Ultimate Guide to CPT Code 90847: Family Therapy Billing Simplified for 2026
- Sirius solutions global
- 1 day ago
- 7 min read
We will be straight with you: CPT code 90847 confuses more mental health providers than it should and it's costing practices serious money.
We have watched therapists conduct beautiful family sessions, then bill them as individual therapy, losing $50-$80 per visit. We have seen perfectly legitimate family therapy claims denied because documentation missed one critical element. And
We havee met practice managers who avoid billing 90847 altogether because they think it's "too complicated."
Here's the truth: mastering the ultimate guide to 90847 isn't complicated it just requires understanding a few specific rules. And in 2026, with family therapy becoming standard care for many conditions and reimbursing higher than individual codes, you can't afford to get this wrong.
This guide cuts through the confusion. You'll learn exactly when to use 90847, how to document it bulletproof, and how to avoid the mistakes that trigger denials and audits.
What Exactly Is CPT Code 90847?
CPT 90847 is "Family psychotherapy with patient present, approximately 50 minutes."
Let me break down what that really means:
The patient must be in the room. Non-negotiable. If your patient's not there, it's 90846, not 90847. Patient present = 90847. Patient absent = 90846.
You need 50+ minutes. You're providing psychotherapy, not a quick check-in. Less than 50 minutes? You can't bill this code.
Family involvement is active. At least one family member participates meaningfully in the session. "Family" can be spouse, parent, sibling, child, or significant other.
It's therapy, not education. You're treating the patient's diagnosed mental health condition through family dynamics not just teaching family members about depression or giving general advice.
How 90847 Differs From Other Codes
90847 vs. 90846: Only difference is patient presence. Patient there = 90847. Patient not there = 90846.
90847 vs. 90834/90837 (Individual Therapy): Individual codes are for one-on-one work without significant family participation. If a spouse pops in for 5 minutes, that's still individual therapy. But when family members actively participate in therapeutic work for most of the session, you're looking at 90847.
90847 vs. 90853 (Group Therapy): Group therapy involves multiple patients. Family therapy involves one patient plus family members. Totally different.
When to Use CPT 90847: Real Scenarios
Scenario 1: Teen Depression with Parents
You're treating a 16-year-old with major depression. Family conflict makes symptoms worse. You meet with the teen and both parents for 55 minutes. You work on communication patterns, help parents understand depression's impact, and address specific family triggers.
This is 90847 because: The patient's present, receiving treatment for diagnosed depression through family work.
Scenario 2: Adult Anxiety Affecting Marriage
You're treating a woman with generalized anxiety disorder. Her anxiety strains her marriage significantly. You meet with her and her husband, addressing how anxiety affects their relationship, teaching him to recognize triggers, and working on communication patterns.
This is 90847 because: You're treating her diagnosed anxiety through the marital relationship. She's present and it's focused on her condition.
Scenario 3: Child ADHD and Behavior Management
You're treating an 8-year-old with ADHD. You meet with the child and parents together for behavioral management, consistent consequences, and improved parent-child communication. The child role-plays appropriate responses.
This is 90847 because: Patient's present and actively involved. You're treating diagnosed ADHD through family intervention.
When NOT to Use 90847
Parent meeting without patient: Discussing your teenage patient's treatment while they're at school? That's 90846 or possibly an E/M codenever 90847.
Brief family drop-in: Family member joins your individual session for 10 minutes? Bill individual therapy for the actual individual time, not 90847.
Pure education: Teaching family about medication without therapeutic work addressing family dynamics? That's education, not psychotherapy.
Relationship counseling without diagnosis: Couples therapy for relationship issues when neither has a diagnosed mental health condition being treated? That's counseling, not medical psychotherapy.
Documentation That Prevents Denials
Your documentation must prove you provided family psychotherapy meeting CPT criteria. Here's what every 90847 note needs:
Must-Have Elements
1. Clear patient identification + diagnosis "Patient: Sarah Johnson, 15F with major depressive disorder, recurrent (F33.1), present with both parents for family therapy."
2. Who attended "Present: Patient, mother Jennifer Johnson, father Michael Johnson."
3. Medical necessity statement "Family therapy medically necessary as patient's depression worsens with family conflict. Goals include improving communication patterns triggering depressive episodes."
4. Session time "Face-to-face family psychotherapy: 55 minutes."
5. Specific interventions Not "discussed family issues." Instead: "Cognitive restructuring of negative communication patterns; behavioral activation with family support; conflict resolution addressing patient's social activities; safety planning for managing suicidal ideation."
6. Patient participation "Patient actively engaged, expressing feelings about family conflicts, participating in communication exercises, working on coping strategies with family."
7. Clinical observations "Mother interrupts patient frequently, leading to withdrawal. Father misattributes depression symptoms to laziness. Patient tearful discussing feeling unsupported. By session end, parents showed improved listening, patient more willing to communicate."
8. Progress and plan "Progress: Family conflict decreased from daily to 2-3x weekly. Patient feels 'somewhat more understood.' Plan: Continue family therapy every other week. Homework: practice active listening 15 minutes 3x weekly."
Quick Documentation Template
Family Psychotherapy Note (CPT 90847)
Patient Name/DOB/Diagnosis
Session Duration: ___ minutes face-to-face
Participants: Patient + [family members]
Medical Necessity: [Why family therapy for this diagnosis]
Focus: [Issues addressed]
Interventions: [Specific techniques]
Patient Participation: [How they engaged]
Observations: [Family dynamics noted]
Progress: [Treatment goals status]
Plan: [Next steps, homework]
Denial-Prevention Tips
✓ Be specific, not generic. "Practiced boundary-setting with role-play, processed patient's feelings about structure" beats "discussed boundaries."
