Family’s presence plays a significant role in supporting mental health treatment, and at times, therapy sessions prove to be more effective in the absence of the patient. CPT Code 90846 Family Psychotherapy Without Patient Present is used for billing these specialized sessions. This ensures providers responsible for offering mental health services are properly and timely reimbursed for their time spent working with the family members to boost patient results, strengthen interaction, and support the goals for treatment. For CPT code 90846, family psychotherapy, accurate billing and documentation are critical. Even the slightest misuse can lead to denied claims, compliance issues, or delayed repayments.
At RPM CCM Health, our team assists providers in navigating 90846 billing guidelines, requirements regarding insurance coverage, and best practices to stay on track with compliance so they can look after patients.
What is CPT Code 90846?
CPT Code 90846 represents family psychotherapy without the patient present. This typically lasts for 50 minutes and is designed for therapeutic sessions, where the provider directly works with family members or caregivers to address issues affecting the patient’s recovery and treatment.
Clinical scenarios for 90846 include
- To educate family members about the diagnosis of the patient’s mental health.
- Guide the family members on how their behavior can influence the patient’s symptoms.
- Teach strategies to cope so they can provide a better home environment for the patient.
- Support children, parents, or adults during treatment.
- Address marital or stress from the caregiver’s end that is impacting patient care.
90846 vs. 90847
It’s vital to differentiate between the two key family therapy billing codes:
- 90846
Family psychotherapy without the patient present.
- 90847
Family psychotherapy with the patient present.
Both are equally valuable units of mental health treatment, but again, correct code selection is necessary for compliance and repayment.
90846 Billing Guidelines
Understand the 90846 billing guidelines, as that is how you can ensure that claims are correctly being processed:
Who can bill 90846?
- Psychologists, psychiatrists, licensed marriage and family therapists, licensed professional counselors, and clinical social workers can bill 90846.
- Remember that some states or payers might ask for particular credentials, so always verify before billing.
When to use 90846?
- When your therapeutic concentration is on family members instead of the patient.
- When your patient’s presence may hinder candid family discussions.
- While planning treatment sessions, you need to talk to the family separately.
Session time requirements
- 90846 shows a 50-minute session.
- If the sessions are shorter than 30 minutes, you need not bill them.
Payer-specific Considerations
- Insurers might require prior authorization.
- The patient’s psychotherapy session documentation must clearly mention why it was necessary to conduct the therapy in the absence of the patient.
- The insurer’s coverage may vary depending on what was diagnosed and how you plan to treat the issue.
Family Therapy Billing Codes Overview
Keep in mind that family therapy is very different from individual psychotherapy, clinically and in terms of billing:
- 90846 without patient and 90847 with patient are the primary family therapy billing codes.
- Providers are required to carefully document whether the patient was there to choose the correct code.
- This kind of psychotherapy is usually billed in behavioral health practices, marriage counseling, pediatric care, and treatment programs, where support from the family is considered critical.
Using these codes correctly assists in ensuring these providers are properly reimbursed for the care they provide.
Documentation Requirements for 90846
The clearer the documentation, the quicker the reimbursement for CPT code 90846 family psychotherapy:
Required Elements
- Session Length: Mention that the session lasted for 50 minutes.
- Reason For Excluding Patient: Provide an explanation for why the patient was not there. It could be treatment planning, a sensitive family environment, and age appropriateness.
- Family Involvement and Clinical Focus: Write which family members were part of the session and what goals were addressed.
- Progress Toward Treatment Goals: Share the progress of the patient toward treatment goals.
Best Practices To Reduce Audit Risk
- Avoid generalized session notes
- Associate family therapy discussions back to the clinical needs of the patient.
- Separate billing for family psychotherapy from individual psychotherapy.
90846 Insurance Coverage and Reimbursement
90846 insurance coverage claims depend on the diagnosed issue, payer, and treatment plan
How Insurers Handle 90846?
- When judged medically necessary, most commercial insurance plans cover 90846.
- The patient has to qualify for a mental health diagnosis to access coverage.
- The paperwork must give substantial reasons why the session was without the patient.
Medicare Coverage
- Medicare reimburses family psychotherapy services if properly documented.
- Providers should confirm with local coverage determination for particular rules.
Common Denial Reasons
- Vague details about the patient’s absence.
- There is a lack of clarity between the family session and the patient’s treatment goals.
- Exceeding session limits without prior authorization.
Challenges and Best Practices in Billing 90846
Frequent Provider Barriers
- Confusion between 90846 and 90847.
- Continuous inconsistency of detailing sessions.
- Different payer requirements deny the claims.
Best Practices
- Train the billing staff on family therapy coding differences.
- Use documentation templates to capture required details.
- Track payer-specific rules for easier claims processing.
- Remember telehealth compliance requirements when applicable.
How RPM CCM Health Supports Providers?
RPM CCM Health is an expert in assisting providers through the complicated behavioral health billing and staying compliant:
Our services include:
Expert Coding Guidance: We accurately use the family therapy billing codes, including 90846 and 90847.
Claims Management: Simplifies submissions and decreases denial rates with payer-specific rules.
Telehealth Support: Our teams remain compliant with changing psychotherapy rules without the patient present.
Teach Staff: Teach staff about the latest updates in coding and compliance.
Letting RPM CCM Health manage the billing and reimbursement allows you and the practices to deliver quality care.
Contact RPM CCM Health Today
Struggling with family psychotherapy billing and coding? RPM CCM Health can help you optimize compliance for CPT code 90846 family psychotherapy and maximize reimbursement.
Frequently Asked Questions (FAQ)
Q1: What does CPT code 90846 cover?
A: The code covers family psychotherapy sessions without the patient present, which lasts for 50 minutes.
Q2: Can 90846 be billed for telehealth sessions?
A: Only if the necessary guidelines and standards of the telehealth documentation are met. Always confirm with the insurance provider.
Q3: What’s the difference between 90846 and 90847?
A: 90847 is used when the patient participates in the psychotherapy session, while 90846 is applicable in family therapy sessions without the patient in the room.
Q4: Does insurance cover 90846?
A: Majority insurers cover 90846, but requirements and reimbursements vary. Kindly check your payer’s rules to learn about coverage details.
