CPT Code 90847: How and When to Maximize Reimbursement for Therapists

In Brief

Accurate billing is a vital part of running a successful therapy practice, especially when it comes to therapy sessions. One CPT code that frequently arises in practice due to it’s multiple uses is 90847. This code is used for billing both couples therapy and family psychotherapy sessions when the identified patient is present. However, knowing when and how to apply this code correctly can be tricky.

This guide will provide you with a comprehensive understanding of CPT code 90847—detailing its appropriate use, billing criteria, common pitfalls, and strategies for ensuring proper reimbursement. By the end of this article, you will feel confident in applying this code and optimizing your billing process while maintaining high standards of care for your clients.

What is the CPT Code 90847?

CPT code 90847 is used for conjoint psychotherapy with the patient present, often referred to as family therapy, and can also be utilized for couples therapy. This code is applicable when a therapist provides therapy to a family unit or a couple, with at least one member being the identified client receiving treatment. The session focuses on improving communication, addressing relational dynamics, and resolving conflicts within the system, all while considering the individual needs of the identified client. In couples therapy, 90847 is often used to explore and address relationship patterns, enhance connection, and support shared goals for the partnership. Documentation for sessions billed under this code must emphasize the therapeutic goals, clinical necessity, and progress within the relational context, as well as the relevance to the identified client’s treatment plan.

When to use CPT Code 90847

CPT code 90847 can apply to billing in a number of situations: family psychotherapy sessions when the identified patient is not present. This code fits various situations:

Family dynamics and communication: Use this code when working with family members to enhance communication, resolve conflicts, or address dysfunctional patterns within the family system.
Couples therapy: When working with couples to explore relationship dynamics, improve communication, and resolve conflicts while supporting the identified client’s treatment goals.
Support for the identified client: When involving family members or a partner is necessary to support the identified client’s treatment plan and improve their mental health outcomes.
Parenting interventions: When helping parents or caregivers develop strategies to support the identified client with the client present, such as improving parenting skills or addressing communication challenges in the parent-child dyad.
Relational dynamics affecting treatment: When exploring how family or couple dynamics may contribute to the client’s presenting issues, such as stress, anxiety, or depression.
Systemic support for change: When involving the family or partner is essential to facilitate behavioral changes, address family roles, or improve overall relational functioning.
Trauma processing within relationships: When addressing trauma that affects family or couple relationships, such as attachment wounds or intergenerational trauma.
Treatment of specific disorders: When relational dynamics are a contributing factor to disorders such as substance use, eating disorders, or mood disorders in the identified client.

Remember, CPT code 90847 should be used only when the session focuses on family dynamics, functioning, or concerns related to the identified patient's treatment. It is not suitable for individual therapy sessions with family members that do not directly address the patient's care or treatment goals.

When applying CPT code 90847, the therapist must document the session's duration, participants, and key themes or interventions in the patient's medical record. The note should clearly state that the identified patient was present and explain how the session connects to the patient's overall treatment plan and goals.

When not to use CPT Code 90847

While CPT code 90847 helps with billing family therapy sessions without the identified patient present, there are times when it should not be used:

Individual therapy for family members: If you're conducting individual therapy sessions for family members that do not directly involve the identified patient's treatment or care, CPT code 90847 is not suitable. Instead, use codes specific to individual therapy for the family member being focused on, such as 90832, 90834, or 90837, depending on the session duration.
Group therapy: CPT code 90847 is not appropriate for group therapy sessions involving multiple families or unrelated individuals. For these sessions, use the suitable group therapy codes, such as 90853.
Non-therapeutic meetings: If you're meeting with family members for reasons other than therapy, such as scheduling or administrative purposes, CPT code 90847 should not be applied. These meetings are generally not billable as psychotherapy services.

Understanding the limitations of CPT code 90847 helps avoid incorrect billing and potential compliance issues. Always make sure that the code accurately reflects the services provided and aligns with the patient's treatment plan and goals.

Requirements and Billing Criteria for CPT Code 90847

To bill correctly with CPT code 90847, therapists need to follow specific documentation and reporting guidelines:

Session length: Use CPT code 90847 for sessions lasting 26 minutes or more where the client and one or more family member is present.
Session participants: Document that the client was present along with the names and relationships of the family members involved in the session.
Session content: Focus the session on family dynamics, communication, or issues related to the identified patient's treatment. Clearly describe the main themes, interventions, and outcomes of the session.
Treatment plan: Explain how the family session fits into the identified patient's overall treatment plan and comment on the client’s progress toward goals..
Medical necessity: Show the medical necessity for the family session by demonstrating how the involvement of family members or a partner directly supports the identified client’s treatment goals, addresses relational dynamics impacting the client’s mental health, or facilitates progress in managing specific symptoms or conditions.

When billing with CPT code 90847, remember:

Frequency limits: Some insurance plans may limit the number of family therapy sessions allowed without the patient present. Check the specific plan's requirements to ensure compliance.
Modifiers: In certain situations, you may need to add a modifier to the CPT code to indicate special circumstances, such as a telehealth session (GT or 95 modifier) or a session that is part of a Medicare Partial Hospitalization Program (PH modifier).
Proper documentation: Keep clear, concise, and timely documentation of the session in the patient's medical record, including the date, duration, participants, and a summary of the content discussed.

