CPT Code 90847: When to use, Common mistakes, FAQs
GUIDE
As a mental health professional, understanding the intricacies of CPT codes is crucial for accurate billing and optimal reimbursement. This comprehensive guide focuses on CPT code 90847, which is essential for billing family psychotherapy sessions. We'll cover everything from basic definitions to advanced billing strategies, helping you navigate the complexities of family therapy billing.
For a comprehensive guide to all CPT codes with cheat sheet and examples, refer here.
What is CPT Code 90847?
CPT code 90847 is defined as: "Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes"
This code is used for family therapy sessions where the identified patient is present, along with one or more members of their family (including a spouse or partner). It involves working with family members to address interpersonal, behavioral, or emotional problems that are affecting the family dynamics and the identified patient's condition.
90847 vs. 90846 CPT codes: Key Differences
Understanding the difference between 90847 and 90846 is crucial for accurate billing:
90847: Family psychotherapy with the patient present
90846: Family psychotherapy without the patient present
The main difference is the presence of the identified patient. If the identified patient is present for at least 26 minutes of the session, you would use 90847. If you're seeing only family members or partners of the identified patient, you'd use 90846.
Who Can Bill CPT Code 90847?
The following mental health professionals can typically bill using CPT code 90847:
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 (more on this later).
Documentation Requirements
Proper documentation is essential when billing CPT code 90847. Your clinical notes should include:
Identified patient and family members present
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
How the family therapy is expected to improve the patient's condition
Ensure your documentation clearly supports the need for family therapy and justifies the use of CPT code 90847.
Automate documentation
Documentation especially for family sessions is hard. You can use Supanote to automatically write your documentation for family sessions and save time. Supanote directly 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 and write relevant notes. 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 90847 can vary widely based on factors such as geographic location, provider type, and insurance plans. Here's an overview of recent Medicare reimbursement rate for 90791:
2024: $100.53
2023: $99.63
2022: $111.15
2021: $102.59
2020: $107.19
Private insurance reimbursement rates typically range from $85 to $200 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.
Frequency of Billing
The frequency of billing CPT code 90847 is generally not limited by insurance providers. However, the medical necessity for the frequency of sessions should be clearly documented in the treatment plan.
Some providers might have specific policies about the number of family therapy sessions covered in a given time period, so it's wise to verify this information for each patient's insurance plan.
Medical Necessity and Insurance Coverage
For 90847 to be covered by insurance, there must be sufficient evidence that the service is medically necessary to treat a diagnosis of the identified patient. Key points to remember:
One person in the session must be your identified patient with 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.
Always verify benefits and coverage details with the insurance provider before beginning treatment.
Common Billing Scenarios
Couples Therapy: Can be billed as 90847 if one partner is the identified patient with a clinical diagnosis.
Blended Families: Bill 90847 as long as the identified patient and at least one family member are present.
Multiple Family Members: If you see multiple family members who are all identified patients, you may need to bill individual sessions for each patient. Check with the insurance provider for their specific policies.
Telehealth: Many insurance providers now cover 90847 for telehealth sessions. Be sure to use appropriate telehealth modifiers as required by each payer.
Mixed Individual and Family Sessions: If you see the identified patient individually and then bring in family members, you may be able to bill both an individual therapy code (like 90834) and 90847 on the same day if the sessions are distinct.
Using Add-On Codes with 90847
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: 90847
100-minute session: 90847 + 99354
140-minute session: 90847 + 99354 + 99355
Always check with the insurance provider to ensure they cover these add-on codes with 90847.
Best Practices and Potential Pitfalls
Clearly identify the patient at the start of treatment and maintain consistency in documentation.
Don't bill 90847 for taking family history or brief updates before/after individual sessions.
Ensure your documentation supports the medical necessity of family therapy (Use tools like Supanote to write insurance-ready documentation).
Be cautious about billing 90847 and individual therapy codes on the same day without clear distinction.
Don't bill the same session twice (e.g., as two individual sessions for a couple).
Regularly audit your billing practices to ensure compliance.
Stay updated on any changes to coding practices or insurance policies.
Frequently Asked Questions
Can I bill 90847 if only one parent and the child are present?
Yes, as long as the identified patient (typically the child) is present along with at least one family member.
How do I bill if the session goes over 89 minutes?
For sessions 90 minutes or longer, you can use the add-on codes +99354 and +99355. Always check with the specific insurance provider for their policy on extended sessions.
Can I use 90847 for couples therapy?
Yes, 90847 can be used for couples therapy if one member of the couple is the identified patient with a clinical diagnosis. However, some insurance plans may have specific requirements or limitations for couples therapy.
What if the identified patient leaves the session early?
If the identified patient is present for at least 26 minutes, you can still bill 90847. If they leave earlier, you may need to use 90846 or another appropriate code.
Can I bill 90847 for a family session conducted via telehealth?
In most cases, yes. However, be sure to use the appropriate telehealth modifier and check with the insurance provider for any specific telehealth requirements.
How do I bill if I'm seeing multiple families together?
For multi-family group therapy, you should use CPT code 90849 instead of 90847.
Can I bill 90847 if I'm working with foster families?
Yes, you can use 90847 when working with foster families, as long as the identified patient (usually the foster child) is present along with at least one foster family member.
Is couples therapy always covered under 90847?
Coverage can vary. Some insurance plans may cover couples therapy under 90847 if one partner is the identified patient with a clinical diagnosis. Others may have specific exclusions for marital therapy. Always verify coverage with the insurance provider.
Can I bill 90847 multiple times in one day for the same family?
Generally, you should only bill 90847 once per day for a family. If you have multiple distinct sessions with different combinations of family members, consult with the insurance provider for proper billing procedures.
Conclusion
Mastering the use of CPT codes 90847 and 90846 is essential for mental health practitioners who provide family therapy services. 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, insurance policies & reimbursement rate as the healthcare landscape is continually evolving. When in doubt, don't hesitate to consult with billing specialists or contact insurance companies 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.