CPT 90847 is the go-to billing code for family therapy sessions where the identified patient is present and participating. Whether you are treating couples navigating relationship challenges, families working through communication issues, or conducting conjoint sessions with a minor and their parents, getting this code right is essential for proper reimbursement and compliance.
This guide covers everything you need to know about CPT 90847: who qualifies as "family," time requirements, the critical distinction between 90847 and 90846, documentation essentials, and payer-specific rules that can make or break your claims. If you bill for any type of family or couples therapy, you will find practical guidance here.
What is CPT 90847?
CPT 90847 is a Current Procedural Terminology code used to bill for family psychotherapy sessions when the identified patient is present. The code covers therapeutic interventions that address family dynamics, communication patterns, and relational issues as they relate to the patient's mental health treatment.
The official AMA description reads: "Family psychotherapy (conjoint psychotherapy) (with patient present), approximately 50 minutes." This means the session involves the patient plus one or more family members, and the therapeutic work focuses on the family system rather than individual pathology alone.
Unlike individual therapy codes (90832, 90834, 90837), CPT 90847 is not strictly time-based with defined ranges. The "approximately 50 minutes" descriptor is a guideline, not a rigid boundary. However, your documentation should still reflect the actual session duration, and sessions significantly shorter than 50 minutes may raise questions from payers.
The Key Distinction: Patient Present
The defining characteristic of 90847 is that the identified patient participates in the session. This is the person whose diagnosis supports medical necessity for the therapy. When you bill insurance, you bill under this patient's name and insurance, using their diagnosis code.
If you are conducting a session with family members but the identified patient is not present, you would use CPT 90846 instead. This distinction is critical and is one of the most common sources of billing errors in family therapy.
The Patient Present Requirement
For CPT 90847 to be appropriate, the identified patient must be physically or virtually present and actively participating in the session. Simply being in the room is not sufficient. The patient needs to engage in the therapeutic process.
What "Present" Means
The patient must be an active participant in the family therapy session. This includes verbal participation, engagement with therapeutic interventions, and involvement in family discussions. For telehealth sessions, the patient must be visible and audible on the video call. A patient who is in the waiting room, asleep in the session, or only present for the last five minutes does not meet the "patient present" requirement.
Documentation of Patient Presence
Your progress notes should clearly document that the patient was present and participated. Include specific details about the patient's engagement:
- Who attended the session - Name all participants and their relationship to the patient
- Patient's level of participation - Did they contribute actively or need prompting?
- Patient's responses to interventions - How did they engage with the therapeutic work?
- Observations of patient within family context - Family dynamics, communication patterns
Time Requirements for CPT 90847
Unlike the individual psychotherapy codes (90832, 90834, 90837), CPT 90847 does not have strictly defined time ranges. The code describes sessions of "approximately 50 minutes," which provides more flexibility than the rigid time boundaries of individual therapy codes.
That said, most payers expect family therapy sessions to fall within a reasonable range. Sessions lasting 45 to 60 minutes are typical and unlikely to trigger any questions. Sessions significantly shorter than 45 minutes or longer than 75 minutes should have clear documentation justifying the duration.
| Session Duration | Billing Guidance | Documentation Notes |
|---|---|---|
| Under 30 minutes | May not be appropriate for 90847 | Consider whether session was truly family therapy |
| 30-45 minutes | Generally acceptable with documentation | Document reason for shorter session |
| 45-60 minutes | Standard, expected duration | Standard documentation sufficient |
| 60-75 minutes | Acceptable for complex situations | Document clinical necessity for extended time |
| Over 75 minutes | May attract scrutiny | Strong documentation required |
CPT 90847 vs 90846: Understanding the Difference
The distinction between these two codes is simple in concept but frequently misapplied in practice. The only difference is whether the identified patient is present in the session.
- +Identified patient participates in session
- +Family members also present
- +Couples therapy (both partners present)
- +Parent-child conjoint sessions
- +Family sessions with adolescent patient
- +Working with family about the patient
- +Parent consultation for child patient
- +Collateral sessions with spouse
- +Family psychoeducation without patient
- +Caregiver support focused on patient care
Common Billing Mistake
A frequent error is billing 90847 for parent consultation sessions when the child patient is not present. If you are meeting with parents to discuss their child's treatment, progress, or to provide parenting guidance, and the child is not in the session, use 90846. The child's diagnosis still supports medical necessity, but the code must reflect that the patient was not present.
When Patients Leave Mid-Session
Family therapy sessions sometimes have a fluid structure where participants enter or leave at different points. If the identified patient participates for the majority of the session but steps out briefly, 90847 is still appropriate. However, if the patient leaves early and you continue working with family members for a significant portion of the session, your documentation should address this.
