CPT 90849Mental Health

Multiple family group psytx

CPT code 90849 covers group therapy sessions where a mental health professional works with multiple families together (not individual family therapy). This is typically used when several families dealing with similar issues meet as a therapeutic group.

Showing rates for

National Average

Base Medicare rate

$37.52

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

0.65

PE RVU (NF)

0.49

MP RVU

0.02

Total RVU

1.16

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

NCCI bundling edits

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Billing tips

Verify the number of families present meets payer definition of 'multiple family group' (typically minimum 2-3 families required)
Impact: Billing for single family as 90849 instead of 90846-90847 results in automatic denial and $30-80 underpayment per session
Document each family unit separately in the clinical note with specific interventions and participation details for each family
Impact: Prevents medical necessity denials and audit recoupments; audits of group therapy result in 60% denial rate when individual family participation not documented
Bill on the date of service, not on a consolidated monthly basis, and ensure time documentation supports the service
Impact: Delayed billing beyond 90 days may result in timely filing denials; specific time documentation prevents downcoding disputes
Check if payer requires pre-authorization or treatment plan submission for ongoing multiple family group therapy
Impact: Pre-auth denials can result in $0 payment; some Medicaid programs require treatment plans every 6 months
Use place of service code 11 (office) for outpatient settings, 53 for community mental health centers - impacts facility vs non-facility rate difference of $8.08
Impact: Incorrect POS code triggers $8.08 per session variance between $37.52 and $29.44 rates
For Medicare, ensure service is rendered by qualified practitioner as Medicare does not recognize all counselor credentials independently
Impact: Non-qualified practitioner billing independently results in 100% denial; incident-to billing may be option with proper supervision

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Frequently asked questions

What is the difference between CPT 90849 and 90847?

CPT 90849 is for multiple family group psychotherapy where several different families meet together in one group session. CPT 90847 is for family psychotherapy with patient present, treating one single family unit. The key distinction is whether you're treating multiple families together (90849) or one family (90847).

How many families are required to bill CPT 90849?

Most payers require a minimum of 2-3 separate family units to qualify as multiple family group therapy under 90849. If only one family is present, you must bill the appropriate single family therapy code (90846 or 90847). Document each family unit clearly in your notes.

What is the Medicare reimbursement rate for CPT 90849 in 2025?

The 2025 Medicare national average reimbursement for CPT 90849 is $37.52 for non-facility settings and $29.44 for facility settings. Actual payment may vary based on geographic locality adjustments and your specific MAC region.

Can I bill 90849 for telehealth services?

Yes, CPT 90849 can be billed for telehealth services when conducted via synchronous audio-video platform. Append modifier 95 to indicate telehealth delivery. Verify current payer policies as telehealth coverage varies by state and insurance plan, especially post-public health emergency.

Do I need a treatment plan to bill CPT 90849?

Yes, most payers require an individualized treatment plan for each family participating in multiple family group therapy. The treatment plan should document why the group modality is clinically appropriate for each family's diagnosis and treatment goals. Some Medicaid programs require treatment plan updates every 6 months.

What credentials do I need to bill CPT 90849?

You must be a licensed mental health professional authorized to provide psychotherapy in your state. This typically includes psychiatrists, psychologists, LCSWs, LMFTs, or LPCs. For Medicare, the provider must be a physician or qualified non-physician practitioner enrolled in Medicare. State licensing requirements vary.

Can I bill 90849 and 90847 on the same day for the same patient?

Generally not recommended without compelling clinical documentation showing distinct, separate sessions at different times. If both services are provided on the same day, append modifier 59 to indicate a distinct procedural service and document separate start/stop times, different therapeutic goals, and medical necessity for both sessions. Many payers will deny as duplicate services.