Mental health billing can be tricky, especially when it comes to couples therapy and family counseling sessions. If you’ve ever asked, “Can I bill insurance for couples therapy?” or “What’s the difference between CPT 90847 and 90846?”, you’re not alone.
CPT codes 90847 and 90846 are the go-to billing codes for family psychotherapy, but they serve different purposes and have unique documentation, presence, and coverage requirements:
Understanding when and how to use these codes is essential for:
- Maximizing reimbursement
- Avoiding denials
- Ensuring payer compliance
- Providing holistic care to clients and their families
This complete guide breaks down everything you need to know: billing guidelines, documentation tips, insurance rules, common mistakes to avoid, and a clear side-by-side comparison of CPT 90847 vs. 90846.
Whether you’re a solo therapist, group practice owner, or mental health biller — this resource will help you bill smarter, stay audit-ready, and focus more on client care than claim forms.
What is CPT Code 90847?
CPT code 90847 is the go-to procedure code for couples therapy or family psychotherapy with the patient present. It’s widely used by therapists billing for family dynamics that involve a patient with a mental health diagnosis.
This code is used when the therapist sees the family — including the identified patient — to address issues impacting the patient’s treatment. In couples therapy, this is the most frequently used code if one partner is the identified patient and present during the session.
Consider a therapist meets with Maria (diagnosed with anxiety) and her husband. The session focuses on how their relationship affects her symptoms and recovery. The therapist bills using CPT code 90847—because Maria (the identified patient) is present and engaged.
Key characteristics of CPT 90847:
- Patient is present for most or all of the session.
- The focus is on how family dynamics affect the patient’s mental health.
- Often used for marriage counseling, family systems therapy, and couples therapy with patient participation.
- Considered medically necessary when part of a larger treatment plan for the identified patient.
- Covered by most insurance payers, though medical necessity must be documented.
- Typical session time: around 50 minutes (standard time range for this code).
CPT Code 90847 Description
- CPT 90847: Family psychotherapy (with patient present)
- 90847 CPT Code Time Range: Typically 50 minutes
- Used For: Couples counseling, marriage therapy, parent-child conflict, family support
- Also Called: Couples therapy CPT code, marriage counseling CPT code, CPT code family therapy with patient present.
What is CPT Code 90846?
CPT 90846 refers to family psychotherapy (without the patient present). This is billed when the therapist meets with one or more family members — like a parent, spouse, or partner — without the patient in the room.
For example, a therapist meets with a child’s parents to discuss how to set boundaries and support treatment—without the child in the room. CPT code 90846 is the correct billing code here.
This is commonly used in the following scenarios:
- Educating family members on the patient’s condition or treatment is crucial.
- Helping a spouse/partner develop supportive behaviors.
- Working through relational dynamics or parenting strategies that indirectly support the patient’s care.
Key features of CPT 90846:
- Patient is NOT present.
- Focus is on family psychoeducation, support, or coaching.
- Must be tied to the patient’s treatment plan and medically justified.
- Some insurers may restrict or deny coverage without proper documentation.
- Session length is typically 50 minutes.
- Used in situations like parent training, partner education, or co-parenting interventions.
CPT Code 90846 Description
- CPT 90846: Family psychotherapy (without patient present)
- Time Range: Typically 50 minutes (like 90847)
- Used For: Parental coaching, spousal support, behavior management
CPT 90847 vs. 90846 – Know the Difference
| Feature | CPT 90847 – With Patient Present | CPT 90846 – Without Patient Present |
| Patient Present? | ✅ Yes | ❌ No |
| Common Use | Couples/marriage/family therapy w/ client | Parent or spouse-only education sessions |
| Insurance Reimbursement | ✅ More commonly covered | ✅ Sometimes restricted; must justify |
| Session Focus | Treating the patient within the family context | Educating/supporting the family without the patient |
| Typical Session Duration | ~50 minutes | ~50 minutes |
| Place of Service (POS) | Office, telehealth, outpatient, home | Office, telehealth, outpatient, home |
| Keyword Match | CPT code for couples therapy | Family therapy without the patient present CPT |
| Telehealth Eligibility | ✅ Yes (with 95/GT modifiers if allowed) | ✅ Yes (with 95/GT modifiers if allowed) |
Is There a CPT Code for Marriage or Couples Counseling?
Here’s a common billing myth: “There must be a separate CPT code for marriage counseling or couples therapy.”
Nope. There is no standalone CPT code for marital therapy. For insurance billing, CPT 90847 (if one person is the patient) is typically used as the code for couples therapy. If the patient isn’t present, use CPT 90846.
