The 90846 CPT code is specifically designated for family psychotherapy sessions where the identified patient (IP) is not present.
Licensed mental health professionals use this code to document therapeutic sessions focused on family dynamics, communication patterns, and overall relational health without direct interaction with the IP.
This code covers sessions typically lasting 50 minutes, though it is billable for sessions as short as 26 minutes, provided that the duration is accurately recorded.
Applying the 90846 CPT code effectively can help therapists speed up billing and provide support for families dealing with difficult relational dynamics.
Usage Guidelines for 90846 CPT Code
The 3 main usage guidelines you need to abide by are:
- Session Duration: The code specifies a standard duration of 50 minutes, though sessions of 26 minutes or longer can be billed under this code. Detailed documentation of the session’s length is important to ensure proper billing and reimbursement.
- Insurance and Reimbursement: While reimbursement for CPT 90846 varies by insurance provider, rates typically range from $60 to $115, with some differences based on the therapist’s licensure level. The reimbursement rate for CPT Code 90846 in 2024 is $95.94. Some insurance companies may impose age requirements, typically 18 or 21, for eligible clients. Pre-authorization is recommended, as certain providers may need prior approval for coverage.
- Billing Limitations: CPT 90846 cannot be billed concurrently with CPT 90847 (family psychotherapy with the IP present). Additionally, it must be billed independently, without being combined with other codes, even for sessions extending 90 minutes or longer.
Comparison with Other Psychotherapy Codes
90846 CPT code is part of a family of psychotherapy codes that cover various session types. Here’s a quick comparison:
| CPT Code | Description | Session Duration |
| 90834 | Individual psychotherapy | 45 minutes |
| 90837 | Individual psychotherapy | 60 minutes |
| 90846 | Family psychotherapy (without IP present) | 50 minutes (billable from 26 min) |
| 90847 | Family psychotherapy (with IP present) | 50 minutes |
When to Use CPT Code 90846 vs. 90847
Distinguishing between CPT codes 90846 and 90847 is necessary for accurate billing. Use 90846 for family therapy sessions without the IP, while 90847 is reserved for sessions that include the IP.
If both are used on the same day, prioritize billing only 90847 to prevent claim denial. For mental health providers managing complex billing situations, using a billing service like Medical Claims Billing may be the smartest option for you. This way, you can focus on your clients without needing to worry about billing these codes correctly.
Who Can Bill 90846 CPT code?
Only licensed mental health professionals are eligible to bill CPT 90846. This includes:
- Licensed Clinical Social Workers (LCSW)
- Licensed Professional Counselors (LPC)
- Licensed Marriage and Family Therapists (LMFT)
- Clinical Psychologists (PhD or PsyD)
- Psychiatrists (MD)
Tips for Billing 90846 CPT code
When billing this code, keep in mind these tips:
- Documentation: Always document session start and end times and the duration in the patient’s file. Precise records facilitate insurance compliance and ensure accurate reimbursement.
- Insurance Verification: Each insurance provider has specific policies on CPT Code 90846, so confirm billing guidelines, especially if age restrictions or pre-authorization are required.
- Completing the CMS 1500 Claim Form: The CMS 1500 form should list the IP in section 24(c), and ensure all demographic information is accurate to avoid claims processing delays.
Knowing this code’s billing process and usage guidelines, can significantly enhance billing efficiency and ensure compliance with insurance policies.If you have any questions about billing this or any other CPT codes, feel free to reach out to us.
