When family relationships are involved in the healing process, proper billing is more than an administrative task; it serves as a safeguard for both patient care and provider reimbursement. CPT code 90847 family psychotherapy is the standard for sessions where the patient and family members work together in therapy.
With the help of the correct code, providers can offer effective treatment while maintaining compliance with billing regulations. At RPM CCM Health, our expert team ensures that your use of CPT code 90847 is accurate and compliant, helping you maximize reimbursement and focus on delivering quality care.
What is CPT Code 90847?
CPT code 90847 is the billing code for family or couples therapy sessions in which the identified patient is present. These sessions focus on family interaction with the patient to address patterns, behaviors, or conflicts that intersect with the patient’s treatment progress.
For instance, a clinician may provide therapy to a teenager and their parents with the intention of improving their communication or may provide psychotherapy to a couple to address relational stress that could be contributing to the patient’s anxiety or depression.
It is necessary to differentiate CPT code 90847 family psychotherapy from code 90846, which covers family therapy where the patient is not present. Both codes are worthwhile, but they are appropriate for different types of clinical situations, and choosing the correct code is essential for compliance and reimbursement.
90847 Billing Rules
Like all psychotherapy billing codes, 90847 billing rules have designated requirements for billing. The code is generally billed by either licensed mental health providers, such as psychiatrists, psychologists, or licensed clinical social workers, or mental health professionals such as marriage and family therapists, depending on the payers.
Another thing to note is that the length of sessions is usually documented in 50-minute segments, and most payers will allow 90847 billing rules with sessions beginning at 26 minutes long. Providers must be aware of payer-specific policies. While Medicare and most commercial insurers recognize 90847, local coverage requirements can vary, especially around billing for same-day service or telehealth.
Regardless of the carrier, what’s consistent across all carriers is that 90847 should not be used for case management, gathering a family history alone, or meetings that don’t involve psychotherapy interventions.
Documentation Requirements for 90847
Because reimbursement depends heavily on defensible charting, comprehending 90847 documentation requirements is important. A well-documented session should always include:
- The session date, start and stop times, and total minutes.
- Identification of who attended and their relationship to the patient.
- A clear explanation of why family participation was necessary for treatment.
- Specific therapeutic interventions and clinical goals.
- The patient’s involvement and response to the session.
- The treatment plan is moving forward.
Strong documentation goes beyond supporting medical necessity; it will also protect the provider in the event of a claim denial or audit. Payers typically view vague notes, i.e., “family therapy provided” or “group therapy session”, as a red flag, whereas concise yet detailed goal-oriented 90847 documentation requirements will help you avoid denials in the future.
Family Therapy With Patient vs. Without Patient (90847 vs. 90846)
People often get confused about whether to use family therapy with patient CPT 90847 or 90846. The difference is simple but necessary to know:
- 90847 — This applies when the patient participates in the family or couples session; these sessions focus on their interaction with relatives or significant others.
- 90846 — This practice applies when the provider meets only with family members or caregivers, without the patient, generally to provide support, gather collateral information, or address family dynamics separately.
Knowing the correct billing code can help avoid denials and ensure an accurate reflection of the clinical service delivered.
Insurance Coverage and Reimbursement for 90847
When properly submitted, most large insurers, including Medicare, will reimburse 90847 billing rules. However, reimbursement limits and policies vary widely. Common denial problems include:
- Missing or incomplete time documentation.
- Insufficient evidence of medical necessity.
- Using 90847 when the patient wasn’t present.
- Lack of clarity on whether the service was psychotherapy versus case management.
To make the most of reimbursement, providers need to verify coverage and benefits before beginning the treatment.
Furthermore, during this process, document every required element thoroughly and stay informed about payer-specific rules. For instance, Medicare recognizes CPT Code 90847 family psychotherapy but places limits based on provider type and service location.
How RPM CCM Health Supports Providers
The billing procedure of psychotherapy can be complicated, and any errors can further increase the cost. With that in mind, at RPM CCM Health, we provide the expertise providers need to work through these challenges with confidence. With the help of our expert team, you can expect:
- Guidance on the correct use of 90847 vs 90846 billing and other behavioral health codes.
- Claims review and denial management to identify recurring issues.
- Documentation support to align with payer expectations and reduce audit risks.
- Training and ongoing compliance support to keep providers current with policy updates.
By working with RPM CCM Health, clinicians can focus on patient care while we help handle the intricacies of billing and compliance.
Make Every Family Session Count — and Get Paid for It
Family therapy is an effective method of treatment for mental health, but it must be billed the right way to achieve both clinical and financial success.
If you need expert assistance working with CPT code 90847 family psychotherapy, from billing guidance to documentation strategies, RPM CCM Health can assist you. Contact us today to reduce denials, simplify your claims, and feel confident after getting the reimbursement you deserve.
FAQ
What is CPT code 90847 used for?
CPT Code 90847 family psychotherapy is used for family or couples psychotherapy sessions with the patient present, typically documented as lasting 50 minutes.
How is 90847 different from 90846?
90847 includes the patient in the family session, while 90846 is used when the patient is not present.
Can 90847 be billed for telehealth?
Absolutely, a lot of payers, including Medicare in certain circumstances, allow 90847 to be billed for telehealth if documentation and consent requirements are met.
Does Medicare cover 90847?
Medicare generally covers family psychotherapy sessions, but reimbursement details vary by provider type and regional Medicare Administrative Contractors.
