CPT Code 90847: What Therapists Need to Know About Family Psychotherapy Billing

In family psychotherapy, one empty chair can change the CPT code.

When the identified patient participates in family psychotherapy, CPT code 90847 may apply. If that same patient is absent, the billing code changes.

That small attendance detail matters, but it is only part of getting 90847 right.

The session still needs to be family psychotherapy, the work should support the patient’s treatment, and the documentation needs to show what happened during the visit. For Medicare, CMS also states that 90847 should not be reported for services lasting less than 26 minutes.

So before choosing the code, it helps to look beyond who was in the room.

This guide explains CPT code 90847, including who can bill it, time requirements, documentation, reimbursement, telehealth billing, and how it differs from 90846 and individual psychotherapy codes.

Key Takeaways

• CPT 90847 is used for family psychotherapy with the patient present: The identified patient participates in the family therapy session.
• Medicare requires a minimum of 26 minutes: CMS states that 90847 should not be reported for services lasting less than 26 minutes.
• Family attendance alone does not support 90847: The session must involve family psychotherapy, not only information gathering.
• 90846 applies when the patient is not present: Patient participation is the main difference between the two codes.
• Documentation must support medical necessity: The note should explain participants, interventions, treatment focus, and connection to care goals.

What Is CPT Code 90847?

CPT code 90847 is used for family psychotherapy when the identified patient is present. CMS describes 90847 as family psychotherapy involving the patient and identifies the service as 50 minutes.

The session may involve parents, spouses, partners, caregivers, or other people involved in the patient’s care. But there is an important distinction.

A family member being in the room does not automatically make the service family psychotherapy.

The focus of the session for Medicare needs to be on the treatment of the patient’s condition. Examples are: observing and altering interactions between the patient and family members, resolving conflicts among family members that affect treatment.

That could include work around:

• Family communication
• Parent and child interactions
• Treatment adherence
• Behavior patterns
• Conflict affecting treatment
• Responses to symptoms
• Coping strategies

The question to ask is not simply, “Did the family attend?”

The better question is:

“Was the family interaction part of the psychotherapy being used to treat the patient?”

Who Can Bill CPT Code 90847?

CPT 90847 may be billed by qualified mental health professionals when the service falls within their professional scope, and they meet the requirements of the payer.

Medicare recognizes several types of professionals who may furnish covered mental health services, including:

• Physicians, Including Psychiatrists
• Clinical Psychologists
• Clinical Social Workers
• Clinical Nurse Specialists
• Nurse Practitioners
• Physician Assistants
• Marriage And Family Therapists
• Mental Health Counselors

CMS recognizes eligible behavioral health professionals who may furnish covered mental health services under applicable Medicare requirements.

CPT 90847 may be billed by qualified mental health professionals who are permitted to provide psychotherapy under their state license, payer requirements, and applicable Medicare rules.

MFTs and mental health counselors can enroll in Medicare and bill for covered services to diagnose and treat mental illness on their own from January 1, 2024.

• State licensure: The clinician must be licensed or otherwise authorized to provide psychotherapy.
• Scope of practice: Family psychotherapy must fall within the clinician’s permitted professional services.
• Payer credentialing: The clinician must meet the insurer’s participation requirements.
• Medicare enrollment: Eligible clinicians must be properly enrolled when billing Medicare directly.
• Patient benefits: The patient’s plan must cover the service.

Commercial insurance and Medicaid requirements may differ from Medicare.

When Should CPT Code 90847 Be Used?

CPT 90847 may be appropriate when the patient participates in family psychotherapy and the clinician is treating family interactions that affect the patient’s condition.

For example, consider a child receiving treatment for anxiety.

The therapist may work with the child and parents to identify how repeated reassurance or avoidance at home affects symptoms. The family then practices a different response that supports the child’s treatment goals.

Another example might involve a patient and spouse working on communication patterns that are interfering with the patient’s treatment.

CMS states that family psychotherapy may be covered when there is a need to observe and correct patient-family interactions or help family members manage conflicts and barriers affecting treatment.

