CPT Code 90846: How to Use, Common Mistakes and FAQs
Guide
As a mental health professional, mastering CPT codes is crucial for accurate billing and optimal reimbursement. This comprehensive guide focuses on CPT code 90846, which is essential for billing family psychotherapy sessions where the patient is not present. We'll cover everything from basic definitions to advanced billing strategies, helping you navigate the complexities of this specific type of family therapy billing.
For a comprehensive guide to all CPT codes with cheat sheet and examples, refer here.
What is CPT Code 90846?
CPT code 90846 is defined as:
"Family psychotherapy (without the patient present), 50 minutes"
This code is used for family psychotherapy sessions where the identified patient is not present, but one or more family members (including a spouse or partner) attend the session. It involves working with family members to address interpersonal, behavioral, or emotional problems that are affecting the family unit and the identified patient's condition.
In the case of individual psychotherapy sessions, you would use CPT codes 90837, 90834 or 90832, depending on the duration of the session.
90846 vs. 90847: Difference between the CPT codes
Understanding the difference between 90846 and 90847 is crucial for accurate billing:
90846: Family psychotherapy without the patient present
90847: Family psychotherapy with the patient present
The main difference is the absence of the identified patient in 90846 sessions. If family members or partners are seen without the identified patient, you'd use 90846.
If the identified patient is present for at least 26 minutes of the session, you would use 90847 instead.
Who Can Bill CPT Code 90846?
The following mental health professionals can typically bill using CPT code 90846:
Licensed Clinical Social Workers (LCSW)
Licensed Marriage and Family Therapists (LMFT)
Licensed Professional Counselors (LPC)
Licensed Mental Health Counselors (LMHC)
Clinical Psychologists
Psychiatrists
Always verify with your state regulations and insurance providers, as requirements may vary.
Session Length and Time Requirements
While the code description specifies 50 minutes, the actual time requirements can be more flexible:
Minimum time: 26 minutes
Maximum time: Up to 89 minutes (before considering add-on codes)
Typical time: 50 minutes
It's crucial to document the exact start and end times of your sessions. For sessions lasting 90 minutes or more, you may need to use add-on codes.
Documentation Requirements
Proper documentation is essential when billing CPT code 90846. Your clinical notes should include:
Identified patient (even though they're not present)
Family members present in the session
Start and end times of the session
Presenting problem or focus of the session
Interventions used
Family dynamics observed
Progress towards treatment goals
Plan for future sessions
Clinical rationale for family-based intervention without the patient
How this session is expected to improve the patient's condition
Ensure your documentation clearly supports the need for family therapy without the patient present and justifies the use of CPT code 90846.
Automate documentation with Supanote
Documentation especially for family sessions is hard. You can use Supanote to automatically write your documentation for family sessions and save time. Supanote securely listens to your session and writes your progress note for you in the way insurance companies require. Supanote can distinguish between different members in the session. It also comes with several pre-built note templates like SOAP, DAP, GIRP, BIRP and many others. Here's a detailed guide to AI Therapy Note tools and how they work.
Reimbursement Rates
Reimbursement rates for CPT code 90846 can vary based on factors such as geographic location, provider type, and insurance plans. Here's an overview of recent Medicare reimbursement rates:
2024: $95.94
2023: $95.56
2022: $107.37
2021: $99.10
2020: $103.58
Private insurance rates typically range from $80 to $180 per session. Rates may be higher for psychiatrists and in areas with a higher cost of living. Always verify specific rates with each insurance provider.
Medical Necessity and Insurance Coverage
For 90846 to be covered by insurance, there must be sufficient evidence that the service is medically necessary to treat a diagnosis of the identified patient, even though they're not present. Key points to remember:
The identified patient must have a legitimate clinical diagnosis.
The family therapy must be clinically focused, not solely on communication skills or personal growth.
Z-codes are generally not sufficient for insurance coverage.
The treatment should be expected to improve the patient's condition.
You must justify why the session without the patient present is necessary for treatment.
Always verify benefits and coverage details with the insurance provider before beginning treatment.
Common Billing Scenarios
Parents of a Child Patient: Often used when working with parents to develop strategies for managing a child's behavioral issues.
Spouse/Partner of an Adult Patient: Can be used for sessions focusing on how to support a partner with mental health challenges.
Family Members of Patients with Substance Use Disorders: Useful for educating and supporting family members in the recovery process.
Caregivers of Elderly Patients: Can be used when working with caregivers of patients with dementia or other age-related conditions.
Telehealth: Many insurance providers now cover 90846 for telehealth sessions. Be sure to use appropriate telehealth modifiers as required by each payer.
Using Add-On Codes with 90846
For sessions extending beyond 89 minutes, you can use add-on codes:
+99354: Use for sessions 90-134 minutes (first hour of extended time)
+99355: Use for each additional 30 minutes beyond 134 minutes
Example billing:
90-minute session: 90846
100-minute session: 90846 + 99354
140-minute session: 90846 + 99354 + 99355
Always check with the insurance provider to ensure they cover these add-on codes with 90846.
Best Practices and Potential Pitfalls
Clearly identify the patient in your documentation, even though they're not present.
Don't use 90846 for brief updates or consultations with family members before/after individual sessions.
Be cautious about billing 90846 and individual therapy codes on the same day without clear distinction.
Ensure your documentation supports why the session without the patient is necessary for treatment. Use tools like Supanote to automate documentation and save time.
Regularly audit your billing practices to ensure compliance.
