CPT Code 90846 and 90847: Know Your Codes
90846 and 90847 Code Description
The main difference between these codes is that the 90846 CPT code is used for appointments when the patient is not present, and the 90847 CPT code is used for appointments when the patient is present. Often, these appointments entail family participation in the treatment process of a person in that family. If a married couple identifies as a family, they may qualify for the family code as well depending on the insurance. When it’s a child being treated, it’s usually with the expectation that intervention in their family interactions will improve their emotional or behavioral disturbances.
- 90846 CPT Code Description: Family psychotherapy (without the patient present), 50 minutes.
- 90847 CPT Code Description: family psychotherapy (with the patient present), 50 minutes.
As per our experience – Most of the insurance companies will not cover 90847. CPT Code 90847 is not considered to be a routine service by all insurers. Medicare only will allow for it under two situations.
- A need to observe and correct a patient’s interaction with family members.
- Where there is a need to assess the conflicts or impediments within the family and assist, through psychotherapy, the family members in the management of the patient.
Individual vs Family Psychotherapy Sessions
If a family member is brought into individual psychotherapy sessions intermittently or briefly, you don’t have to bill these family codes. You can use individual psychotherapy codes, 90832, 90834, or 90837. Just make sure the intent of the session/s is not the family member’s benefit. The patient can get some benefit by having the family member there, but if both people are benefiting, then you must use 90846 CPT code or 90847 CPT code, since family sessions are about all individuals in the session benefiting from the service.
When you call to check coverage, don’t ask if they cover couples or family counseling (which to them may sound like you are doing couples communication work) – ask instead if the plan covers 90847 CPT code for a client with a diagnosis.
Couples or family therapy may be covered when it is necessary to assess and treat the diagnosis of one family member. This means the goal of treatment can’t be solely relationship growth or communication skills – for insurance to cover it, you’ll need to have someone in the room who is your identified patient (IP) who has a diagnosis (typically something more than a DSM-V Z-code).
Billing CPT Code 90846 and 90847
Assess all members of the couples or family for diagnoses, and choose one client with a diagnosis as your identified patient. If two or more clients have diagnoses, you may choose , though you may want to choose the one with the more severe symptoms, or ask the clients if they have a preference. If one client is the primary holder of their insurance you might choose him/her. The CPT code 90847 on the claim reflects a couples or family session therapy session took place. The names of other session attendees should not be listed on the claim. Put only your IP’s diagnosis code on the claim (not the name of the diagnosis).
The individual clinician is always responsible for ensuring they are using the most accurate and appropriate CPT billing code when billing for services provided, regardless of who does the actual billing on the clinician’s behalf. Please ensure you understand and bill for the correct CPT code for the services provided to your patient.
Additional Reimbursement Tips
Some insurance providers, like Medicare, cover family psychotherapy services only when the primary purpose of the visit is the treatment of the patient’s condition. Examples of this include:
- When there is a need to observe and correct, through psychotherapeutic techniques, the patient’s interaction with family members
- When there is a need to assess the conflicts or impediments within the family, and assist, through psychotherapy, the family members in the management of the patient
You may also run into limitations such as:
- Only being able to bill family codes a certain number of times a year
- Specific age-requirements for children being treated
- Adult patients not being covered
CPT © Copyright 2021 American Medical Association
For accurate Mental/Behavioral Health medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate Mental/Behavioral Health medical billing and coding. To know more about our services call us at 888-552-1290 or write to us at [email protected]