CPT 90846Mental Health

Family psytx w/o pt 50 min

CPT code 90846 covers family or couple psychotherapy sessions that last approximately 50 minutes where the patient is not present. This allows mental health professionals to work with family members to improve treatment outcomes and address family dynamics affecting the patient's condition.

Showing rates for

National Average

Base Medicare rate

$98.66

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

2.63

PE RVU (NF)

0.36

MP RVU

0.06

Total RVU

3.05

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document medical necessity clearly by linking the family session to the identified patient's diagnosis and treatment plan
Impact: Reduces denial rate by approximately 60-70%; medical necessity is the #1 reason for 90846 denials
Explicitly state in the note why the patient's absence was therapeutically indicated (not just convenience)
Impact: Critical for payer acceptance; without this justification, expect 40-50% initial denial rate
Verify the identified patient has an active treatment relationship and recent individual session within the same episode of care
Impact: Payers typically require individual sessions within 30-60 days; failure to demonstrate ongoing treatment results in denials
Time documentation must support 50 minutes (38-52 minutes acceptable range); document start and stop times
Impact: Sessions under 38 minutes should be billed as 90847 (not 90846); underdocumented time leads to downcoding and $40+ loss
For commercial payers, verify coverage of 90846 in advance as some plans exclude family therapy without patient present
Impact: Pre-authorization can prevent 100% payment loss; approximately 15-20% of commercial plans have specific exclusions
Bill 90846 under the identified patient's name and member ID, not the attending family member's information
Impact: Billing error causes immediate rejection; correct patient identification is essential for claims processing

Applicable modifiers

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Frequently asked questions

What is CPT code 90846 used for?

CPT code 90846 is used to bill for family or couple psychotherapy sessions lasting approximately 50 minutes where the identified patient is not present. The session focuses on treating the patient's mental health condition by working with family members or significant others to modify family dynamics, provide psychoeducation, or develop strategies to support the patient's treatment.

How much does Medicare pay for CPT 90846 in 2025?

Medicare pays $98.66 for CPT 90846 in non-facility settings and $98.33 in facility settings based on the 2025 national average rates. Actual reimbursement may vary by geographic location due to locality-based adjustments to the Medicare Physician Fee Schedule.

Can I bill 90846 if the patient is present in the session?

No, CPT 90846 is specifically for sessions where the identified patient is NOT present. If the patient is present during the family therapy session, you should bill CPT 90847 instead, which is family psychotherapy with the patient present.

How many times can you bill 90846 for the same patient?

There is no specific Medicare limit on the frequency of billing 90846, but medical necessity must be documented for each session. Commercial payers may have visit limits or require authorization after a certain number of sessions. Best practice is to intersperse 90846 sessions with individual therapy (90832-90838) to demonstrate ongoing patient treatment and avoid scrutiny.

What is the difference between 90846 and 90847?

The key difference is patient presence: 90846 is family psychotherapy WITHOUT the patient present (50 minutes), while 90847 is family psychotherapy WITH the patient present (50 minutes). Both are 50-minute sessions focused on family dynamics, but 90846 requires specific documentation justifying why the patient's absence was therapeutically indicated.

Can I bill 90846 and individual therapy on the same day?

Yes, you can bill 90846 and individual therapy codes (90832-90838) on the same day if they are distinct sessions with different participants and separate documentation. Use modifier 59 on 90846 to indicate a separately identifiable service. Ensure each session meets time requirements and has independent medical necessity documentation.

Do I need patient consent to bill 90846 when they are not present?

Yes, you need the identified patient's authorization to conduct and bill for family therapy sessions in their absence, as the service is billed under the patient's name and insurance. This should be documented in your initial consent forms. For minors, parental consent is typically sufficient, but state laws vary regarding adolescent consent requirements for mental health treatment.