Diagnoses of mental illnesses utilize various coding systems. One such system includes the 90847 CPT code, which helps therapists categorize their work and secure payment for their services.
One of the preferred codes is CPT 90847, which is applicable for family or couples therapy when the patient is present. Compliance with the relevant law and regulations, as well as payment, depends on the proper usage of this code.
If you are providing therapy services, there are important points regarding this family therapy code that you should know. In this article, we will discuss the main aspects related to 90847.
What Is CPT 90847?
The CPT code 90847 description does not require much elaboration. It defines family psychotherapy when the patient is present and involves activities like therapy with a child and his parents, and also couples therapy.
The time allotted for the 90847 CPT code is not less than 50 minutes of therapy. Some billing companies might agree to accept no less than 45 minutes, like the CPT code for 45-minute psychotherapy does.
This code can only be claimed by professionals who are licensed mental health specialists. This encompasses a wide variety of persons, such as psychologists, professional counselors with licenses, clinical social workers, and psychiatrists.
90847 would be the correct code to use if the family members and the patient are together, working on any emotional or behavioral problems in one session.
When to Use CPT Code 90847
CPT code 90847 should be used in the case where:
· The patient is included with one or more family members (with the patient in the session).
· The patient’s mental health is a focus (how it will be better with the interaction of family members)
· The provider and family are working together for the fast recovery of the patient.
· This is different from the group psychotherapy CPT code, which applies to unrelated individuals in a therapy group.
· It also differs from the psych eval CPT code, which applies to assessments, not therapy.
· Family therapy with 90847 often includes couples counseling, child behavioral therapy, and assisting in recovery from addiction. In the absence of the patient, a different code should be used.
Billing Requirements for CPT 90847
To bill CPT 90847 correctly, these prerequisites must be met:
· Document the patient’s participation
· And note the therapeutic goals, session progress, and outcomes
· The requirement of time (45-50+ min) for the session duration is also critical
· Details of how the family dynamics impact the health of the patient must also be provided
Like with billing in general, avoid common errors like:
· Patient not present and still using 90847
· Not linking the session to the diagnosis or treatment plan of the patient
· Copying and pasting the notes during the session
· Well-documented progress notes are integral to succeeding in an insurance audit and obtaining reimbursement on time
CPT 90847 vs 90846
For precise use of related codes, it’s vital to know the difference between 90846 and 90847. Here is a quick comparison:
| Code | Patient Present? | Session Type | Typical Use |
| 90847 | Yes | Family Therapy | Therapy with the patient |
| 90846 | No | Family Therapy | Parent or partner-only |
Use 90846 when the patient is not present in the session. This type of session may be conducted for educational purposes, parent coaching, or partner counseling.
But 90847 works best when the patient is involved in the therapy. This may also be referred to as the CPT code for marital therapy, or couples therapy, where both the patient and a family member are included in therapy.
Tips for Reimbursement
Insurance payers require supporting evidence justifying medical necessity for CPT 90847. To substantiate the claim, be certain to:
· Illustrate the impact of the family’s involvement on the patient’s recovery
· Tie the session to the patient’s mental health treatment plan
· Ensure consistency across diagnosis and monitoring of progress
Payment for 90847 varies by provider type as well as insurance plan. Generally, the payment amount is at least slightly greater than that of individual sessions, especially when documentation supports complexity.
Avoid delays or denials by submitting clearly marked notes and accurate time records along with clean claims.
Before initiating any psychotherapy sessions, especially under CPT code 90847, it’s important to ensure the patient’s insurance details are verified. Not sure how to locate the essential policy number on an insurance card? Here’s a simple guide to help you find and understand Policy Number on Insurance Card.
Telehealth Considerations
Many providers ask Is CPT 90847 applicable for telehealth? The answer is frequently yes, but only if:
· The payer’s policies allow it
· The state has telehealth regulations
· Meeting time and content requirements for the session meet the requirements of 90847
· Documented attendance is essential to substantiate their roles if the patient attended the session virtually.
Some other payers require modifiers or place of service codes for telehealth, so check the guidelines before billing 90847 via telehealth.
Frequently Asked Questions
Can 90847 be submitted alongside other CPT codes?
Yes, sometimes, but only when there are no stipulations from the payers. Ordinarily, it cannot be billed alongside a full psychotherapy code for the same session.
How often can 90847 be used in a plan?
There is no specific limit on using this code, but using it may often trigger the insurance reviews. Use it only when involving a family member is essential for the patient’s health.
Common Billing Mistakes
Here are some common billing errors that one should avoid for billing CPT code for couple therapy
· Using it for a session with only the patient’s family member in attendance (90846 for these cases is more suitable)
· Missing the effect of family lifestyle on the present condition of the patient
· Providing incorrect session duration (do not forget, 90847 CPT code time range is usually 45-50 minutes).
Confirm that you have reviewed the notes before final submission. Routine audits or team collaborations can prevent issues that may lead to claim denials or audits ensuing.
Conclusion
The proper use of CPT 90847 is essential to receiving reimbursements for valuable family therapy sessions. It enables mental health professionals to involve spouses, partners, or family members in the treatment while meeting the billing compliance regulations.
As with all family therapy CPT code billing, verification must be made that the patient is there, the session is necessary, and your reports undeniably justify the intent of the therapy.
If you are in doubt or are facing repeated challenges with claim submissions, enlisting the services of a billing professional would decrease the chances of mistakes, thereby increasing your revenue.
Bonus Tip:
Collaborating with a qualified billing staff will streamline practices, reduce denial rates, and allow the practice to concentrate on the clients rather than paperwork.
