CPT Code 90846: When to Use and How to Maximize Reimbursement for Therapists

Navigating billing codes can feel overwhelming for any mental health professional. However, knowing how to use these codes correctly ensures you receive proper reimbursement and maintain a successful practice. One important code for therapists to know is 90846.

Let’s examine some of the details of the 90846 CPT code: covering its definition, usage, billing criteria, and more – ensuring you get your reimbursement while delivering excellent care to your clients.

What is the 90846 CPT Code?

‍Therapists use the 90846 CPT code to bill for family psychotherapy sessions without the patient present. This code allows therapists to charge for sessions that address family dynamics and relationships that affect the client and their functioning, even when the identified patient is absent. Key features of this code emphasize family-centered treatment and provide flexibility in dealing with family issues without the patient's direct involvement.

When to use 90846

‍The 90846 CPT code applies in various scenarios where family psychotherapy is necessary, but the identified patient is not present during the session. You might use this code in situations such as:

• Family dynamics and relationship issues: When helping families work through communication challenges, conflicts, or unhealthy patterns that affect the identified patient's mental health and well-being.
• Parenting concerns: When offering guidance and support to parents or caregivers about the identified patient's treatment, behavior management strategies, or developmental needs.
• Collaborative treatment planning: When discussing and coordinating the identified patient's care with family members, discussing treatment goals, and outlining roles and responsibilities, such as how the family member can support the client.
• Psychoeducation: When providing information and resources to family members about the identified patient's diagnosis, treatment options, and ways to support their recovery.

To decide if 90846 is the right code for a session, consider these guidelines:

• The session should primarily focus on family dynamics, relationships, or concerns that directly affect the identified patient's mental health and treatment.
• The identified patient must not attend the session. If the patient is present for any part of the session, a different CPT code (e.g., 90847) is more appropriate.
• The session should include at least one family member or significant other, but may involve multiple family members or support persons if needed.
• The session must last at least 26 minutes to qualify for reimbursement with this code.

Requirements and Billing Criteria for 90846

‍To bill correctly using the 90846 CPT code and ensure reimbursement, therapists need to meet specific documentation and billing criteria. Here are the key requirements:

• Session duration: The family psychotherapy session without the patient present must last at least 26 minutes to qualify for reimbursement using the 90846 code.
• Session focus: The documentation should clearly state that the session focused on family dynamics, relationships, or concerns directly affecting the identified patient's mental health and treatment, even though the patient was not present.
• Participants: The session must include at least one family member or significant other. If multiple family members or support persons are involved, document their roles and relationships to the patient.
• Treatment plan: Link the session to the patient's overall treatment plan, showing how meeting with the family members aligns with the patient's mental health goals and objectives.
• Medical necessity: Establish the medical necessity of the family psychotherapy session by connecting it to the patient's diagnosis and treatment needs. Use appropriate ICD-10 codes to support the CPT code.
• Progress notes: Keep clear, detailed, and timely progress notes that describe the session's content, interventions used, and any plans for future sessions or follow-up.
• Billing forms: Complete all necessary billing forms, including the CMS-1500 or electronic equivalent, ensuring that the 90846 code is entered correctly, along with the appropriate ICD-10 code(s) and any applicable modifiers.
• Claim submission: Submit the claim to the appropriate insurance provider or payer, following their specific guidelines for CPT code 90846. Be prepared to provide additional documentation if requested to support the claim.

Proper documentation and adherence to these billing criteria are important to avoid claim denials, audits, or other complications. Regularly review and update your billing practices to ensure compliance with the latest guidelines and regulations surrounding the use of the 90846 CPT code.

