What Are CPT 90846 and 90847?
Both codes are used for family psychotherapy services.
The key distinction is whether the patient is present.
90846
Family psychotherapy, without the patient present.
90847
Family psychotherapy, with the patient present.
CMS's current Medicare guidance identifies 90846 as family psychotherapy without the patient present and distinguishes it from 90847.
90846
90846 is used when the psychotherapy session is conducted with the patient's family member(s) or other appropriate participants without the patient present, when the service meets the applicable requirements.
The documentation should clearly support:
- Who participated
- Relationship to patient
- Clinical purpose
- Treatment relevance
- Service provided
- Time, where applicable
- Medical necessity
90847
90847 is used when the patient is present during the family psychotherapy service.
The record should support the involvement of the patient and family/other participants as applicable.
Common 90846/90847 Billing Problems
Wrong Code
A practice may accidentally submit 90846 when the patient was present or 90847 when the patient was not.
Documentation
The record should make participation clear.
Authorization
Some plans have specific behavioral-health authorization requirements.
Eligibility
Family therapy benefits may differ from individual psychotherapy benefits.
Telehealth
Telehealth requirements can differ by payer.
For Medicare professional telehealth claims, POS 02 and POS 10 distinguish whether the patient is located outside or inside their home.
Always verify the applicable payer's requirements.