Family Therapy Billing Codes and Reimbursement

Family Therapy Billing Overview

Family therapy uses two primary CPT codes: 90847 (with patient present) and 90846 (without patient present). Reimbursement for 90847 ranges from $100 to $160 per session. 90846 reimburses $90 to $140. Both require the identified patient to have an active diagnosis and treatment plan on file. The distinction between the two codes is whether the patient participates in the session.

When to Use Each Code

1. 90847: Patient is in the room and participating. Use for parent-child sessions, couples therapy under a patient's plan, or family sessions addressing the patient's treatment goals.
2. 90846: Patient is not present. Use for collateral sessions (e.g., training a parent in behavioral management techniques for a child's diagnosis). The session must still address the patient's treatment plan.
3. Do not use 90847/90846 for family education or support groups. Those are not reimbursable under psychotherapy codes.

Documentation and Payer Rules

Document session length (minimum 26 minutes), all participants by name and relationship to patient, treatment goals addressed, modality used, and patient outcome. UnitedHealthcare requires prior authorization for family therapy after the initial evaluation. Anthem accepts family therapy without separate auth if it's part of the treatment plan. Aetna covers both codes at parity with individual therapy rates. Medicare covers family therapy under Part B when medically necessary.

Common Denials

CO-16 occurs when the wrong code is used (90847 vs 90846). CO-50 indicates missing authorization. PR-1 flags missing participant documentation. Always verify which code matches the session before submitting. See behavioral health denial appeals for payer-specific escalation.