CPT 90847 = Couples Counseling (with diagnosis + patient present)
CPT 90846 = Family Counseling without the patient
These serve as the primary couples therapy billing codes and are often referred to as:
- CPT code for couples psychotherapy
- Couples therapy CPT
- Code for couples therapy
- CPT code couples therapy 60 minutes
Reimbursement & Coverage
Insurance payouts vary by payer, state, and credentialing.
- Medicare: $110–$130 per 90847 session
- Private Payers (e.g., BCBS, Aetna): $85–$150
- Medicaid: $60–$110 (varies widely)
Billing code 90847 is one of the most frequently used in behavioral health. If you’re a provider not using it correctly, you’re probably leaving money on the table.
Scenario 1: Billing CPT Code 90847
Client: Alex (diagnosed with depression) attends therapy with his spouse.
Session: 52 minutes
Code Used: 90847
Diagnosis: F33.1 (Major Depressive Disorder)
Reimbursement: $124 (BCBS)
Scenario 2: Billing CPT Code 90846
Client’s Parent: Attends alone to learn parenting skills
Session: 50 minutes
Code Used: 90846
Diagnosis: F90.0 (ADHD) – child not present
Reimbursement: $108 (Medicare)
Documentation Tips for 90847 and 90846
Using 90847 billing code or 90846? Ensure your notes show:
- Diagnosis tied to a DSM-5 condition (Z63.0, F33.1, etc.)
- Who was present
- Session length (match to 90847 CPT code time range)
- Medical necessity (don’t just call it “relationship support”)
- Goals related to the patient’s diagnosis
Always use a Z code for relationship problems if no mental health condition is diagnosed, but remember: not all payers cover Z codes.
Related CPT Codes You Should Know
| CPT Code | Description |
| 90837 | 60-minute psychotherapy (individual) |
| 90785 | Interactive complexity (add-on for sessions w/ conflict) |
| 99354 | Additional time (for extended therapy sessions) |
| 90849 | Multiple-family group psychotherapy |
| 92508 | Group speech/hearing therapy (not psychotherapy) |
| H0046 | Community mental health service (Medicaid) |
| G0323 | Tele-behavioral health service (Medicare) |
Sample Claim: Couples Counseling CPT Code
- CPT Code Used: 90847
- Diagnosis: F43.10 (PTSD)
- Session Time: 55 minutes
- Patient: John (present with spouse)
- Insurance: UnitedHealthcare
- Billed Amount: $145
- Paid Amount: $126
Common Billing Mistakes with CPT 90847 & 90846 – And How to Avoid Them
Accurate billing for couples therapy and family sessions using CPT 90847 and CPT 90846 can be tricky. Many providers make simple errors that result in claim denials, underpayment, or compliance red flags. Below are the most frequent billing mistakes — and how you can avoid them to protect your revenue cycle.
Mistake 1: Confusing Patient Presence Status
Billing CPT 90847 (with patient present) when the patient was not in the room, or billing CPT 90846 (without patient) when they were present.
These codes are explicitly defined by whether the identified patient is in the session. Misbilling violates coding rules and may trigger audits or denials.
How to avoid it:
- Carefully document who was present in every session note.
- Use CPT 90847 only when the patient is present.
- Use CPT 90846 only when the patient is absent for the entire session.
- If the patient joins briefly, bill as 90847 but document the timing.
Mistake 2: Not Identifying the Patient of Record
Submitting claims where the family or couple is billed as the “client,” rather than identifying a specific patient.
Insurers require a designated patient for claims processing, even in family or couples therapy.
How to avoid it:
- Always identify the patient of record (e.g., the person with the mental health diagnosis).
- Use that patient’s name, DOB, diagnosis code, and insurance info on the claim form.
- Tie the family/couples session to the patient’s treatment goals in documentation.
Mistake 3: Using CPT 90847/90846 Without a Covered Diagnosis
Submitting family therapy codes for services that insurers consider non-medical (e.g., relationship counseling without a mental health diagnosis).
Many insurers only reimburse if the session supports a mental health diagnosis and is part of a treatment plan.
How to avoid it:
- Use a billable mental health diagnosis for the identified patient (e.g., F33.1 – Major depressive disorder).
- Document how the session addresses symptoms, treatment compliance, or family dynamics contributing to the diagnosis.
- Avoid codes like Z63.0 (relationship distress) as the primary diagnosis — many payers don’t cover it.
Mistake 4: Forgetting Medical Necessity Documentation
Assuming family or couples therapy is automatically covered without documenting why it’s medically necessary.
Insurance companies require clear proof that the therapy supports the diagnosed patient’s mental health treatment.
How to avoid it:
- Include a brief clinical rationale in every progress note.
- Example: “This session focused on helping the patient’s spouse understand panic triggers and develop a safety response plan to reduce ER visits.”
- Update the treatment plan to show that family therapy is a component of care.