A practical approach: If the patient is present for at least 75% of the session time and actively participates, 90847 is defensible. For sessions where the patient leaves after the first 15 minutes and you spend 35 minutes with family members alone, consider whether 90846 might be more accurate.
Who Qualifies as "Family" for Billing Purposes?
The definition of "family" for CPT 90847 is broader than you might expect. It extends well beyond blood relatives and legal family members to include anyone who functions in a family-like role with the patient.
Who Counts as "Family" Under CPT 90847
- Legal family members: Spouse, parents, children, siblings, grandparents
- Unmarried partners: Domestic partners, long-term significant others, fiances
- Chosen family: Close friends who function as family, godparents
- Caregivers: Foster parents, legal guardians, primary caregivers
- Household members: Roommates in certain therapeutic contexts, live-in partners
- Extended support: Grandparents raising grandchildren, aunts/uncles serving as primary caregivers
The key criterion is not legal relationship but functional relationship. The family member should be someone who significantly impacts the patient's daily life, mental health, or treatment outcomes. Your documentation should explain the relationship and why including this person in family therapy is clinically relevant.
Couples Therapy and CPT 90847
Yes, couples therapy is typically billed using CPT 90847. When both partners are present and you are addressing relationship dynamics, communication patterns, or other relational issues, 90847 is the appropriate code.
There is an important billing consideration: You must identify one partner as the patient for insurance purposes. This person's diagnosis and insurance are used for billing. The diagnosis should be legitimate (not fabricated for billing purposes) and should connect to why couples therapy is medically necessary for that individual.
Common diagnoses used for couples therapy billing include:
- F43.25 - Adjustment disorder with mixed disturbance of emotions and conduct
- F32.x - Major depressive disorder (when relationship issues contribute)
- F41.1 - Generalized anxiety disorder (when relationship is a stressor)
- Z63.0 - Problems in relationship with spouse or partner (may not be covered by all payers)
Z-Code Warning
Many insurance companies do not cover Z-codes as primary diagnoses because they are not considered mental disorders. If you use Z63.0 (relationship problems) as your primary diagnosis for couples therapy, expect denials from many payers. You generally need a mental health diagnosis (F-codes) that is clinically impacted by the relationship issues.
Medicare vs Commercial Reimbursement Rates
CPT 90847 typically reimburses higher than individual psychotherapy codes because family sessions involve more participants and often more complex dynamics. Here are current benchmarks:
2024 Medicare Rates
Medicare reimbursement for CPT 90847 varies by geographic location. The national average for 2024 is approximately $132.18 for non-facility settings (private practice) and $109.42 for facility settings.
| Code | Description | Medicare Non-Facility | Medicare Facility |
|---|---|---|---|
| 90846 | Family therapy without patient | $126.93 | $105.21 |
| 90847 | Family therapy with patient | $132.18 | $109.42 |
| 90834 | Individual therapy, 45 min | $114.53 | $95.37 |
Commercial Insurance Rates
Commercial payers typically reimburse 15-50% higher than Medicare for family therapy codes:
- Blue Cross Blue Shield - Typically $145-185 depending on state and plan
- Aetna - Usually $140-175 for in-network providers
- Cigna - Generally $135-170 range
- UnitedHealthcare - Approximately $140-180 depending on network tier
- Out-of-Network - You set your rate; patient reimbursement varies by plan
Documentation Requirements
Family therapy documentation requires more detail than individual therapy notes because you are capturing multiple participants, complex interactions, and family system dynamics. Every 90847 session note should include these essential elements:
CPT 90847 Documentation Checklist
Sample Documentation Language
Weak documentation: "Met with family. Discussed communication issues. Family will try to communicate better."
Strong documentation: "Session participants: John (identified patient, 16yo), mother Sarah, father Michael. Patient present throughout 50-minute session and actively participated. Family addressed ongoing conflict around patient's school performance and its impact on patient's depressive symptoms. Observed critical communication pattern from father toward patient, with mother attempting to mediate. Introduced Gottman repair attempt technique. Practiced structured dialogue with each family member expressing needs using I-statements. Patient initially defensive but engaged after mother modeled vulnerability. Family demonstrated improved active listening by session end. Homework: Each family member to initiate one positive interaction daily. Supports treatment goal 3: Reduce family conflict to decrease depressive triggers. Patient's affect brighter at session end; reported feeling 'actually heard' by father for first time in months."
Couples Therapy and CPT 90847
Couples therapy presents unique billing considerations because you have two adults who may each have their own insurance, and you must determine which partner is the identified patient.
Choosing the Identified Patient
In couples therapy, one partner becomes the identified patient for billing purposes. This decision should be based on clinical factors, not insurance benefits:
- Which partner has a diagnosable mental health condition?
- Whose symptoms are most directly impacted by the relationship issues?
