CPT code 90847 and 90846 couples and guides for family medicine (2025)

When billing for family and doubles therapy, it is important for accurate and efficient claims to understand the difference between CPT codes 90847 and 90846. These codes are used for therapy sessions that include family members or joints, but they have specific guidelines based on how they are present during the session and what type of treatment is provided.

What are CPT code 90847 and 90846?

CPT Code 90847: This code is used for the treatment of family or joints when the patient (personal demand therapy) is present in the session. It is commonly used for ongoing therapy sessions where couples or family members participate in therapy simultaneously.

CPT Code 90846: This code is used for treating patients or joints, which is present without the patient. If the primary patient is not in the session, but other family members are present, it is the right code to use.

Key Differences between 90847 and 90846

90847 involves the patient (the primary person seeking therapy) attending the session.
90846 are for sessions where the primary patient is not present, but family members are still involved in the therapy.

When to Use Each Code

CPT Code 90847: Use this code when the patient is involved in the therapy session, and it focuses on the treatment of family or joints.
For example, if two partners in a marriage are participating in therapy with being a primary patient with a person, then 90847 is the code to use.
CPT Code 90846: Use it when the patient (person seeking help) is not present, but family members are still receiving medical treatment.
For example, if the family is being consulted, but the primary patient is absent, use 90846.

Duration for Billing 90847 and 90846

Both CPT codes require the therapy session to last at least 26 minutes. The ideal time limit to use these codes is between 50 and 74 minutes.

If the therapy session is more than 74 minutes, you can consider adding a billing code to cover the extra time.

Reimbursement rate for 2025

CPT code 90847 (currently family medicine with the patient) has a 2025 reimbursement rate of $ 102.86.
CPT code 90846 (family medicine without a patient) has a 2025 reimbursement rate of $ 98.66.

These rates can vary depending on the insurance provider and your location, so always check with the insurance company before the billing.

Billing Scenario Example

Let’s say you have a family of three involved in therapy:

Client A (mom)
Client B (child)
Client C (child)
Session 1: All family members attend therapy together (use CPT Code 90847 for family therapy with the patient present).
Session 2: The mother attends therapy alone to discuss treatment for the child (use CPT Code 90846 for family therapy without the patient present).
Session 3: The child attends therapy alone (this would be an individual therapy session, so use CPT Code 90837 for individual therapy).
Session 4: The mother returns for therapy focused on her issues (again, use CPT Code 90837 for individual therapy).

Important Billing Tips

Primary Treatment seeker: Always ensure that the person who is the first aid seeker is listed as a patient on your claim, even if other family members are present.
Check insurance policies: The reimbursement rate may be different, and some insurance companies may have specific requirements or limitations on how they reimburse for family medicine. Always check with the insurance company to ensure that your claims are processed correctly.

Common Billing Questions

Can you bill 90847 twice in one day?
Yes, it is possible, depending on the insurance and the provider. However, some insurance companies may deny claims if they consider the sessions to be duplicative. Always verify with the insurance provider before billing.
What if a therapist sees two siblings in the same session?
If both siblings are seen together for an evaluation, CPT Code 90847 may be used if both siblings are part of the therapy treatment, and at least one of them is the primary patient.

Conclusion

CPT codes should not complicate billing for joints and family therapy using 90847 and 90846. Just remember to focus on who is present during the session and make sure the session time meets minimum requirements. By understanding the nuances between these codes and following the guidelines, you will be able to successfully manage your medical billing.

If it feels heavy or if you need help, feel free to reach out for professional assistance with billing services.

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