CPT Codes for Couples and Family Therapy: 90846 & 90847

When billing insurance for couples or family therapy, proper documentation and coding takes a few extra steps. That’s because these types of sessions are only covered if your notes clearly demonstrate that addressing the couple or family is medically necessary in order to treat the diagnosis of one insured member.

The following guidelines will help you meet insurance regulations as well as ethical standards when seeking reimbursement.

Insurance coverage for couples and family therapy

Coverage for couples therapy depends on the plan, state laws, and the client’s account. In general, to bill insurance for couples sessions, certain diagnostic criteria must be met.

Key things to know:

• One partner (the Identified Patient whose insurance will be billed) must have a diagnosable mental health condition for which care is medically necessary.
• It be documented that the relationship dynamics need to be addressed to treat this condition.
• A diagnosis beyond a DSM-5 Z-code is typically required to establish medical necessity.

CPT codes for couples and family therapy

The two most common CPT codes used for couples and family therapy are code 90847 and code 90846.

90847

90847 CPT code description: Conjoined therapy with the client present. The maximum session length is 50-minutes with a minimum session length of 26 minutes.

90846

90846 CPT code description: Therapy without the client present. Session length can be up to 50 minutes and must be longer than 26 minutes.

How to use codes 90847 & 90846

While you, as a licensed clinician, are ultimately responsible for accurate billing, the general guidance below will help you check all the necessary boxes.

• For initial intake (where significant other or collateral is present for information related to family dynamics), use CPT Code 90791 to establish the IP's diagnosis and develop a treatment plan.
• If a session includes the IP alone, use individual therapy codes, such as 90832, 90834, or 90837.
• If a session includes the significant other without the IP present, use code 90846.
• If a session includes both the significant other and the IP (conjoined therapy), use code 90847.

How to bill for individual and couples/family therapy occurring on the same day

There may be cases where you see a client for individual therapy and family therapy on the same day. This requires a very specific coding setup, which includes adding a -59 modifier to the appropriate family/relationship code. This will convey that the two sessions were separate and distinct services, and not one continuous session.

Following these steps will help you code this properly:

1. Choose one code for individual therapy: 90832 for 30 mins psychotherapy, 90834 for 45 mins psychotherapy, or 90837 for 60 mins psychotherapy.
2. Choose one code for family therapy: 90846 for family/relationship therapy without the patient, or 90847 for family/relationship therapy with the patient.
3. Apply the -59 modifier (Distinct Procedural Service) to the second service billed on the same day.

In the instance that you see a client for these two separate services in one day, only one claim should be submitted. Note that some insurance plans will have specific instructions for submitting this claim. Contact the plan directly and inquire to ensure compliance.

Reducing audit risk when billing for couples and family therapy

Using 90834 or 90837 for couples therapy can trigger audits or denied claims because these are codes for individual psychotherapy and do not match the service unit (a couple/family) documented in the note.

Be cautious and ensure proper utilization of these codes — for family therapy sessions where an identified patient with a mental health diagnosis is present (90847) or not present (90846), and the therapy is focused on treating that patient's condition within the couple/family context.

Using CPT codes 90846 or 90847 for couples therapy without a clear medical necessity tied to an identified patient's mental health diagnosis is inappropriate.

See 90847 Guidance: Ensuring Medical Necessity for more info on best practices.

When self-pay is required

Providers should let clients know that self-pay is the appropriate option when:

• Neither partner has an identified mental health condition requiring treatment.
• The focus is primarily on relationship issues rather than individual mental health concerns.
• Treatment format or modality is not covered by the insurance plan.

A few last documentation tips

• Where appropriate, focus on the identified patient’s symptoms and treatment goals. Maintain session notes that explicitly link the session to the treatment of the diagnosed condition. The partner with the diagnosis should consistently be identified as the "patient" in all documentation.
• Record session details: participants, start/stop times, location (e.g., telehealth).
• Document IP selection, significant discussions, and changes in the treatment unit.