Family psytx w/pt 50 min
CPT 90847 covers family or couples psychotherapy sessions that last about 50 minutes and include the patient as an active participant. This is used when the therapist treats the patient alongside family members or partners to address mental health issues affecting relationships.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times in medical record; 90847 requires 38-52 minutes of face-to-face time with patient and family
Impact: Insufficient time documentation is the #1 audit trigger and can result in downcoding to 90846 (without patient) or full recoupment of $102.86 per session
Explicitly document the patient's active participation in the session; passive presence is insufficient for 90847
Impact: Auditors will downcode to 90846 ($95.87) if notes don't demonstrate patient engagement, resulting in $6.99 loss per session
Bill 90847 only once per date of service per patient regardless of session length beyond 52 minutes; use add-on code 90785 for interactive complexity when applicable
Impact: 90785 adds approximately $29-33 when complex communication factors are present and documented, increasing total reimbursement to ~$135
Verify provider credentials meet Medicare's psychotherapy requirements; not all mental health professionals can bill independently
Impact: Credentialing errors result in 100% denial; MFTs can bill in some states but not all Medicare contractors recognize them
For telehealth sessions, ensure both audio and video are used and documented; audio-only does not qualify for 90847
Impact: Audio-only sessions may be denied entirely or downgraded to phone consultation codes worth only $14-37
When family members join in-person session via telehealth, document the patient's physical location and modality used by each participant
Impact: Hybrid session documentation prevents medical review denials; unclear modality can trigger $102.86 recoupment per session
Applicable modifiers
When to use: When family therapy session is delivered via telehealth to patient's home
Reimbursement impact: No payment differential but required for proper telehealth billing; failure to append may cause denial
When to use: For synchronous telemedicine services rendered via real-time interactive audio and video telecommunications
Reimbursement impact: Maintains full reimbursement at $102.86; omission will cause telehealth claim denial
When to use: Via interactive audio and video telecommunications (some payers prefer over 95)
Reimbursement impact: Payer-specific; some state Medicaid programs require GT instead of 95 for telehealth
When to use: When billing same day as E/M or other psychotherapy service to indicate distinct session
Reimbursement impact: Prevents bundling denial; required when medical necessity supports multiple distinct sessions on same date
When to use: Clinical psychologist services provided in specific settings (HCPCS modifier)
Reimbursement impact: May be required by certain Medicare contractors; verify LCD requirements
When to use: Clinical social worker services (HCPCS modifier)
Reimbursement impact: Required by some MACs when LCSW provides service; failure to append may deny as non-covered provider
Common denials
Patient participation not documented in clinical notes
How to appeal: Submit progress note with highlighted sections showing patient's verbal contributions, responses to interventions, and active engagement. Include clinician attestation that patient participated for the documented time period. Reference CPT guidelines distinguishing 90847 from 90846.
Session time documented as less than 38 minutes or greater than 52 minutes without appropriate code selection
How to appeal: If time was actually 38-52 minutes, submit corrected documentation with start/stop times clearly marked. If session was shorter, accept downcoding. If longer than 52 minutes, explain CPT time rules do not allow billing multiple units of 90847 and this represents single session.
Billed same date as 90846 (family therapy without patient) without modifier 59
How to appeal: Submit documentation showing two distinct sessions occurred at different times with separate clinical purposes. Append modifier 59 to second service. Demonstrate medical necessity for both sessions on same date.
Provider type not recognized by payer for independent psychotherapy billing
How to appeal: Submit state licensure documentation and Medicare enrollment verification. If provider is MFT or LPC, verify contractor's Local Coverage Determination allows these credentials. May require incident-to billing under supervising physician if independent billing not allowed.
Frequently asked questions
What is the difference between CPT code 90847 and 90846?
CPT 90847 requires the patient to be present and actively participating in the family therapy session for 50 minutes, while 90846 is family psychotherapy without the patient present. The patient must engage in the therapeutic process for 90847, not just be physically in the room. Medicare pays $102.86 for 90847 versus $95.87 for 90846 in 2025.
How much does Medicare pay for CPT 90847 in 2025?
Medicare pays $102.86 for 90847 in non-facility settings and $102.54 in facility settings based on the 2025 Physician Fee Schedule. The code has 3.18 total RVUs (2.74 work RVU, 0.38 non-facility PE RVU, 0.06 MP RVU) multiplied by the conversion factor of 32.3465.
Can I bill 90847 for couples therapy?
Yes, 90847 is appropriate for couples therapy when one partner is the identified patient with a diagnosed mental health condition and both partners actively participate in the 50-minute session. The therapy must address the patient's condition through relationship dynamics, not just general relationship counseling.
What is the time requirement for billing CPT 90847?
90847 requires 38-52 minutes of face-to-face time. The typical time is 50 minutes, but CPT allows billing the code if actual time falls within this range. Sessions shorter than 38 minutes cannot be billed as 90847, and sessions longer than 52 minutes still only support one unit of 90847.
Can 90847 be billed via telehealth?
Yes, 90847 can be billed for telehealth services when provided via synchronous two-way audio and video technology. Append modifier 95 or GT (payer-specific) and ensure documentation reflects the telehealth modality. Audio-only sessions do not qualify for 90847. Medicare telehealth flexibilities currently allow billing from patient's home.
Who can bill CPT code 90847?
Psychiatrists, psychologists, licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), marriage and family therapists (MFTs), and psychiatric nurse practitioners can bill 90847, depending on state licensure and payer credentialing requirements. Medicare recognizes psychiatrists, psychologists, LCSWs, and psychiatric NPs; LPC and MFT recognition varies by Medicare contractor.
Can I bill 90847 and an E/M code on the same day?
Generally no, psychotherapy codes like 90847 are not billable with E/M codes on the same date unless the E/M represents a significant, separately identifiable service requiring modifier 25. Most payers consider psychotherapy to include assessment components. Exception: psychiatrists performing medication management may bill 90863 as add-on code with 90847 or use 99XXX with psychotherapy add-on codes instead.