Cpt code family therapy 60 minutes
Couples and Family Therapy Billing Guide
CPT Code 90847 and procedure code 90846 can be challenging to bill. Here's a guide on how to bill mental health family therapy CPT codes 90847 and 90846. We will teach you the differences between family and couples or marriage counseling.
NOTE: This guide has been updated in 2022 to reflect current CPT Code 90847 reimbursement rates.
Unlike individual therapy sessions, using the correct code to bill mental health family therapy depends on the members of the family in session.
We are going to explain both CPT Code 90847 and CPT Code 90846 for couples and family therapy, walk through four hypothetical treatment scenarios and explain how to bill each example.
By the end of this article you’ll know what codes to use, when, to bill family therapy for mental health CPT codes 90847 and 90846.
We’ll also explain which Add-on codes to use in conjunction with billing codes 90846 and 90847 as well as the 90847 reimbursement rates for family therapy with or without the patient present.
If you’d prefer to just have us help you do this, we provide an insurance billing service exclusively for mental health providers and we’re happy to help.
Article Index
- 90847 Description
- Reimbursement Rates
- Time Length
- Billing Instructions
CPT Code 90847 Description
- 90847 – Family or couples therapy with the patient present.
These sessions need to be at least 26 minutes in length. This is the CPT code for ongoing couples therapy or marriage and family therapy for two clients. You cannot bill both clients, this is considered one “service code” and will most often reimburse at a higher rate.
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CPT Code 90846 Description
- 90846 – Family or couples therapy without the patient present.
These sessions need to be at least 26 minutes in length.
- 90837 – Individual therapy for 60 minutes.
These sessions need to be at least 53 minutes in length.
If medical management services are performed, use the 25 modifier. Interactive complexity services CPT code 90785 are not allowed with this service.
If you’d rather not worry about remembering any of this, we can help you decipher these situations into maximally paid claims on your behalf with our mental health billing service.
90847 Reimbursement Rates for Family & Couples Therapy
Medicare lists the national payment amount for couples and family therapy as:
CPT Code 90847 Reimbursement Rate (2022): $111.15— Family psychotherapy with the patient present Medicare reimbursement rate.
CPT Code 90847 Reimbursement Rate (2020): $107.19
CPT Code 90847 Reimbursement Rate (2021): $102.59
CPT Code 90846 Reimbursement Rate (2022): $107.37— Family psychotherapy without the patient present Medicare reimbursement rate.
CPT Code 90846 Reimbursement Rate (2020): $103.
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CPT Code 90846 Reimbursement Rate (2021): $99.10
CPT Add-On Code +99354 Reimbursement Rate (2022): $140.26— Additional time up to 1 hour and 45 minutes for a diagnostic interview
CPT Add-On Code +99354 Reimbursement Rate (2020): $132.09
CPT Add-On Code +99354 Reimbursement Rate (2021): $129.10
CPT Add-On Code +99355 Reimbursement Rate (2022): $101.32— Additional time up to three hours for a diagnostic interview (must be used with +99354)
CPT Add-On Code +99355 Reimbursement Rate (2020): $100.33
CPT Add-On Code +99355 Reimbursement Rate (2021): $96.31
(Source)
Each insurance company will reimburse for different amounts for the above CPT codes depending on your license, location, relationship with that insurance company, and the type of plan the client may have.
Not all add on codes or family therapy codes are allowed by insurance, so please call to verify eligibility and benefits before seeing your clients (or we can do it for you).
90846 & 90847 Time Length
CPT Code 90847 Time Frame: 50 to 74 Minutes
There are technically no maximums for coding family therapy sessions with CPT codes 90846 and 90847.
If you do want to bill additional time for providing services, we recommend at least 74 minutes of family therapy service before considering using an add-on billing code for additional time rending couples therapy or family therapy services.
CPT Code 90846 Time Frame: 50 to 74 Minutes
Medicare lists the minimum required time for couples therapy or family therapy with or without the patient present at 50 minutes. (Source)
CPT Code 90847 Video Guide
90846 & 90847 Add-On Codes for Extra Billing Time
If your services are longer than 74 minutes, often the case with marriage counseling or family therapy codes, use +99354 to bill an additional 30 minutes of time.
So if your session is between a bit over an hour and 1 hour and 45 minutes, use +99354.