- Who initiated treatment seeking relief from distress?
- Whose diagnosis most clearly connects to the need for couples therapy?
Insurance Gaming Warning
Do not choose the identified patient based on who has better insurance benefits. This could constitute fraud. The identified patient should be the person whose mental health condition is being treated through the couples therapy. If neither partner has a diagnosable condition, couples therapy may not be covered by insurance at all, and you should discuss private pay options with the couple.
When Both Partners Have Diagnoses
Sometimes both partners have legitimate mental health diagnoses. In this case, you still bill under one person's insurance. Consider:
- Whose diagnosis is most directly tied to the presenting relationship issues?
- Which partner's treatment plan includes couples therapy as an intervention?
- Whose insurance provides better coverage (only after clinical factors are considered)?
Document your rationale for identifying one partner as the primary patient. The other partner is a collateral participant supporting that person's treatment.
Payer-Specific Rules
Different insurance companies have varying policies for family therapy coverage. Understanding these differences helps prevent denials and ensures proper reimbursement.
Medicare
- Covers 90847 when medically necessary for the identified patient
- Patient must have a covered mental health diagnosis
- Family therapy must be part of the patient's treatment plan
- Telehealth coverage expanded for family therapy post-pandemic
- Does not cover marriage counseling for relationship issues alone
Medicaid
- Coverage varies significantly by state
- Some states require prior authorization for family therapy
- May have session limits (e.g., 20 family sessions per year)
- Often requires specific credentials or supervision arrangements
- HO modifier may be required for masters-level clinicians
Commercial Payers
- Most cover family therapy when tied to a covered diagnosis
- Some require treatment plan documentation after initial sessions
- Annual session limits are common (check member benefits)
- "Marital therapy" or "couples counseling" may be carved out as not covered
- May require pre-authorization for extended treatment
Benefit Verification Tip
When verifying benefits, ask specifically about "family psychotherapy" and "CPT code 90847." Some plans cover individual therapy but exclude family services. Also ask whether there are different copays or session limits for family therapy compared to individual therapy. Getting clear answers upfront prevents surprises for you and your clients.
Common Denial Reasons and Solutions
Family therapy claims face higher denial rates than individual therapy, often around 15-20%. Here are the most common reasons and how to prevent them:
1. Diagnosis Does Not Support Family Therapy
Problem: Using Z-codes or diagnoses where the connection to family therapy is not clear.
Solution: Use a primary mental health diagnosis (F-codes) and document how family dynamics contribute to the condition or how family therapy will improve outcomes.
2. Service Coded as Marital Counseling
Problem: Documentation describes "marriage counseling" or "relationship therapy" without tying it to mental health treatment.
Solution: Frame the service as psychotherapy addressing how relationship issues impact the patient's diagnosed condition. Avoid terms like "marriage counseling" in your notes.
3. Patient Presence Not Documented
Problem: Notes do not clearly state the identified patient was in the session.
Solution: Explicitly document: "Identified patient [name] was present and participated throughout the session."
4. Wrong Code Selected (90846 vs 90847)
Problem: Billing 90847 when patient was not present, or 90846 when patient was present.
Solution: Verify patient presence before selecting the code. When in doubt, check your notes.
5. No Prior Authorization
Problem: Some payers require authorization before family therapy begins.
Solution: Always verify authorization requirements when checking benefits. Request authorization before the first session if required.
6. Session Limits Exceeded
Problem: The patient has used all covered family therapy sessions for the benefit year.
Solution: Track session counts. Inform clients when they are approaching limits. Discuss private pay or alternative treatment options.
Real-World Billing Scenarios
Let us work through several common situations to illustrate proper billing decisions:
Scenario 1: Adolescent Patient with Parents
Situation: You are treating a 15-year-old for depression. Today you meet with the teen and both parents to address family communication patterns contributing to the depression.
Answer: Bill 90847. The identified patient (adolescent) is present, and the session addresses family dynamics related to their mental health condition. Bill under the teen's insurance using their depression diagnosis.
Scenario 2: Parent Consultation Without Child
Situation: Same 15-year-old patient, but today you meet with just the parents to discuss parenting strategies and update them on treatment progress. The teen is at school.
Answer: Bill 90846. The identified patient is not present, but you are providing family therapy services that support their treatment. The teen's diagnosis and insurance still apply.
Scenario 3: Couples Therapy for Depression
Situation: A married couple comes in. The wife has major depressive disorder, and relationship conflict is a significant contributing factor to her symptoms.
Answer: Bill 90847 under the wife's insurance using her depression diagnosis. Document how the couples work addresses her depressive symptoms. The husband is a collateral participant.
Scenario 4: Family Session via Telehealth
Situation: You conduct a family therapy session with a 10-year-old patient with anxiety and their parents via video. Everyone is on the same screen at home.