✓ Connect everything to patient's diagnosis. Every intervention ties back to treating their diagnosed condition.
✓ Don't copy-paste notes. Each session should reflect unique content.
✓ Document the 50 minutes honestly. 48 minutes? Can't bill 90847.
✓ Show therapy, not just education. Demonstrate work on family dynamics impacting the patient's condition.
Reimbursement and Payer Rules
Medicare Coverage
Medicare covers 90847 when medically necessary for treating a beneficiary's mental health condition. Standard cost-sharing applies (80% coverage after deductible).
Key point: Medicare doesn't cover couples therapy for relationship issues alone. But treating a Medicare beneficiary's diagnosed condition through family therapy? Absolutely covered.
Commercial Payers
Most cover 90847, but watch for:
Authorization requirements (especially beyond 12 sessions/year)
Session limits (sometimes counted toward individual therapy limits)
Medical necessity criteria (must show family dynamics impact diagnosis)
Reimbursement rates (typically between 90834 and 90837 rates, sometimes higher)
Medicaid
Coverage varies dramatically by state. Some generous, others restrictive. Check your state's behavioral health policies some carved out to MCOs with different rules.
Common Payer Pitfalls
✗ Poor documentation of patient's active participation ✗ Unclear medical necessity ✗ Bundling confusion with same-day services ✗ Missing time documentation ✗ Credentialing gaps (not all clinicians credentialed for family therapy)
Common Coding Errors to Avoid
Error #1: Patient Not Present Using 90847 when patient didn't attend. Fix: Patient absent = 90846.
Error #2: Brief Family Involvement Billing 90847 when family joined for 10 minutes of an individual session. Fix: Bill individual therapy code for actual individual time.
Error #3: Insufficient Time Billing 90847 for 45-minute sessions. Fix: Need 50+ minutes minimum.
Error #4: Weak Medical Necessity Generic notes not explaining why family therapy specifically treats the diagnosis. Fix: Explicitly connect family dynamics to patient's condition and treatment goals.
Error #5: Confusing Therapy with Counseling Billing couples therapy when no diagnosed condition is being treated. Fix: 90847 requires treating a diagnosed mental health condition.
Error #6: Education vs. Therapy Billing psychotherapy for educational sessions. Fix: Teaching about conditions isn't therapy it's education.
Compliance and Audit Protection
Why 90847 Gets Scrutinized
Higher reimbursement invites upcoding concerns
Boundaries with individual therapy can feel gray
Documentation is more complex
Protect Your Practice
✓ Impeccable documentation on every claim ✓ Clear medical necessity in treatment plans ✓ Accurate time tracking (time-stamped notes help) ✓ Prove patient participation (make it obvious in notes) ✓ Conduct internal audits (catch problems before payers do) ✓ Consistent training for all clinicians ✓ Know payer-specific policies
Red Flags That Trigger Audits
Nearly all sessions billed as 90847 (unusual pattern)
Every session exactly 50 minutes (suspiciously consistent)
Identical notes across multiple sessions (copy-paste obvious)
Family therapy billed for unusual populations without clear rationale
Practical Workflow Tips
Pre-Session Checklist
✓ Verify authorization if required ✓ Confirm family member attendance ✓ Review treatment plan alignment ✓ Prepare therapeutic agenda
During Session
✓ Note start time immediately ✓ Take brief process notes ✓ Document patient participation examples
Post-Session
✓ Complete notes same day ✓ Use structured template ✓ Review for completeness (60-second check)
Billing Team Process
✓ Verify documentation before submitting ✓ Use checklist for required elements ✓ Track denials by reason ✓ Monitor reimbursement timelines
Quality Assurance
Quarterly: Sample 10-15 claims, review documentation and coding, share findings non-punitively, track improvement.
How Sirius Solutions Global Helps
Mental health billing is complex 90847 is just one piece. Between psychotherapy codes, medication management, E/M services, and constantly changing payer rules, it's a lot.
Sirius Solutions Global specializes in psychiatry billing for mental health practices. Their team understands your unique challenges: complex codes like 90847, strict documentation requirements, variable payer policies, and balancing maximum reimbursement with compliance.
They provide:
Specialized coding expertise in all psychiatry CPT codes, staying current on updates and payer changes.
Documentation education helping clinicians understand what payers need, reducing denials.
Payer rules mastery across Medicare, Medicaid, and commercial plans authorization requirements, session limits, medical necessity criteria.
Credentialing support ensuring uninterrupted billing ability.
Denial management analyzing patterns, appealing appropriately, preventing future issues.
Compliance monitoring through regular audits and documentation reviews.
Full revenue cycle management from eligibility to payment posting to A/R follow-up.
Results? Practices typically see 15-25% fewer denials, 30-45 day faster reimbursement, reduced administrative burden, and stronger compliance.
Learn more at Sirius Solutions Global Psychiatry Billing.
Bottom Line: Get 90847 Right
CPT 90847 offers significant clinical and financial value. Family therapy often works best for many conditions, and proper billing ensures fair compensation for specialized work.
Key Takeaways:
✓ Patient must be present (that's 90847 vs 90846) ✓ Need 50+ minutes documented ✓ Medical necessity must be crystal clear ✓ Document specifically with details ✓ Know your payer's specific rules ✓ Run regular internal audits
Master these elements, and 90847 becomes reliable revenue. Ignore them, and you're leaving money on the table while risking compliance issues.
Take Action Now
Schedule a complimentary billing consultation to discuss your practice's family therapy billing challenges and identify revenue opportunities.
