Family psytx w/o pt 50 min
CPT 90846 covers family or couples therapy sessions lasting approximately 50 minutes where the patient themselves is not present. This allows therapists to work with family members or partners to address issues affecting the identified patient's mental health treatment.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times for the 50-minute session and explicitly state that the identified patient was not present
Impact: Prevents denials based on insufficient documentation or confusion with 90847; protects full $98.66 reimbursement
Include clear medical necessity documentation linking the family session to the identified patient's treatment plan and diagnosis
Impact: Reduces denial rate by 40-60% for lack of medical necessity; essential for audit defense and reimbursement protection
Bill under the identified patient's name and account, not the family member attending the session, using the patient's active mental health diagnosis code
Impact: Critical for claim processing; billing under wrong patient causes immediate denial and delays payment by 30-60 days during correction
Verify payer-specific visit limits for family therapy; many plans limit 90846 to 2-4 sessions per year without prior authorization
Impact: Proactive authorization can secure payment for additional sessions worth $98.66 each; retroactive denials are difficult to overturn
Do not bill 90846 on the same day as 90847 (family therapy with patient present) without modifier 59 and clear documentation of separate sessions
Impact: Bundling denials result in loss of one service payment ($98.66); modifier 59 with proper documentation protects both claims
For Medicare patients, ensure the service meets the partial hospitalization or intensive outpatient program criteria if billing in those settings
Impact: Incorrect setting billing can trigger facility vs. non-facility rate differences ($0.33 per claim) and potential compliance audits
Common denials
Lack of medical necessity or insufficient documentation linking family session to patient's treatment plan
How to appeal: Submit treatment plan showing family therapy as integral component, progress notes documenting family dynamics impact on patient outcomes, and clinical rationale for excluding patient from this specific session
Patient present during session (should have been coded 90847 instead of 90846)
How to appeal: Provide session note with explicit statement that patient was not present, list attendees by relationship to patient, and explain clinical rationale for patient's absence; may need to submit corrected claim with 90847 if patient was actually present
Exceeds payer's annual or quarterly visit limits for family therapy without patient present
How to appeal: Submit prior authorization request with clinical justification for additional sessions, document crisis intervention or significant changes in patient's condition requiring increased family involvement, and provide outcome data from previous sessions
Services billed under family member's name/account instead of identified patient's name/account
How to appeal: Submit corrected claim with proper patient identification, include patient's active diagnosis code, and attach explanation that service was for identified patient's benefit; original claim typically requires complete rebilling rather than appeal
Frequently asked questions
What is CPT code 90846 used for?
CPT code 90846 is used for family or couples psychotherapy sessions lasting approximately 50 minutes where the identified patient is NOT present. The therapist works with family members, partners, or significant others to address issues affecting the patient's mental health treatment.
How much does Medicare pay for CPT code 90846 in 2025?
Medicare pays $98.66 for 90846 in non-facility settings and $98.33 in facility settings based on the 2025 national average rates. Actual reimbursement may vary by geographic locality based on the GPCI adjustment factors.
What is the difference between CPT 90846 and 90847?
CPT 90846 is family psychotherapy WITHOUT the patient present, while 90847 is family psychotherapy WITH the patient present. The key difference is whether the identified patient attends the session. Documentation must clearly state patient presence or absence.
Can I bill 90846 and 90847 on the same day?
Yes, but only if they are distinct and separate sessions with clear documentation supporting medical necessity for both. Modifier 59 should be appended to one code, and documentation must show different start/stop times and separate therapeutic interventions for each session.
How long does a 90846 session need to be?
CPT 90846 represents approximately 50 minutes of face-to-face psychotherapy time. While some flexibility exists, sessions significantly shorter than 45-50 minutes may require modifier 52 (reduced services) and will likely receive reduced reimbursement.
Who can bill CPT code 90846?
Independently licensed mental health professionals can bill 90846, including psychiatrists, psychologists, clinical social workers (LCSWs), licensed professional counselors (LPCs), and marriage and family therapists (LMFTs). State licensure and payer credentialing requirements apply.
Does insurance cover family therapy without the patient present?
Most insurance plans cover 90846 when medically necessary as part of the identified patient's treatment plan, but many impose visit limits (typically 2-4 sessions per year) without prior authorization. Medical necessity documentation linking the family session to the patient's diagnosis and treatment goals is essential for coverage.