CPT Code 90847 & 90846: The Definitive Guide (+Reimbursement Rates)

CPT Code 90847 and procedure code 90846 can be challenging to bill.  Here's a guide on how to bill mental health family therapy CPT codes 90847 and 90846. We will teach you the differences between family and couples or marriage counseling.

NOTE: This guide has been updated in 2020 to reflect current CPT Code 90847 reimbursement rates.

Unlike individual therapy sessions, using the correct code to bill mental health family therapy depends on the members of the family in session.

We are going to explain both CPT Code 90847 and CPT Code 90846, walk through four examples, and explain how to bill each example.

CPT Code 90847 vs CPT Code 90846

By the end of this article you’ll know what codes to use, when, to bill family therapy for mental health CPT codes 90847 and 90846.

We’ll also explain which Add-on codes to use in conjunction with CPT codes 90846 and 90847 as well as the 90847 reimbursement rates for family therapy with or without the patient present.

If you’d prefer to just have us help you do this, we provide an insurance billing service exclusively for mental health providers and we’re happy to help.

CPT Code 90847 Description

  • 90847 – Family or couples therapy, with patient present.

These sessions need to be at least 26 minutes in length.  This is the cpt code for ongoing couples therapy or marriage and family therapy for two clients.  You cannot bill both clients, this is considered one “service code” and will most often reimburse at a higher rate.

CPT Code 90846 Description

  • 90846 – Family or couples therapy, without patient present.

These sessions need to be at least 26 minutes in length.

  • 90837 – Individual therapy for 60 minutes.

These sessions need to be at least 53 minutes in length.

If medical management services are performed, use the 25 modifier. Interactive complexity services CPT code 90785 are not allowed with this service.

If you’d rather not worry about remembering any of this, we can help you decipher these situations into maximally paid claims on your behalf with our mental health billing service.

90846 & 90847 Reimbursement Rates for Family & Couples Therapy

Medicare lists the national payment amount for couples and family therapy as:

CPT Code 90846 Reimbursement Rate (2020): $103.58

— Family psychotherapy without the patient present Medicare reimbursement rate

CPT Code 90847 Reimbursement Rate (2020): $107.19

— Family psychotherapy with the patient present Medicare reimbursement rate

CPT Add-On Code +99354 Reimbursement Rate (2020):  $132.09

— Additional time up to 1 hour and 45 minutes for family therapy with or without the patient present

CPT Add-On Code +99355 Reimbursement Rate (2020):  $100.33

— Additional time up to 2 and a half hours for family therapy with or without the patient present

(Source)

Each insurance company will reimburse for different amounts for the above CPT codes depending on your license, location, relationship with that insurance company, and the type of plan the client may have.

Not all add on codes or family therapy codes are allowed by insurance, so please call to verify eligibility and benefits before seeing your clients (or we can do it for you).

90846 & 90847 Time Frame

CPT Code 90847 Time Frame: 50 to 74 Minutes

There are technically no maximums for coding family therapy sessions with CPT codes 90846 and 90847.

If you do want to bill additional time for providing services, we recommend at least 74 minutes of family therapy service before considering using an add-on CPT code for additional time rending couples therapy or family therapy services.

CPT Code 90846 Time Frame: 50 to 74 Minutes

Medicare lists the minimum required time for couples therapy or family therapy with or without the patient present at 50 minutes.  (Source)

90846 & 90847 Add-On Codes for Extra Billing Time

If your services are longer than 74 minutes, use +99354 to bill an additional 30 minutes of time.

So if your session is between a bit over an hour and 1 hour and 45 minutes, use +99354.

If your session for couples therapy or family therapy is longer than 1 hour and 45 minutes, add +99355 to your claim form for an additional 44-45 minutes of services.  CPT code +99355 covers couples and family therapy sessions between 1 hour and 45 minutes and 2 hours and 30 minutes.

  • First 74 minutes:  CPT Code 90846 or 90847
  • 75 to 1 hour and 45 minutes:  Code 90846 or 90847 +99354
  • 1 hour and 45 minutes to 2 and a half hours:  90846 or 90847 +99354 +99355

Family Therapy Insurance Billing Scenario

Let’s say three people all attend therapy:

  • Client A (mom),
  • Client B (child),
  • and Client C (child).

Let’s say that Client B is the person who is specifically needing treatment.  Client A and Client C are part of the reason that treatment is needed, as it’s a family matter.  Then Client A, the mother, due to her own distress, decides to enter treatment.

Let’s say these folks have 4 total sessions.  Here’s what they look like:

Session 1)  They all attend therapy together.

Session 2)  Then the following week, the mother, Client A is seen about the child in treatment, Client B.

Session 3)  Then the next day, Client B is seen individually.

Session 4)  And a final week later, the mother, Client A, decides that she needs to seek out therapy as well and sees the therapist about her own treatment needs.

How to Bill These Family Therapy Sessions

Session 1:  We use CPT code 90847 for family therapy with the patient (Client B) present.  We then use Client B’s information when filing the claim, including their diagnosis code.

Session 2:  We use CPT code 90846 for family therapy with the patient (Client B) not present.  We use Client B’s information and diagnosis code when filing out the claim form.  We may want to add additional diagnoses here as we learn more about the treatment situation.

Session 3:  We use CPT code 90837 here for treatment with the client, Client B.  Even if this client is seeking therapy about their family issues, they are seeking individual therapy.  Use Client B’s information on the claim forms too.

Session 4:  We are also using CPT code 90837 for the new client, Client A, as Client A is now requesting their own treatment (about their family issue).  We would use Client A’s information and diagnosis when filing this form.

Summary

Always use the person who is the primary treatment seeker on your claims forms.  They are the person who is seeking treatment, even if a family member is attending therapy to their benefit (90847).  So even if they are not in session, like with 90846, their information is to be used.

If all of this is too much, feel free to drop us a line about our mental health billing service for therapists.  We handle these sorts of questions daily.