If your session for couples therapy or family therapy is longer than 1 hour and 45 minutes, add +99355 to your claim form for an additional 44-45 minutes of services. CPT code +99355 covers couples and family therapy sessions between 1 hour and 45 minutes and 2 hours and 30 minutes.
- First 74 minutes: CPT Code 90846 or 90847
- 75 to 1 hour and 45 minutes: Code 90846 or 90847 +99354
- 1 hour and 45 minutes to 2 and a half hours: 90846 or 90847 +99354 +99355
| Couples or Family Therapy CPT Code | Add-On CPT Code for Extended Session | Length of Session | Services Rendered |
|---|---|---|---|
| 90846 90847 | 99354 | 80-124 minutes | Couples or Family Therapy, Extended Session, 1:20 hrs - 2:04 hrs |
| 90846 90847 | 99354 99355 | 125-154 minutes | Couples or Family Therapy, Extended Session, 2:05 hrs - 3:34 hrs |
| 90846 90847 | 99354 99355 99355 | 155-184 minutes | Couples or Family Therapy, Extended Session, 3:35 hrs - 4:06 hrs |
| 90846 90847 | 99050 | N/a | Services performed outside of business hours. |
| 90846 90847 | 99051 | N/a | Planned services performed in the evening, weekend, or during a holiday. |
Family Therapy Insurance Billing Scenario
Let’s say three people all attend therapy:- Client A (mom),
- Client B (child),
- and Client C (child).
Let’s say that Client B is the person who is specifically needing treatment. Client A and Client C are part of the reason that treatment is needed, as it’s a family matter. Then Client A, the mother, due to her own distress, decides to enter treatment.
Let’s say these folks have 4 total sessions. Here’s what they look like:
Session 1) They all attend therapy together.
Session 2) The following week, the mother, Client A is seen about the child in treatment, Client B.
Session 3) The next day, Client B is seen individually.
Session 4) A week later, the mother, Client A, decides that she needs to seek out therapy as well and sees the therapist about her own treatment needs.
How to Bill These Family Therapy Sessions
Session 1: We use billing code 90847 for family therapy with the patient (Client B) present. Use Client B’s information when filing the claim, including their diagnosis code.
Session 2: We use billing code 90846 for family therapy with the patient (Client B) not present. Use Client B’s information and diagnosis code when filing out the claim form. We may want to add additional diagnoses here as we learn more about the treatment situation.
Session 3: We use billing code 90837 here for treatment with the client, Client B. Even if this client is seeking therapy about their family issues, they are seeking individual therapy. Use Client B’s information on the claim forms too.
Session 4: We are also using billing code 90837 for the new client, Client A, as Client A is now requesting their own treatment (about their family issue). Use Client A’s information and diagnosis when filing this form.
90847 Billing Guidelines
Medicare suggests that providers do not bill 90847 when performing a family history or E/M counseling services. Use Evaluation and management sessions for billing according to the proper allotted time. See our mental health CPT code guide for more. SourceMedicare requires that providers conduct family therapy only when the services are required to have a direct impact on the treatment of a single individual. See Noridian’s guidelines.
Summary
Always use the person who is the primary treatment seeker on your claims forms. They are the person who is seeking treatment, even if a family member is attending therapy to their benefit (90847). So even if they are not in session, like with 90846, their information is to be used.
If all of this is too much, feel free to drop us a line about our mental health billing service for therapists. We handle these sorts of questions daily.
A Quick Overview of Family CPT Codes (90846 and 90847)
There's a lot of information out there about family CPT codes, spread across multiple sources.
So, we thought we’d consolidate it for you. Here’s what you need to know about 90846 and 90847.
Want to learn more about CPT codes? Read A Quick Overview of CPT Codes on our blog.
What are family codes?
The CPT codes 90846 and 90847 are used for face-to-face or telehealth family psychotherapy sessions of 26 minutes or longer.
The main difference between these codes is that 90846 is used for appointments when the patient is not present, and 90847 is used for appointments when the patient is present. Often, these appointments entail family participation in the treatment process of a person in that family. If a married couple identifies as a family, they may qualify for the family code as well depending on the insurance. When it’s a child being treated, it’s usually with the expectation that intervention in their family interactions will improve their emotional or behavioral disturbances.
