The 90847 CPT code belongs to the family of CPT codes for mental health. This code is specifically for family or couples therapy sessions where the main patient is present, making it ideal for treating issues that need a family-focused approach.
But what do you need to document? How does insurance work with this code? And what happens if you’re doing a telehealth session instead of in-person?
We’ll answer these questions and more in the following.
90847 CPT Code Explained
The 90847 CPT code refers to a 50-minute family or couples therapy session in which the identified patient is present along with one or more family members, such as a spouse or partner.
This integrated approach allows for a deeper understanding of family dynamics, aiding in the treatment of the patient’s clinical diagnosis. To qualify for reimbursement from most payers, the patient must have a confirmed diagnosis that the session is designed to help treat.
For example, in cases like a teenager diagnosed with major depressive disorder, the provider may work with the family to support the patient’s recovery by promoting communication and offering guidance.
Key Documentation Requirements for 90847 CPT Code
Proper documentation is fundamental for the successful billing of the 90847 CPT code.
Essential documents include:
- Session Notes: A detailed summary of each session, capturing key observations, interventions, and client responses.
- Treatment Plans: Comprehensive treatment plans that outline therapy goals, strategies, and interventions.
- Client Consent: Signed consent forms that authorize family therapy as part of the treatment approach.
Additional documentation details include CMS 1500 forms, discharge summaries, and session details such as start and stop times, topics discussed, goals reviewed, and any mental health assessments conducted. This thorough documentation helps to justify the therapeutic approach and provides essential context for billing and compliance.
90847 CPT Code Time Frame
The 90847 CPT code is used for billing a 50-minute session of psychotherapy, which is the standard duration for family therapy. The minimum requirement for this code is at least 26 minutes of documented face-to-face time.
However, the time frame can range from 50 to 74 minutes, and there is no strict maximum for coding these sessions. If additional time is needed, it is advisable to reach at least 74 minutes before using an add-on billing code for extended family or couples therapy services.
90847 CPT Code Reimbursement Rate for 2024
The Medicare reimbursement rate for CPT code 90847 in 2024 is $100.53.
This code covers family psychotherapy sessions where the patient is present, ensuring that families receive support in a therapeutic setting while benefiting from fair compensation for these essential mental health services.
Insurance Coverage for 90847 CPT Code
Insurance coverage for the 90847 CPT code varies by provider and must be verified prior to therapy sessions. Most major providers, including Aetna, Blue Cross Blue Shield, Cigna, Medicaid, Medicare, and United Healthcare, may cover 90847 under specific conditions.
Key factors influencing insurance coverage include:
- Billing Guidelines and Fee Schedules: Each insurer may have unique requirements for billing CPT 90847. Familiarity with fee schedules and any required modifiers—such as Modifier -59 for distinct procedural services—helps in preparing accurate claims.
- Documentation and Coding Compliance: Proper documentation of the session’s purpose and progress is crucial for avoiding reimbursement challenges.
- Diagnosis Requirements: Coverage often hinges on specific diagnoses that validate the necessity of family therapy.
Therapists who are aware of these factors are better equipped to handle the technicalities of insurance and minimize delays in reimbursement.
Modifiers for 90847 CPT Code
Sometimes it’s crucial to use the right modifiers when billing 90847 CPT code.
For instance:
- Modifier 25: Indicates a distinct service provided on the same day as another service, often used for concurrent medical management.
- Modifier -59: Signifies reduced services or adjustments, applicable when the therapy session deviates from the standard setup.
- CMS 1500 Forms: Essential for submitting claims with modifiers and accurately recording services.
Modifiers such as these help in clearly defining the type of services rendered and supporting comprehensive billing.
Telehealth and 90847 CPT Code
As telehealth therapy sessions gain popularity, the 90847 CPT code can be used for virtual family or couples therapy under specific conditions.
Requirements for billing telehealth sessions with 90847 include:
- Qualifications for Telehealth Sessions: Ensure the session meets standards for telehealth family therapy and complies with state regulations.
- Insurance Provider Requirements: Not all insurers cover telehealth under the 90847 CPT code, so verify eligibility with each provider.
- Documentation and Reimbursement: Compile thorough documentation of telehealth session details, including interactive complexity services.
Telehealth makes therapy more accessible and provides clients the flexibility to attend sessions from their preferred location.
How to Bill for 90847 CPT Code?
In the following, we will show you how you can bill for 90847 code depending on the session.
Session 1
For a family therapy session where the primary client is present, use billing code 90847. File the claim using the primary client’s information, including their diagnosis code.
Session 2
For family therapy conducted without the primary client present, use billing code 90846. Still, file the claim under the primary client’s information and diagnosis code. You may add additional diagnoses as the therapy context unfolds.
Session 3
For individual therapy focused on family issues but provided directly to the primary client, use billing code 90837. This remains an individual therapy session, so all claim forms should include the primary client’s information.
Session 4
When another family member begins therapy sessions addressing similar family-related issues, use billing code 90837 for their individual sessions. File the claim with this new client’s information and relevant diagnosis details.
What’s the Difference Between 90846, 90847, and 90837?
There is a distinct difference between these codes, and knowing this difference is important for proper billing and service documentation.
- 90846 is used for family psychotherapy sessions where the identified patient is not present. This code applies when you meet exclusively with the family member(s) or partner to address issues related to the identified patient.
- 90847 is for family therapy sessions lasting 50 minutes, where the identified patient is present alongside their spouse, partner, or other family members. This code ensures that therapy involving the patient and their support system is appropriately billed.
- 90837 differs from both in that it refers to an individual 60-minute psychotherapy session with only the patient present, focusing solely on the patient’s individual needs rather than family dynamics.
Add-On Codes for CPT 90846 and 90847
For extended therapy sessions, such as marriage or family counseling, the CPT codes 90846 and 90847 allow for billing add-ons if sessions go beyond typical time frames.
These add-ons can help capture the additional time invested in longer sessions.
- Sessions over 74 minutes: If your counseling session extends beyond 74 minutes, you can add code +99354 for an additional 30 minutes.
- Sessions exceeding 1 hour and 45 minutes: If your session goes beyond 1 hour and 45 minutes, add +99355 to capture an additional 44–45 minutes of time.
Additional codes exist for sessions held outside regular business hours. Code +99050 applies to any services conducted after standard business hours, while +99051 can be added for therapy sessions that are scheduled on evenings, weekends, or holidays.
Need Help Billing the 90847 Family Therapy Code?
Billing the 90847 CPT code can be a bit tricky with all the documentation and insurance details.
But if you’re not sure where to start, Medical Claims Billing can handle it for you. We know exactly what’s needed for successful claims, including the right documents, treatment details, and insurance checks.
When you let us handle your 90847 billing, you save time and avoid mistakes that could delay your payments. Plus, you can focus on your clients without needing to worry about the paperwork.
If you have questions or need help with specific cases, feel free to contact us.
