless the payer allows it (rare), this combo will likely get denied.
Common Myths About Family Therapy Billing
Let’s bust a few billing myths:
- “I can bill 90847 twice if two family members show up.”
- → False. CPT codes are per session, not per person.
- “If the patient walks in for 5 minutes, I can bill 90847.”
- → False. The patient must be actively present for most of the session.
- “Medicare covers family therapy automatically.”
- → False. Coverage varies, and Medicare is more restrictive. Document medical necessity.
State-Level Variations: What Providers Should Know
Some state Medicaid plans (e.g., in California, Maryland, and Texas) impose additional rules:
- Pre-authorization may be required
- Services may need to be rendered by specific license types (LCSW vs. LMFT)
- Certain codes may not be covered for telehealth
Global Tech Billing LLC provides credentialing and billing support tailored to your state, specialty, and payer mix — reducing your administrative burden and increasing collections.
What to Do When Claims Are Denied
If your 90847 claim is denied:
- Check the documentation
- Review payer policy (medical necessity, covered services)
- Consider submitting a corrected claim or appeal with detailed notes
Don’t give up on denied claims without a fight — we’ve recovered tens of thousands for practices that initially wrote off family therapy sessions.
Understanding how payers define “new” vs. “established” patients can prevent billing errors and denials. This article on mental health E/M coding breaks down the rules and how they apply in behavioral health settings.
Tips for Successful Reimbursement
- Pre-verify coverage — especially for family therapy codes
- Use structured notes to capture required details
- Avoid overusing 90846 — payers may question frequent sessions without patient involvement
- Bill under the right provider type — some payers restrict which credentials are eligible
Case Study: How One Practice Increased Approval Rate from 63% to 91%
A Chicago-based therapy group billing under a group NPI faced 30% denial rates on 90847 claims due to inconsistent documentation and misused modifiers.
By partnering with Global Tech Billing LLC, they implemented:
- A custom template for session notes
- Claim scrubbing before submission
- Weekly reporting and A/R follow-ups
Within 90 days, their approval rate jumped to 91%, and their average reimbursement per session increased by 18%.
Final Thoughts: Mastering 90846 and 90847 Billing
Billing family therapy is more than just selecting the right code — it’s about knowing the context, meeting payer guidelines, and documenting clearly. With tighter scrutiny from insurers and evolving telehealth rules, providers must stay sharp and supported.
Global Tech Billing LLC specializes in helping therapists and clinics bill smarter. Whether you’re a solo provider or a multi-location practice, we offer HIPAA-compliant billing solutions that simplify your workflow and improve cash flow.
Ready to Fix Your Billing Process?
Let our expert team take the stress out of family therapy billing. Contact Global Tech Billing LLC today to schedule a free billing consultation.
FAQs
1. What is the difference between CPT codes 90846 and 90847?
CPT 90846 is used for family therapy sessions where the patient is not present, typically for caregiver education or treatment planning. CPT 90847 is used when the patient is present and actively participating in therapy with family members.
2. Can both 90846 and 90847 be billed on the same day?
Generally, no. Most insurance payers prohibit billing both codes on the same date of service for the same patient unless you can clearly document that the sessions were distinct, medically necessary, and occurred at different times.
3. Do insurance companies reimburse differently for 90846 and 90847?
Yes. Reimbursement amounts and coverage rules vary by payer. Some insurance plans may require prior authorization for either code or limit the number of covered sessions per year.
4. What documentation is required for billing 90847?
You must include:
- Who attended the session
- How the session addressed the patient’s mental health
- Goals discussed in relation to the treatment plan
- Evidence that the session was clinically justified and patient-focused
5. Are these codes covered for telehealth?
Yes, many payers allow 90846 and 90847 via telehealth, especially after the COVID-19 public health emergency. Be sure to use proper modifiers (e.g., 95 or GT) and confirm individual payer policies.