If a family member is brought into individual psychotherapy sessions intermittently or briefly, you don't have to bill these family codes. You can use individual psychotherapy codes, 90832, 90834 or 90837. Just make sure the intent of the session/s is not the family member's benefit. The patient can get some benefit by having the family member there, but if both people are benefiting, then you must use 90846 or 90847, since family sessions are about all individuals in the session benefiting from the service.
Billing these codes
To bill 90846 or 90847, you must choose one person in the family as the identified patient (ideally the primary holder of the insurance or the one with the more severe symptoms). List only that person's name and diagnosis on your claim and no one else's in the family. Also, be clear about the focus of the session in your documentation.
You generally can’t bill 90846 or 90847 when the service being performed is taking a family history or requesting a brief update on the patient’s behavior prior to or after the individual session takes place.
Family counseling also doesn’t typically include the supervision of or therapy with professional caretakers or staff.
In terms of same-day billing, family therapy codes can be reported on the same day as psychotherapy codes 90832-90834 and 90836-90838 if the services are separate and distinct. You can also typically bill individual and family therapy codes on the same day if they’re two separate counseling sessions, with one including only the patient and the other including both the family member and the patient.
Billing 90846 and 90847 on the same day as each other for the same patient is often not allowed, regardless if it’s two separate sessions.
Getting reimbursed
Insurance policies differ when it comes to family codes.
Some insurance providers, like Medicare, cover family psychotherapy services only when the primary purpose of the visit is the treatment of the patient’s condition. Examples of this include:
- When there is a need to observe and correct, through psychotherapeutic techniques, the patient’s interaction with family members
- When there is a need to assess the conflicts or impediments within the family, and assist, through psychotherapy, the family members in the management of the patient
You may also run into limitations such as:
- Only being able to bill family codes a certain number of times a year
- Specific age-requirements for children being treated
- Adult patients not being covered
As you can see, being reimbursed for family therapy appointments can vary quite widely.
Make sure you find out when you can use these codes before proceeding with these sessions. Good luck!
Sources: CPT® (Current Procedural Terminology), American Medical Association; Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual, APA Practice Organization; Coding and Billing Guidelines, Centers for Medicare & Medicaid Services; Does Insurance Cover Couples Therapy?, GoodTherapy; Billing for Couples and Family Therapy, Barbara Griswold, LMFT
Talk with a member of our Success team and learn how TherapyNotes™ can help.
* The content of this post is intended to serve as general advice and information. It is not to be taken as legal advice and may not account for all rules and regulations in every jurisdiction. For legal advice, please contact an attorney.
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What does CPT code 90836 mean?
What does CPT code 90836 mean? +90836 - Use additional code for understanding-focused, behavior-altering and/or supportive individual psychotherapy 45 minutes with a patient and/or family member (time range 38-52 minutes) when delivered through an assessment and management service.
What does CPT code 90837 mean? 90837 – Psychotherapy 60 minutes. Time range: 53 minutes or more. Some health insurance companies may consider 90834 as a standard psychotherapy session. In such cases, when reporting 90837, it would be helpful to document in the case history why a longer service is warranted rather than a shorter one.
What does CPT code 90791 mean? Code 90791 is a "comprehensive biopsychosocial assessment including history, mental status and recommendations".
It originated in 2013 when many mental health CPT codes were redesigned, replacing the code 90801.
What is the range of the CPT code for psychiatry? CPT codes for outpatient mental health treatment:
90834 - Psychotherapy, 45 minutes (38-52 minutes). 90837 - Psychotherapy, 60 minutes (53 minutes or more). 90846 - Family or couples psychotherapy without the presence of the patient. 90847 - Family or family psychotherapy in the presence of the patient.
What does CPT code 90839 mean?
CPT code 90839 is the main code for a crisis psychotherapy session requiring an urgent crisis assessment and history, mental status examination and decision. The bill is for the first 60 minutes of psychotherapy for a patient in crisis.
Can 90837 and 90847 be paid together?
Extended service codes are "additional codes" which means they cannot be billed separately and must always be billed with 90837 or 90847.
Can 90837 and 90853 be billed together?
Group session and individual session Do not bill for CPT codes 90853 and 90832.
These codes are not billable on the same day to the same participant by the same provider. To avoid claims issues, providers must have an updated list on the Healthy Blue file.
What codes can be set with 90791?
CPT code 90791 Description
CPT code 90791 is usually issued for an initial meeting with a client. Subsequent sessions will be billed with treatment codes 90834 and 90837, depending on the length of the session.
