CPT Code 90846 is a procedure code for licensed behavioral health providers. 90846 is defined as Family psychotherapy (without the patient present), 50 minutes.
Along with 90847 it falls into a subgroup of family psychotherapy procedure codes.
The procedure code is frequently billed by Licensed Clinical Social Workers (LCSW), Licensed Professional Counselors (LPC), Licensed Marriage Family Therapist (LMFT), clinical psychologists and psychiatrists.
CPT Code 90846 Description
Family psychotherapy (without the patient present), 50 minutes.
CPT Code 90846 Time Limit
How long do 90846 sessions have to be? 50 minutes is explicitly mentioned in the code description, so do appointments need to be 50 minutes to bill?
Like other time-based CPT codes, 90846 uses a range that is more flexible than the official description would indicate.
Appointments need to last for a minimum of 26 minutes for you to bill 90846. Shorter sessions cannot use this procedure code. Always make sure to document the time spent to ensure you can bill this code.
90846 vs. 90847
These are very similar CPT codes and both squarely land into the family psychotherapy CPT codes. The difference is 90846 does not have the patient present, whereas 90847 includes the patient.
If you’re struggling to sort through which of these is which, and when to use one versus the other, consider hiring TheraThink’s billing service exclusively for licensed mental health professionals.
CPT Code 90846 Reimbursement Rate
There are no hard rules for 90846 and reimbursement tends to vary depending on the insurer. In addition, reimbursement depends on the degree level of the provider and on average we find that insurer fee schedules allow for payment amounts between 90834 and 90837. This range can vary from $60-$115.
90846 Reimbursement Rate 2021: $99.10
CPT Code 90846 Medicare 2020 Reimbursement Rate: $103.58
There are a couple notable restrictions to 90846.
- 90846 cannot be billed the same day as 90847, so if the client is present for part of the time be sure to bill 9084.
- 90846 can not be billed for extended time. If there is a 90 minute (or longer) session you must still just bill 90846 alone, rather than 90846 + 99354.
- 90846 isn’t always considered routine. Different insurance companies process 90846 differently and it isn’t as universally accepted as other psychotherapy procedure codes. There are often age requirements of 18 or 21. Other insurance companies simply won’t reimburse for 90846. It is always best to call the insurance ahead of time to make sure. Our billing service can do this for you.
- Does 90846 require authorization? In some cases it may. As a result, this is another area where a professional billing service, such as TheraThink can help.
How to Bill CPT Code 90846
On the claim, the client should be listed as the identified patient in the session. On the CMS 1500, you or your biller must include all the required demographic information as you would for a routine psychotherapy like 90834 or 90837.
Just like other CPT codes, it should go in the 24(c) location of a CMS 1500.
90846 License Level Requirements
Make sure you are a licensed mental health professional with one of the following license levels to bill 90846:
- Licensed Clinical Social Workers (LCSW)
- Licensed Professional Counselors (LPC)
- Licensed Marriage Family Therapist (LMFT)
- Clinical psychologists (PhD or PsyD)
- Psychiatrists (MD)