Mistake 5: Ignoring Telehealth Modifier Requirements
Billing CPT 90846 or 90847 for telehealth without the correct modifiers or POS codes.
Payers require modifiers (like 95 or GT) to distinguish telehealth from in-person care — especially post-COVID.
How to avoid it:
- For telehealth sessions, use modifier 95 or GT based on the payer’s policy.
- Use the correct Place of Service (POS) code:
- POS 10 for home-based telehealth (if patient is at home).
- POS 02 for other telehealth locations.
- Always verify payer-specific telehealth requirements.
Mistake 6: Inconsistent Use of Time Guidelines
Billing family therapy codes without meeting the minimum session duration, especially for payers requiring time-based billing.
CPT 90846 and 90847 assume approximately 50 minutes of therapy. Billing shorter sessions may trigger denials or audits.
How to avoid it:
- Ensure sessions last at least 45–50 minutes unless payer policies say otherwise.
- If your EHR allows, add session duration in the progress note.
- For shorter sessions, check if 90832 or 90834 would be more appropriate, depending on the format.
Mistake 7: Repeatedly Billing Family Therapy Instead of Individual Codes
Use 90847 or 90846 as your primary code for all sessions, even when the majority of work is with the individual.
Overusing family therapy codes without variety may trigger payer audits, especially if medical necessity isn’t justified.
How to avoid it:
- Mix 90834 (individual therapy) and 90847/90846 when clinically appropriate.
- Document the purpose and outcomes of each type of session.
- Rotate session types as treatment goals evolve — insurers prefer to see varied modalities.
Conclusion
Mastering the nuances of CPT 90847 (family or couples therapy with the patient) and CPT 90846 (without the patient) is essential for running a compliant and profitable behavioral health practice. From understanding patient presence rules and payer-specific documentation requirements to applying the proper diagnosis and telehealth modifiers — every detail matters when it comes to getting paid correctly and consistently.
Avoiding common mistakes like mismatched presence codes, undocumented medical necessity, and unsupported diagnoses can help you:
- Prevent costly denials
- Accelerate reimbursements
- Maintain payer trust
- Improve your practice’s financial health
By integrating accurate billing practices with detailed clinical documentation, you not only stay audit-ready but also ensure that your clients continue receiving uninterrupted care.
Frequently Asked Questions (FAQs)
What is CPT code 90847?
CPT 90847 is the billing code used for family or couples therapy sessions where the patient is present. This includes psychotherapy that involves the therapist, the patient, and one or more family members—often used in marriage counseling, couples therapy, or parent-child sessions.
What is the difference between CPT code 90847 and 90846?
- 90847: The patient is present during the session.
- 90846: The session is conducted without the patient, typically with parents or a spouse to provide support, education, or guidance.
These codes are often confused. Remember: CPT 90847 = with patient, CPT 90846 = without patient.
How long is a 90847 session supposed to be?
The 90847 CPT code time range is typically 45 to 60 minutes, with 50 minutes being standard. Most insurers accept this range, but it’s best to verify with each payer for exact documentation requirements.
Can I bill both 90847 and 90846 for the same patient in a single day?
No. You cannot bill CPT codes 90847 and 90846 on the same day for the same patient. Choose the most appropriate code based on who was present during the session.
Does insurance cover couples therapy (CPT 90847)?
Yes, but it depends on the medical necessity and diagnosis. Most insurers cover the 90847 CPT code under family psychotherapy, not as “marriage counseling.” Always document a DSM-5 mental health diagnosis and how the family or couple interaction affects the patient’s treatment plan.
What diagnosis code should I use for couples therapy billing?
While the Z63.0 (relationship distress with spouse or partner) is often used, it may not be covered unless accompanied by a primary mental health diagnosis (e.g., depression, anxiety). For the 90847 billing code to be reimbursable, one individual must be the identified patient.
What is the reimbursement rate for CPT 90847 and 90846?
Rates vary by payer and location, but on average:
- CPT 90847: Reimburses $90–$160 per session.
- CPT 90846: Reimburses slightly less, around $70–$130 per session.
Check your payer fee schedule to confirm.
Can unmarried couples use CPT 90847 for therapy sessions?
Yes. Couples therapy CPT code 90847 applies regardless of marital status, as long as there is a mental health diagnosis and the therapy supports the patient’s care. Insurance coverage will still depend on the diagnosis and plan benefits.
Need Help With Mental Health Billing?
ANR Medical Billing Services specializes in comprehensive mental health billing solutions, including expert support for CPT codes 90846 and 90847, telehealth billing, and payer-specific compliance. Whether you’re a solo therapist, group practice, or behavioral health clinic, our team ensures accurate claims submission, faster reimbursements, and fewer denials—so you can focus on client care, not paperwork.