Common Pitfalls to Avoid for CPT Code 90847

When billing with CPT code 90847, therapists should watch out for common mistakes that can lead to denied claims or compliance issues:

Incorrect patient absence: CPT code 90847 is for family psychotherapy sessions when the identified patient is present. If the patient does not attend the session, use CPT code 90846 instead.
Insufficient documentation: Clearly record the session's duration, participants, and content in the patient's medical record. Not providing enough documentation can lead to denied claims or audits.
Unrelated session content: The family or couples session documentation must focus on issues directly related to the identified patient's treatment plan and goals. Avoid using CPT code 90847 for sessions that do not address the patient's care.
Misusing modifiers: Know when and how to use modifiers with CPT code 90847. Using the wrong modifier can lead to denied claims or compliance issues.
Exceeding frequency limits: Keep track of any frequency limits set by insurance plans for family therapy sessions without the patient present. Going beyond these limits can result in denied claims.
Confusing with other codes: Do not use CPT code 90847 for individual therapy sessions with family members or group therapy involving multiple families. Use the appropriate codes for these services.

Regularly review and audit your billing practices to find and fix any errors or inconsistencies in using CPT code 90847. Stay informed about the latest coding guidelines and payer requirements to ensure compliance and get the best reimbursement possible.

How to Improve your CPT Code 90847 Reimbursement

To ensure complete reimbursement when billing with CPT code 90847, consider these strategies and tips:

Stay informed about billing guidelines: Regularly review the latest coding guidelines and payer requirements for CPT code 90847. This helps you remain compliant and avoid denied claims.
Provide thorough documentation: Clearly document the session's duration, participants, and content in the patient's medical record. Use specific examples and link the session to the patient's treatment plan and goals.
Demonstrate medical necessity: Show the medical necessity for the family session by demonstrating how family involvement supports the client’s treatment goals, addresses relational dynamics, or aids in managing symptoms.This supports the use of CPT code 90847.
Use modifiers correctly: When applicable, apply the appropriate modifiers with CPT code 90847, such as the GT or 95 modifier for telehealth sessions. Proper modifier use can help prevent denied claims or compliance issues.
Monitor frequency limits: Keep track of any frequency limits set by insurance plans for family therapy sessions without the patient present. Plan your sessions accordingly to avoid exceeding these limits and facing denied claims.
Negotiate with payers: Use data-driven approaches to negotiate better reimbursement rates for CPT code 90847 with insurance companies. Show the value of family therapy sessions in improving patient outcomes and reducing overall healthcare costs.
Educate patients and families: Help patients and their families understand how family therapy sessions contribute to the overall treatment plan. Encourage their participation and engagement to get the most out of these sessions.

Frequently Asked Questions (FAQ)

What is the difference between CPT codes 90846 and 90847?

CPT code 90846: This code applies to family psychotherapy sessions without the identified patient present.
CPT code 90847: This code is used for family psychotherapy sessions when the identified patient is present for at least part of the session.

Can I bill CPT code 90847 for individual therapy sessions with family members?

No, CPT code 90847 should not be used for individual therapy sessions with family members that do not directly address the identified patient's treatment or care. Instead, use codes specific to individual therapy with the family member as the identified client of that service. For this service use codes such as 90832, 90834, or 90837, depending on the session duration.

What is the minimum time requirement for billing CPT code 90847?

To bill using CPT code 90847, the family psychotherapy session must last at least 26 minutes.

How often can I bill CPT code 90847?

The frequency of billing CPT code 90847 may be limited by the patient's insurance plan and place of service (inpatient settings vs outpatient mental health). It's important to check the specific plan's requirements to ensure compliance and avoid denied claims. Document the medical necessity for each family session to support the billing frequency.

What documentation is required when billing CPT code 90847?

When billing CPT code 90847, therapists need to include the following in the patient's medical record:

Session date and duration: Record the date and length of the family psychotherapy session.
Participants: Document the presence of the client in the session and list the names and relationships of the family members involved in the session.
Session content: Describe the main themes, interventions, and outcomes of the session, focusing on issues related to the identified patient's treatment.
Treatment plan: Explain how the family session fits into the identified patient's overall treatment plan and comment on the client’s progress toward goals.
Medical necessity: Demonstrate the medical necessity for the family session, such as gathering important information or addressing family issues that directly impact the patient's care.

Can I bill CPT code 90847 for telehealth sessions?

Yes, CPT code 90847 can be used for family psychotherapy sessions conducted via telehealth platforms. When billing for telehealth sessions, add the appropriate modifier (GT or 95) to indicate that the service was provided remotely. Ensure that the telehealth platform used is secure, HIPAA-compliant, and meets all necessary requirements for providing remote psychotherapy services.

CPT Code 90847 Bill Code Limitations

While CPT code 90847 allows therapists to bill for family and couples psychotherapy sessions witt the identified patient present, it's important to be aware of the limitations and restrictions associated with this code to ensure proper usage and reimbursement:

Session duration: CPT code 90847 applies only to sessions lasting 26 minutes or more.
Frequency limits: Insurance plans may set limits on the number of family therapy sessions that can be billed without the patient present. Exceeding these limits can lead to denied claims, so reviewing the specific plan's requirements and documenting the medical necessity for each session is important.
Patient presence: This code should be used only when the identified patient is present. If the patient is not present for any part of the session, CPT code 90846 should be used instead.
Session content: The session must focus on family or relationship dynamics, communication, or issues directly related to the identified patient's treatment plan and goals. Using CPT code 90847 for sessions that do not address the patient's care may result in denied claims or compliance issues.
Documentation requirements: Thorough documentation is key when billing with CPT code 90847. The therapist must record the session's duration, participants, and a progress note that clearly shows how the session relates to the patient's treatment plan and the medical necessity for the service.
Modifier usage: Applying modifiers to CPT code 90847 can be complex and varies depending on the situation, such as telehealth sessions or services provided as part of a Medicare Partial Hospitalization Program. Incorrect modifier usage can result in denied claims or compliance issues.

Therapists need to stay updated on the latest coding guidelines and payer requirements to ensure proper use of CPT code 90847 and to avoid potential pitfalls. Regular audits of billing practices can help identify and correct any errors or inconsistencies in the application of this code.