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CPT Code 90846: Essential Guide to Family Therapy Billing (Without Patient Present)

Stanley Efrem

Feb 24, 2025

Mental health practitioners should note that CPT code 90846 projects a reimbursement rate of $103.75 for 2025. This code represents a 50-minute family psychotherapy session without the patient present. Practitioners must document at least 26 minutes of face-to-face time to bill correctly.

The code's requirements matter to Licensed Clinical Social Workers, Licensed Professional Counselors, Licensed Marriage Family Therapists, clinical psychologists, and psychiatrists. Insurance providers handle coverage differently. Medicare, for example, only covers these services that directly help treat the patient's condition.

This detailed guide explains the essentials of CPT code 90846. You'll learn about the simple requirements, billing processes, and common challenges that your practice might face with this code.

Understanding CPT Code 90846 Basics

The family psychotherapy code 90846 represents a 50-minute session where mental health professionals work with family members when the identified patient isn't present. This code belongs to a specific subgroup of family psychotherapy procedure codes and works with code 90847 [2].

The identified patient must have a confirmed clinical diagnosis that the session will treat to get proper reimbursement. Parents might meet with a provider to discuss their teenager's ADHD diagnosis, which helps them understand ADHD better and learn effective parenting strategies.

You can bill this code if the session lasts at least 26 minutes, though the standard duration is 50 minutes [3]. Some state insurance carriers might not follow this national guideline, so verifying requirements with specific insurance providers becomes important [4].

Licensed Clinical Social Workers, Professional Counselors, Marriage Family Therapists, clinical psychologists, and psychiatrists commonly use this code [5]. The service goes beyond simple family history-taking or E/M counseling services. Here's when the code applies:

Working with legally responsible parties for minors or adults with guardians
Engaging with family members or interpreters during visits
Coordinating with third parties like schools or probation officers [3]

The interactive complexity add-on code 90785 works with 90846 when complex communication factors come into play [3]. These factors include managing difficult conversations with challenging family members or working with verbally undeveloped children.

The main difference between 90846 and 90847 relates to patient presence - all patients except one must be present for 90846, while 90847 requires patient attendance [2]. These codes can't be billed on the same day [2]. Insurance coverage varies among providers, as 90846 isn't accepted as widely as other psychotherapy procedure codes [2].

Step-by-Step Billing Process

Billing for CPT code 90846 needs careful attention and must follow specific guidelines. You should check insurance coverage and get prior authorization before starting family therapy sessions [7].

List the identified patient as the primary treatment seeker on your CMS-1500 claim form [8]. The 90846 code goes in section 24(c) of the form [5]. Note that you should document only the identified patient's name and diagnosis, even when they're not present in the session [9].

Your progress notes must include these details to get accurate reimbursement:

Session duration (minimum 26 minutes)
Actual time spent with family members
Clear focus on family dynamics affecting patient treatment
Participants' roles and relationships
Connection to treatment plan goals

Success in billing depends heavily on insurance considerations. Your degree level and the patient's age requirements - typically 18 or 21 years - often determine reimbursement rates. Reach out to insurance providers early to confirm coverage details and specific billing requirements.

Some important billing restrictions apply. You cannot bill 90846 and 90847 on the same day, whatever separate sessions you conduct [9]. Family therapy codes can work with psychotherapy codes 90832-90834 and 90836-90838 when the services don't overlap [9].

Watch your claims carefully after submission. Quick follow-ups with insurance companies help understand any rejection reasons [7]. Clean, accurate claims with complete documentation will speed up payment processing.

Sessions lasting 90 minutes or longer need billing with 90846 alone instead of combining it with other codes. This approach will give a better reimbursement for longer therapeutic work.

Strong documentation should support medical necessity by linking sessions to the patient's diagnosis and treatment needs. Your progress notes must show how family member meetings arrange with the patient's mental health goals and overall treatment plan.

Common Billing Challenges and Solutions

Mental health practitioners face several challenges when they bill insurance companies for family therapy sessions without the patient present. Each insurance provider handles code 90846 differently, which makes it harder to get accepted compared to other psychotherapy codes [2].

Many insurers set minimum age requirements of 18 or 21 years for the identified patient, which creates a big challenge [2]. So, checking these requirements ahead of time helps prevent claim denials.

Claims often get denied because practitioners use outdated codes or don't implement new ones correctly [10]. Your documentation should clearly explain why the patient-absent session helps the treatment plan. Make sure your notes show:

A legitimate clinical diagnosis for the identified patient
Clinical focus rather than general communication skills
Expected improvement in patient's condition
Medical necessity justification

Payment amounts change based on location and provider standards. Each insurance company's reimbursement schedules and policies are different. Check exact reimbursement rates with insurance providers before starting treatment.

The moment you get a claim denial, start the insurance provider's appeal process. You might need to submit more documentation that supports using code 90846. Here's how to make your appeal stronger:

Provide detailed evidence of medical necessity
Include detailed session documentation
Show how treatment plans line up
Make clear connections to patient diagnosis

Insurance coverage can change every year, so stay up to date with policy changes. Regular checks of coverage help you plan finances and manage patient expectations better.

Detailed documentation is vital to successful billing. Insurance providers might want specific documentation to process claims. Meeting these standards increases your chances of getting paid on time.

Don't bill 90846 for quick family updates before or after individual sessions. Be careful when billing both 90846 and individual therapy codes on the same day - make sure you clearly show the difference between services.

Check your billing practices regularly to ensure compliance and spot problems early. This hands-on approach, plus staying informed about coding updates, makes getting reimbursed much easier.

Conclusion

Mental health practitioners need to understand CPT code 90846 when offering family therapy sessions without patients present. The code's standard reimbursement rate of $103.75 makes it valuable. Successful implementation depends on proper documentation, billing procedures, and insurance requirements.

Note that proper documentation protects you best against claim denials. Your reimbursement success rate will improve by a lot when you maintain detailed progress notes, confirm insurance coverage beforehand, and meet minimum time requirements.

Insurance policies and age restrictions can create billing challenges. Complete preparation and understanding of specific provider requirements offer practical solutions. This knowledge helps you handle family therapy billing with confidence as you focus on delivering quality care to your patients' families.

FAQs

What does CPT code 90846 represent in family therapy?

CPT code 90846 represents a 50-minute family psychotherapy session conducted without the patient present. It requires at least 26 minutes of documented face-to-face time with family members or other individuals involved in the patient's care.

How should therapists bill for family therapy using code 90846?

To bill for family therapy using code 90846, therapists should list the identified patient as the primary treatment seeker on the CMS-1500 claim form, enter the 90846 code in section 24(c), and maintain detailed progress notes including session duration, participants, and connection to treatment plan goals.

Can therapists bill both 90846 and individual therapy codes on the same day?

While therapists cannot bill 90846 and 90847 on the same day, they can report family therapy codes alongside individual psychotherapy codes (90832-90834 and 90836-90838) if the services are distinct and separate.

What are common challenges in billing for family therapy without the patient present?

Common challenges include varying insurance policies, age restrictions for patients, proper documentation of medical necessity, and differing reimbursement rates based on geographical location and provider standards.

How can therapists address insurance claim denials for code 90846?

To address claim denials, therapists should promptly initiate the insurance provider's appeal process, submit additional documentation supporting the use of code 90846, provide evidence of medical necessity, and demonstrate clear connection to the patient's diagnosis and treatment plan.