Understanding Current Procedural Terminology (CPT) codes is one of the most challenging and confusing parts of working as a therapist. Unfortunately, to be appropriately paid for your work, it’s essential to understand them clearly and avoid billing mistakes.
CPT code 90847 is the code used for family therapy with the patient present, also known as “conjoint psychotherapy.” You would use this code any time you have a family or couples therapy session with your primary client. Family sessions typically last 50 minutes or longer, but it must be a minimum of 26 minutes to be able to use this code.
Therapists and other medical providers use CPT codes to bill insurance plans, including Medicare and Medicaid, to get reimbursed for their services. There are CPT codes for nearly every medical service, including mental health services like individual, family, and group therapy. They’re managed and regulated by the American Medical Association (AMA).
There are 2 CPT codes used for family therapy: 90847, which we’re talking about today, and 90846. The main difference between the two is that your primary client must be present to bill 90847, while 90846 is used when you’re just meeting with your client’s family without them.
Any licensed mental health provider who is qualified to conduct family or couples therapy can use CPT code 90847.
This includes:
Psychiatrists (MD) and psychiatric nurse practitioners (PMHNP) are also licensed to provide family and/or couples therapy, but it’s more rare. As someone who holds one of these medical licenses, you can use 90847 when you’re only providing family or couples therapy within the session – not when you’re also conducting evaluation or medication management.
Any time you conduct family or couples session with your client present, you can use 90847. This includes any treatment modality you might use for family/couples therapy, like:
Sometimes, you might invite a family member or partner briefly into your client’s individual session. For example, if you are working with an adolescent, you might invite the parent in for the last 10 minutes of the individual therapy session to discuss their progress. Or an adult client might request that their partner be present during their individual therapy session for support.
In these cases, it can be tricky to navigate the line between what’s truly considered “family therapy.”
If the purpose of inviting a family member is to benefit the primary client, you can simply bill the appropriate individual therapy code with the add-on code 90785 for “interactive complexity.” This code is used when the primary client has complications that require another person to be present, like in the case of minors or when the client has requested someone else to be involved in their treatment.
The interactive complexity code is used in conjunction with an individual therapy code. So if the above sessions lasted one hour, you would bill CPT code 90837 with an add-on of 90785.
On the other hand, let’s say your adolescent client’s parent joined the session to learn about new strategies to use in the home. If the purpose of the family or couples session was to benefit all present individuals (including your client), as it is in this example, then you should use 90847.
Billing for family therapy can be trickier than billing for individual therapy because there are so many reasons why clients might come in for family or couples session that don’t involve a mental health problem (for example, if a couple is recovering from infidelity).
However, the basics still stand; you must document your sessions appropriately to be reimbursed for your time.
Here’s some important information to include:
The exact reimbursement rates for any CPT code, including 90847, highly depends on factors like the insurance plan you’re billing for, your license type, and your location. Reimbursement rates typically range from $75 to $150 per session. Depending on your location, Medicare reimburses 90847 at anywhere between $99.30 and $145.87 per session.
Keep in mind that the primary client must have a diagnosis to be reimbursed at all for this code. You need to demonstrate that the family or couples therapy sessions are medically necessary for your primary client’s symptoms to improve. This is why more and more therapists are choosing not to accept insurance for family and couples therapy.
Here are some of the most common mistakes that therapists make when using CPT code 90847, and how to avoid them.
| Mistake | What to do instead |
|---|---|
| Using it when your primary client isn’t present. | Use 90846 when your client isn’t present. |
| Billing for every member of the family. | You can only use family therapy codes for one member of the family, who is considered your “primary client.” |
| Billing 90847 and add-on code 90785 together. | You cannot bill 90847 with an add-on code. You would only use 90785 in cases where the family is only present to support the primary client (bill an individual therapy code + 90785). |
| Choosing the wrong “primary client” to bill for. | Choose the client who is the primary insurance holder or the one with the most severe symptoms. |
| Using a Z-code instead of a diagnosis for reimbursement. | You must prove medical necessity for your primary client to be reimbursed. A Z-code is typically not enough; they must have a psychiatric diagnosis. |
| Assuming you’ll be reimbursed for conducting couples therapy for “relationship issues.” | Unless your primary client has a mental health diagnosis, you may not be able to use 90847 to get reimbursed. |
Here are the answers to some common questions that mental health providers have about this code.
What is CPT code 90847 used for?
This code is used for family therapy sessions with the primary client present.
Is 90847 covered by insurance?
Yes, if you can demonstrate that your client has a medical necessity for the sessions – in other words, that the family or couples therapy is necessary to treat your client for their diagnosis.
What is the difference between 90847 and 90837?
90847 is used for family therapy with the client present, while 90837 is used for individual therapy.
Can you get 90837 and 90847 the same day?
You can bill 90837 (individual therapy) and 90847 on the same day if, and only if, the services were separate and distinct. If you simply invited family members into your client’s individual therapy session, it’s likely that you would use another billing code (probably 90837 with the add-on of 90785 for interactive complexity).
If you truly conducted an individual therapy session with your client, followed by a separate and distinct family or couples therapy session, then you could bill the two codes on the same day.
What are the time limits for 90847?
The session must last a minimum of 26 minutes to be able to bill for this code. Sessions typically last for 50 minutes, but there’s technically no maximum time limit. You may be able to bill add-on codes for extended sessions, but you should check with the insurance provider.
What is the difference between 90847 and 90849?
90849 is used when conducting group therapy involving multiple families. For example, you might run a grief support group that multiple families attend. 90847 is only used for single family units.
What is a common diagnosis for family therapy?
With any CPT code, you should choose the diagnosis that best fits with your primary client’s symptoms. Keep in mind that Z-codes are often not enough for reimbursement by insurance plans. Your primary client must have a psychiatric diagnosis.
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American Psychological Association, 2024 Physician Fee Schedule final rule released
American Psychological Association, Psychotherapy Codes for Psychologists
Centers for Medicare and Medicaid Services, Search the Physician Fee Schedule