How to Improve Your 90846 Reimbursement

‍Improving reimbursement for the 90846 CPT code requires a combination of accurate documentation, strategic billing practices, and effective communication with insurance providers. Here are some key strategies to enhance your 90846 reimbursement:

• Detailed documentation: Keep clear, comprehensive progress notes that justify the use of the 90846 code. Include information about the session's duration, participants, focus on how meeting with the family members helpsthe identified patient, and connection to the treatment plan.
• Proper coding: Use the 90846 code correctly, only for family psychotherapy sessions lasting at least 26 minutes without the patient present. Avoid common mistakes like billing for shorter sessions or when the patient is involved.
• Establish medical necessity: Clearly relate the family psychotherapy session to the identified patient's diagnosis, treatment goals, and mental health needs. Use appropriate ICD-10 codes to support the medical necessity of the service.
• Timely claim submission: Submit claims promptly after the session, ensuring all required information is accurate and complete. Follow up on any pending or denied claims to resolve issues and secure reimbursement.
• Negotiate with insurance providers: Build relationships with insurance companies and advocate for fair reimbursement rates for the 90846 code. Stay informed about industry trends and be ready to justify your rates based on the value of your services.
• Appeal denied claims: If a claim is denied, follow the insurance provider's appeal process and provide additional documentation as needed to support the use of the 90846 code.

Frequently Asked Questions (FAQ)

What is the difference between 90846 and 90847?
The main difference between CPT codes 90846 and 90847 lies in whether the identified patient attends the family psychotherapy session:

• 90846: Use this code for family psychotherapy sessions without the patient present, focusing on treating the client’s mental health through collateral family involvement 
• 90847: Use this code for sessions with the patient present, addressing family issues and relationships with the patient's direct involvement.

Can I bill 90846 if the patient is present for part of the session?
No, you should not use the 90846 code if the identified patient participates in any portion of the family psychotherapy session, even briefly. In such instances, use the 90847 code, which covers sessions with the patient present.

Is there a minimum time requirement for billing 90846?
Yes, to bill with the 90846 CPT code, the family psychotherapy session without the patient present must last at least 26 minutes. Sessions shorter than this do not meet the minimum time requirement for reimbursement under this code.

Can I use 90846 for couples therapy?
The 90846 code may not be suitable for couples therapy sessions that do not focus on an identified patient's mental health and treatment. In these cases, consider using the 90847 code for family psychotherapy or a code specifically designed for couple's therapy.

What documentation is required to support billing 90846?
To support using the 90846 CPT code, your documentation should include:

1. Session duration of at least 26 minutes
2. Emphasis on addressing family dynamics or other family-related concerns that impact the identified patient's mental health and treatment
3. Participants' roles and relationships to the patient
4. Connection to the patient's overall treatment plan and mental health goals
5. Establishment of medical necessity through appropriate ICD-10 codes

Detailed, timely, and accurate progress notes are important to justify the use of the 90846 code and ensure proper reimbursement.

90846 Bill Code Limitations

‍While the 90846 CPT code allows billing for family psychotherapy sessions without the patient present, it has some limitations and restrictions that therapists need to keep in mind to ensure proper reimbursement and compliance. These limitations can affect billing practices and the financial health of a therapy practice.

One major limitation of the 90846 code is the minimum time requirement. To qualify for reimbursement, the family psychotherapy session must last at least 26 minutes. Sessions shorter than this cannot be billed using this code, which may result in lost revenue for shorter but still valuable sessions.

Another limitation is the strict requirement for patient absence. The 90846 code applies only when the identified patient is not present for any part of the session. If the patient joins, even briefly, therapists must use a different code, such as 90847, which covers family psychotherapy with the patient present. This can create billing challenges when sessions unexpectedly shift from patient absence to presence.

Additionally, the 90846 code is not suitable for all types of family-related sessions. For example:

• Couple's therapy: When working with couples without focusing on an identified patient, 90846 may not be the most appropriate code.
• Group therapy: The 90846 code is not intended for billing group therapy sessions, even if they involve family members of the identified patient.
• Non-therapeutic services: Care coordination, case management, and administrative tasks related to family involvement do not fall under the 90846 code.

Therapists should keep updated with the latest billing guidelines and regulations concerning the use of the 90846 code. This may involve:

• Participating in continuing education and training focused on CPT coding and billing practices.
• Consulting with professional organizations, such as the American Psychological Association or the American Medical Association, for guidance and resources.
• Collaborating with experienced colleagues or seeking advice from billing and coding specialists to ensure compliance and optimize reimbursement.
• Regularly reviewing and updating documentation and billing procedures to align with the latest requirements and best practices.

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