What is CPT Code 90847 and How is it Used in Family Therapy?
CPT code 90847 is defined as "Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes". This code is used for billing family therapy sessions where the identified patient (IP) is present along with at least one other family member. The primary focus of these sessions is to address interpersonal, behavioral, or emotional issues that are impacting the family dynamics and the IP's condition. Think of it as a roadmap for billing when the whole family is in the room, working together. These codes have been established to standardize billing for psychotherapy services nationwide.
When Should I Use CPT Code 90847 Versus 90846?
Understanding the distinction between CPT codes 90847 and 90846 is crucial for accurate billing and to avoid claim denials. The key difference lies in the presence of the identified patient (IP). You should use CPT code 90847 when the IP is present for at least part of the session. Conversely, CPT code 90846 is used for family psychotherapy sessions conducted without the IP present. For instance, if you meet with the parents of a child who is your IP to discuss parenting strategies, you would bill 90846. But if the child is in the room for the majority of the session, 90847 is the appropriate code.
Can I Use CPT Code 90847 for Couples Therapy?
Yes, you can use CPT code 90847 for couples therapy, but with a significant caveat: one partner must be the identified patient (IP) with a diagnosable mental health condition. Insurance providers will not typically cover couples counseling for general relationship enrichment or communication coaching. The therapy must be deemed a "medical necessity" to treat the IP's diagnosed condition. For example, if one partner has a diagnosis of depression and the couple's communication patterns are exacerbating the symptoms, then using 90847 for couples therapy would be appropriate.
How Do I Bill for a 90847 Session if it Extends Beyond 50 Minutes?
For sessions that extend significantly beyond the standard 50-minute timeframe, you can use add-on codes. Specifically, CPT code +99354 is used for the first 30-74 minutes of prolonged service, and +99355 can be used for each additional 30 minutes after that. It is critical to remember that these are add-on codes, meaning they must be used in conjunction with 90847, not as standalone codes. However, be aware that reimbursement for prolonged services is not guaranteed. Many insurance payers have strict policies and may not cover these add-on codes. It is always best practice to verify coverage and obtain pre-authorization before billing for an extended session to avoid claim denials.
What are the Most Common Mistakes to Avoid When Billing with CPT Code 90847?
Navigating the nuances of CPT codes can feel like walking a tightrope, and a few common missteps can lead to denied claims. One of the most frequent errors is using 90847 for couples therapy when no specific mental health diagnosis has been assigned to one of the partners. Insurance requires a "medical necessity," which a diagnosis provides. Another common mistake is insufficient documentation; your session notes must clearly reflect that the focus was on the family dynamics as they relate to the identified patient's treatment plan. Finally, ensure the session meets the minimum time requirement. To bill 90847, the session must be at least 26 minutes long. To avoid these pitfalls, consider implementing an EHR system like SimplePractice or TheraNest, which have built-in safeguards and prompts to ensure your billing is compliant.
Who is Qualified to Bill for CPT Code 90847?
A range of licensed mental health professionals are qualified to bill using CPT code 90847, provided they are practicing within the scope of their license and are credentialed with the insurance panel. This typically includes:
- Licensed Marriage and Family Therapists (LMFT)
- Licensed Clinical Social Workers (LCSW)
- Licensed Professional Counselors (LPC)
- Licensed Mental Health Counselors (LMHC)
- Licensed Psychologists (PhD or PsyD)
- Psychiatrists (MD) and Psychiatric Nurse Practitioners (PMHNP)
It's essential to check with your specific state licensing board and insurance panels to confirm your eligibility to bill for family therapy services.
Can CPT Code 90847 Be Used for Telehealth Sessions?
Yes, in today's evolving healthcare landscape, CPT code 90847 is widely accepted for telehealth sessions. The shift accelerated by the COVID-19 pandemic has made virtual family therapy a staple of mental health care. When billing for a telehealth session, you must include the appropriate telehealth modifier on your claim form. The most common modifiers are 95 (synchronous telemedicine service) or GT (via interactive audio and video telecommunication systems). As with all billing, policies can vary between payers, so always confirm the specific telehealth billing requirements with the insurance provider before submitting a claim.
How Can My Documentation Justify the Medical Necessity of a 90847 Session?
Your documentation is your best defense against a claim denial. To justify medical necessity, your progress notes must paint a clear picture of why the family session was essential for treating the identified patient's (IP) diagnosed condition. Think of your notes as telling a story. They should detail how the family's behaviors, communication patterns, or beliefs are impacting the IP's symptoms and progress. For example, a note might state, "Session focused on communication strategies between the adolescent IP (diagnosed with Generalized Anxiety Disorder) and parents. Explored how parental expressions of high expectations contribute to the IP's reported feelings of panic and worry." This directly links the family intervention to the IP's diagnosis. Explore how AI scribe tools like S10.AI can help you capture these crucial details effortlessly, ensuring your documentation is always robust and audit-proof.
What Should I Do if an Insurance Company Denies a Claim with CPT Code 90847?
Receiving a claim denial can be frustrating, but it's often a fixable problem. First, carefully review the denial reason provided by the insurance company. It could be a simple clerical error, like a typo in the patient's name or an incorrect diagnosis code. If the claim details are correct, the next step is to file an appeal. In your appeal, provide a concise, professional letter explaining the medical necessity of the session, referencing your detailed clinical documentation. A pro-tip seen on many clinician forums: when you call the insurance payer, avoid asking if they cover "couples counseling." Instead, ask specifically, "Does this plan cover CPT code 90847 for a patient with [insert diagnosis]?" This uses their language and frames the service as a medical intervention, not relationship coaching, which can significantly improve your chances of a successful appeal.