Answer: Bill 90847 with modifier 95 for telehealth. Use place of service 02 (or 10 depending on payer). Document that all participants were visible and actively engaged via video platform.
Scenario 5: Patient Leaves Early
Situation: In a 50-minute family session, the 17-year-old patient becomes overwhelmed and leaves after 35 minutes. You continue working with the parents for the remaining 15 minutes.
Answer: 90847 is still appropriate since the patient was present for the majority (70%) of the session. Document the patient's participation, their departure, and the continued work with parents. Note the clinical reason for the patient leaving.
Scenario 6: Unmarried Couple
Situation: An unmarried couple living together seeks therapy. One partner has an anxiety disorder exacerbated by relationship stress.
Answer: Bill 90847 under the partner with anxiety. The other partner qualifies as "family" because they function in a family-like role. Document their cohabiting relationship and how the couples work addresses the identified patient's anxiety.
Frequently Asked Questions
Can I bill 90847 for every couples therapy session?
Yes, as long as both partners are present and you are addressing issues related to the identified patient's mental health diagnosis. The identified patient (under whose insurance you bill) must have a covered diagnosis, and your documentation should connect the couples work to that person's treatment. If neither partner has a mental health diagnosis, insurance likely will not cover the sessions.
What if the patient is a child but only speaks briefly during the session?
The patient needs to be present and engaged at a developmentally appropriate level. A 5-year-old may participate primarily through play or brief verbal interactions while parents do more talking. As long as the child is in the room, involved in the therapeutic process (even through observation and non-verbal participation), and the family work addresses their treatment needs, 90847 is appropriate. Document the child's specific participation and responses.
Can I bill the same session under two different insurances for each partner?
No. You cannot bill the same session to two different insurance plans. CPT 90847 represents a single service provided to a family unit. You must choose one person as the identified patient and bill under their insurance. Billing both partners' insurances for the same session would be considered duplicate billing and could constitute fraud.
How do I handle sessions with multiple family members but no clear patient?
For insurance billing, there must be an identified patient with a covered mental health diagnosis. If no one in the family has a diagnosable condition, insurance typically will not cover family therapy. In these cases, discuss private pay options with the family. If someone does have a diagnosis, that person becomes the identified patient, and family therapy must connect to their treatment needs.
Is there a time limit on how long a family therapy session can be?
CPT 90847 does not have a strict time limit like the individual therapy codes. The descriptor says "approximately 50 minutes," which provides flexibility. Sessions of 45-75 minutes are generally acceptable without question. Sessions longer than 75 minutes may receive scrutiny. If you regularly conduct longer sessions, document the clinical necessity. Sessions under 30 minutes may not be appropriate for this code.
Can a friend who lives with the patient be included in family therapy?
Potentially, yes. The definition of "family" for CPT 90847 includes individuals who function in a family-like role. A roommate or close friend who significantly impacts the patient's daily life and mental health could be included if there is clinical justification. Document the nature of the relationship and why including this person serves the patient's treatment goals. Chosen family and supportive household members can qualify.
What modifiers do I need for telehealth family therapy?
Most payers accept modifier 95 for synchronous telehealth family therapy. Some still require the GT modifier. Use place of service code 02 (telehealth) or 10 (patient home) depending on payer preference. All participants should be visible and audible on the video call. Document that services were provided via HIPAA-compliant video platform and that all family members actively participated.
Key Takeaways
CPT 90847 Summary
- 1.CPT 90847 is for family psychotherapy when the identified patient is present and participating. Without the patient present, use 90846 instead.
- 2."Family" includes anyone in a family-like role: spouses, partners, parents, children, caregivers, and sometimes close friends or household members.
- 3.Sessions should be approximately 50 minutes. Unlike individual therapy codes, there are no rigid time ranges, but extremely short or long sessions need documentation support.
- 4.For couples therapy, designate one partner as the identified patient based on clinical factors, not insurance benefits. Their diagnosis supports medical necessity.
- 5.Documentation must explicitly state patient was present, list all participants, describe family dynamics, and connect the session to the patient's diagnosis and treatment goals.
- 6.Medicare reimburses approximately $132 for 90847. Commercial rates typically run 15-50% higher. Denial rates are higher for family therapy, so careful documentation is essential.
Family therapy billing requires attention to detail, but the core concepts are straightforward: document who was there, confirm the patient participated, connect the work to the patient's diagnosis, and choose the right code based on patient presence. Build these habits into your workflow, and you will minimize denials while maximizing appropriate reimbursement.
Looking for a practice management platform that simplifies family therapy documentation and billing? TheraFocus tracks session participants, generates compliant notes, and streamlines your claims submission. See how TheraFocus can help your practice thrive.
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The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.