Which codes can be used to invoice 90785?
The code 90785 is an additional code for interactive complexity and can be added to a diagnostic psychiatric examination (90791, 90792), psychotherapy (90833-90838), and group therapy (90853).
Can I pay for 90791 and 90853 together?
Can 90853 and 90834 be paid together? These types of providers cannot delegate to another provider under their license, such as doctors and psychologists. Treatment codes 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, and 90853 can only be billed if one of the state's mandatory diagnoses is present.
Can I pay only for CPT code 90833?
Billing for E/M and psychotherapy
Additional psychotherapy codes: 90833 (16-37 minutes), 90836 (38-52 minutes) and 90838 (≥53 minutes). If your job is not medical, you can simply use the standalone psychotherapy codes 90832, 90834, or 90837.
What does CPT code 90785 mean?
Interactive Complexity (90785) is an additional code designed specifically for mental health services. to communication difficulties during a psychiatric procedure.
What does CPT code 90899 mean?
CPT® 90899, Other Mental Health Services or Procedures
Current Procedural Terminology (CPT®), code 90899 maintained by the American Medical Association, is a medical procedural code in the scope of Other Mental Health Services or Procedures.
What is the difference between CPT code 90791 and 90792?
Psychiatrists now use the code 90792, which indicates that medical services have been provided, and non-medical providers use the code 90791, which does not include medical services.
Who can bill CPT 90832?
CPT code 90832 is a billing procedure code that describes individual psychotherapy services provided within 30 minutes by a licensed mental health provider. Insurance companies require coders, billers, or therapists to use CPT code 90832 for 30-minute routine outpatient appointments.
What does CPT code 99213 mean?
CPT Code 99213: An office or other outpatient visit for the assessment and treatment of an identified patient that requires a medically relevant history and/or examination and a low level of medical decision making.
What is modifier 59?
Modifier 59 is used to identify procedures/services other than E/M services that are not normally reported together but are appropriate in the circumstances. Documentation in the medical record must meet the criteria required by any NCCI-related modifier used.
Who can bill 90847?
To bill 90846 or 90847, you must select one family member as an identified patient (ideally a primary insurer or someone with more severe symptoms).
How often can 90837 be billed?
90837 Extra Codes for Advanced Therapy Services
99355 is billed once for every additional 30 minutes over 99354. In other words, 99355 can be used multiple times for the same appointment.
Is it possible 90853 to issue invoices twice on the same day?
You code it once for each patient who is in the group for their documented group visit in that DOS. Billing multiple times on the same day would be appropriate if the patient was in more than one group at the same time and if their payer's permission would allow this as part of their treatment plan.
Who can bill CPT 90853?
90853 Requirements for license level
Licensed Clinical Social Workers (LCSW) Licensed Professional Counselors (LPC) Licensed Psychological Counselors (LMHC) Licensed Family Therapists (LMFT)
Can 97110 and 97150 be paid together?
This is permitted subject to the CPT and CMS rules for individual and group therapy.
The CPT Code for Group Therapy (97150) and Direct 15-Minute CPT Codes for One-on-One Treatments (97110-97542) are covered by Medicare's National Correct Coding Initiative (NCCI).
Can 90791 be billed for inpatient treatment?
90791/2 can be used in both inpatient and outpatient settings. Changes to the CPT Psych codes for 2013 eliminated the differentiation of codes by installation.
How do I bill for EMDR?
CPT code 90834 should be used when EMDR is used as a therapy component during an acute stress disorder or post-traumatic stress disorder psychotherapy session. When billed on the CMS-1500 claim form, if 90899 is billed with 90834, this will be considered the content of the service.
Is 90832 an additional code?
reporting an interactive complexity complement code of 90785 in combination with 90791 or 90792. CPT 2017 removed "and/or family" from psychotherapy codes (90832, 90833, 90834, 90836, 90838, 90839). These are individual psychotherapeutic codes focused on the patient.
Family therapy, 60 minutes
Family therapy is an independent area of psychological assistance. It is focused on the correction of interpersonal relationships, the elimination of emotional and behavioral disorders in the family.
The psychotherapist's attention is focused on relationships, patterns of communication, distribution of power, construction of reality, and development of the personality within the family. The effectiveness of family psychotherapy is based on changing the entire family system.