Stay updated on any changes to coding practices or insurance policies.
Consider using AI-powered documentation tools to ensure comprehensive and compliant notes.
Billing Examples: Which Particular Code Should Be Used?
To help illustrate the proper use of CPT code 90846 and related codes, let's examine some common scenarios. For each example, we'll present the situation and then provide the correct billing code with an explanation.
Example 1: Parents of a Child with ADHD
Scenario: You have a 10-year-old patient diagnosed with ADHD. You schedule a 50-minute session with both parents to discuss behavior management strategies and medication adherence. The child is not present for this session.
Question: Which CPT code should be billed?
Answer: CPT code 90846
Explanation: This scenario is a perfect example of when to use 90846. The identified patient (the child) is not present, but you're working with family members (the parents) to address issues related to the patient's diagnosis and treatment.
Example 2: Spouse of a Patient with Depression
Scenario: Your patient is a 45-year-old woman diagnosed with major depressive disorder. You have a 50-minute session with her husband to discuss how he can support her treatment and recognize signs of worsening symptoms. The patient is not present.
Question: Which CPT code should be billed?
Answer: CPT code 90846
Explanation: Again, this is an appropriate use of 90846. You're working with a family member (the spouse) to address issues related to the identified patient's mental health condition, and the patient is not present.
Example 3: Family Session with Patient Present
Scenario: You're treating a 16-year-old for an anxiety disorder. You have a 50-minute session with the teen and both parents to work on family communication and support strategies.
Question: Which CPT code should be billed?
Answer: CPT code 90847
Explanation: In this case, you would use 90847 instead of 90846 because the identified patient (the teen) is present for the family therapy session.
Example 4: Brief Consultation with Parent
Scenario: After a 45-minute individual therapy session with a 12-year-old patient, you spend 10 minutes speaking with the child's mother about the session and providing brief recommendations.
Question: Which CPT code(s) should be billed?
Answer: CPT code 90834 only (for the individual session with the child)
Explanation: The brief 10-minute consultation with the parent is not separately billable. It's considered part of the individual therapy service. You would not bill 90846 for this brief interaction.
Example 5: Extended Session with Family Members
Scenario: You have a 100-minute session with the parents and siblings of an 18-year-old patient diagnosed with schizophrenia. The session focuses on education about the condition and developing a family support plan. The patient is not present.
Question: Which CPT code(s) should be billed?
Answer: CPT codes 90846 + 99354
Explanation: You would bill 90846 for the base family therapy session without the patient present. Because the session extended beyond 89 minutes, you would also add the 99354 code for the additional time.
Example 6: Multiple Family Members, Multiple Diagnoses
Scenario: You're seeing a married couple. The husband is diagnosed with alcohol use disorder, and the wife is diagnosed with anxiety. You have a 50-minute session with both of them focused on their relationship dynamics and mutual support.
Question: Which CPT code should be billed?
Answer: CPT code 90847
Explanation: In this case, even though both individuals have diagnoses, you would typically identify one as the primary patient for the session and use 90847, as both members of the couple are present. You would not bill 90846 or attempt to bill two separate codes for this single session.
By analyzing these examples, you can see how the presence or absence of the identified patient, the length of the session, and the focus of the therapy all play crucial roles in determining the appropriate CPT code to use. Always remember to document clearly why you chose a particular code and how the session relates to the treatment of the identified patient.
Frequently Asked Questions
Can I bill 90846 if the patient briefly joins the session?
If the identified patient is present for less than 26 minutes, you can still bill 90846. If they're present for 26 minutes or more, you should use 90847 instead.
How do I bill if the session goes over 89 minutes?
For sessions 90 minutes or longer, you can use the add-on cpt codes +99354 and +99355. Always check with the specific insurance provider for their policy on extended sessions.
Can I use 90846 for couples therapy if one partner is the patient but not present?
Yes, you can use 90846 for a couples therapy session with just one partner if the identified patient (the other partner) has a clinical diagnosis and the session is focused on their treatment. However, verify coverage with the insurance provider.
Can I bill 90846 for a session with just siblings of the identified patient?
Yes, as long as the session is focused on the treatment of the identified patient and you can justify why their presence isn't necessary for this particular session.
Is it possible to bill both 90846 and 90847 on the same day for the same family?
While it's technically possible to bill both codes on the same day if you have separate, distinct sessions, it's not common practice. Always check with the insurance provider for their specific policies on same-day billing.
How do I document the medical necessity for a 90846 session?
Clearly state in your notes why the session without the patient present is necessary for treatment. For example, "Session focused on educating parents about strategies to manage the patient's anxiety symptoms at home."
Can I bill 90846 for phone consultations with family members?
Generally, 90846 is for face-to-face sessions (including video telehealth). Phone consultations typically require different codes. Check with the insurance provider for their policies on telephone services.
Conclusion
Mastering the use of CPT code 90846 is essential for mental health practitioners who provide family therapy services without the patient present. By understanding the nuances of this code, including session length requirements, documentation needs, and billing scenarios, you can ensure proper reimbursement while focusing on providing high-quality care to families.
Remember to stay informed about any changes in coding practices or insurance policies, as the healthcare landscape is continually evolving. When in doubt, don't hesitate to consult with billing specialists or contact insurance providers directly for clarification.
By following the guidelines and best practices outlined in this guide, you'll be well-equipped to navigate the complexities of family therapy billing, ensuring that you're fairly compensated for the vital services you provide to families in need, even when the identified patient isn't present in the session.