Often the reasons leading to an appointment with a psychotherapist lie in the family, in relationships with a spouse, with children or parents, and other relatives. A family therapist is focused on working with the whole family, even if not all of its representatives are present at the reception.
Family therapy helps to identify and understand the destructive, traumatic aspects of interaction in the family system.
With the help of a specialist, the family's own internal resource leads it to a constructive and harmonious existence. Timely appeal for help and support will save the family, save it from returning to the same problems.
Family psychotherapy determines the difficulties that prevent a person from being happy in marriage, parenthood. In addition, it is important for a specialist to identify personal difficulties aimed at controlling, correcting and experiencing traumatic relationships that existed in the parental family. People's commitment to parental patterns of behavior, emotional reactions is one of the most serious obstacles to positive change.
When we create a family, we implement our internal patterns of behavior (inherited from ancestors, formed in the process of upbringing) with spouses and children. Thus, members of our family are involved in the process of transference: a spouse or child is perceived by us in a certain way, as it was established in the parental family.
And this attitude can be changed only by realizing the error in perception.
Instead, family members try to find a solution to their internal conflicts in interpersonal relationships, transforming these conflicts into accusations against a spouse, child, or parent. Problems that arise in relationships: mistrust, bickering, detachment, adultery, power struggles, difficulties in sexual relations, the emptiness of relations between spouses, the dilemma of merger or differentiation - can be explained by the fact that the key concepts of family relationships: intimacy, love, independence, privacy, kindness, respect, etc. - partners invest different meanings learned in parental families.
Family therapy will help you improve family relationships, which will eliminate the isolation of one of the family members, improve relations between spouses, children, parents, in separated families, relationships become closer.
Family therapy is especially useful in the following situations:
- impossibility to establish any relationship, without first discussing these issues with one of the parents, brother, sister, other relative;
- divorce of parents that occurred in the past;
- separated families;
- the desire of adult children to come to reconciliation with their parents;
- inability to establish close relationships that give satisfaction;
- families with intruding mothers or distant fathers.
Family therapy can last from a few weeks to several years. The duration of family therapy depends on the severity of mental disorders in a family member, on the severity of interpersonal conflicts, as well as on the desire and motivation of family members to achieve change.
Stages of family therapy:
1. Diagnostics of the family system.
At the first stage, the family system is diagnosed, hypotheses are built, and a family diagnosis is made.
Family diagnosis is a typification of disturbed family relationships (typical - often recurring) taking into account the individual and personal characteristics of all family members. Diagnosis of family relationships is based on the development and testing of problematic diagnostic hypotheses by the psychotherapist. At the same time, information received from one of the family members at unilateral meetings is compared and compared with information received from other family members.
Family diagnostics is necessary for the psychotherapist to choose certain psychotherapeutic techniques and interventions.
2. Mediation of family conflicts.
The second stage is aimed at eliminating the actual problem - relieving tension in the family, resolving family conflict, eliminating painful symptoms; the origins of family conflicts are revealed.
A family therapist helps parties to a conflict learn to speak a language that everyone understands. At the same time, he takes on the role of an intermediary (mediator of family relations) and transmits, without emotional involvement, information about the conflict from one family member to another in an agreed volume. This leads to clarity and understanding of the needs of the participants in the conflict, to the beginning of constructive negotiations between family members.
3. Reconstruction of the family system.
At this stage, with the help of a psychotherapist, a plan is made for the reconstruction of the family system or its pathogenic areas that impede the harmonious formation and development of the family.
In the process of discussing problems, elements of behavioral training and conflict resolution training are used, which teach the rules and techniques of a constructive dispute.
4. Fixing the results of family psychotherapy.
The last stage of family psychotherapy is testing and at the same time supportive for the family. There is a check of the selected options for sensory responses, new forms of behavior and feedback from all participants in family psychotherapy - support, adjustment and fixation.
If necessary, more effective methods of interaction between family members obtained at the previous stage of family psychotherapy are selected.
At psychotherapy sessions, observations are made of the dynamics of intra-family relations, of ongoing changes, counseling and correction of acquired communication skills, as well as their adaptation to real life conditions.
Family therapy in Yaroslavl
The Center for Evidence-Based Medicine is one of the largest clinics in Yaroslavl, where family psychotherapy has been successfully practiced for many years.