The session must clearly support treatment of the identified patient’s condition.

When Should You Not Bill CPT 90847?

Not every appointment involving family members supports 90847.

A Family Member Only Provides Information

Suppose a parent joins an individual psychotherapy visit for a few minutes to explain what happened at home. That does not automatically make the service family psychotherapy.

The 2026 Medicare NCCI Policy Manual states that individual psychotherapy codes 90832 through 90838 include psychotherapy where family members are present as informants.

The Session Is Only Family History Taking

Family history gathering alone is not the same as family psychotherapy. The clinician should be performing a psychotherapeutic intervention rather than simply collecting background information.

The Session Is Not Focused on the Patient’s Treatment

For Medicare coverage, family psychotherapy must primarily support treatment of the patient’s condition. General family or relationship discussions without that treatment connection may not meet the same medical necessity standard.

CPT 90847 Time Requirements

CPT code 90847 describes 50 minutes of family psychotherapy with the patient present.

For Medicare, CMS adds an important minimum: Do not report 90847 for a service lasting less than 26 minutes.

The 50 minutes refers to the CPT code descriptor. CMS states that 90847 should not be reported for services lasting less than 26 minutes. The documented session time should accurately reflect the service provided.

For example:

Scheduled Appointment: 10:00 AM to 11:00 AM

Actual Family Psychotherapy: 10:06 AM to 10:54 AM

Document the service that actually occurred rather than relying only on the time reserved on the calendar. Commercial insurers may have their own billing policies, so always verify payer requirements.

CPT 90847 Documentation Requirements

A well-written CPT 90847 note should include reasons for the need for family psychotherapy and the benefits it provided to the patient identified in the note. Documentation is essential for medical necessity and to properly describe the service rendered which is required by CMS.

What to Include in a CPT 90847 Note

Session Time: Record the actual psychotherapy time according to payer requirements. 

Participants: Record the identified patient and all participating family members, caregivers, partners, or significant others.

Treatment Focus: Explain the family interaction, relationship pattern, or concern addressed during the session.

Examples may include:

• Communication problems
• Behavioral patterns
• Family conflict
• Treatment adherence
• Responses to symptoms
• Parenting responses affecting treatment

Psychotherapy Intervention: Describe the therapeutic techniques used, such as communication work, behavioral interventions, problem solving, or conflict resolution.

Patient and Family Response: Document how the patient and family responded to the intervention, including progress or ongoing challenges.

Treatment Plan Connection: Explain how the session supports the patient’s treatment goals and ongoing care plan.

A note such as:

“Patient and parents attended. Discussed family issues.”

does not clearly support the service.

A stronger note explains what was addressed, what intervention was provided, and how the session supported the patient’s treatment.

CPT 90847 vs. CPT 90846

The main difference between CPT 90847 and CPT 90846 is whether the identified patient participates.

CPT Code	Service	Patient Participation
90846	Family Psychotherapy	Patient Not Present
90847	Family Psychotherapy	Patient Present

CMS states that 90846 is used when the patient is not present and 90847 when the patient is present.

For example:

A therapist meets only with the parents of a teenager receiving treatment.

Potential Code: 90846

The teenager attends the next family psychotherapy session with the parents.

Potential Code: 90847

The patient’s participation changes, but both services still need to support treatment of the identified patient’s condition.

CPT 90847 vs. Individual Psychotherapy

This is where many providers run into billing questions.

Imagine that a therapist is providing individual psychotherapy to a patient and the patient’s spouse joins briefly to provide an update.

That does not automatically support 90847.

According to the CMS 2026 NCCI manual, individual psychotherapy (codes 90832 – 90838) is considered psychotherapy if family members are informants.

Family psychotherapy is also relevant when the therapist is focusing on the interactions between the patient and a member of the patient’s family. Providers should also understand how this differs from longer individual psychotherapy services such as CPT 90837.

Consider the purpose of the session rather than the number of people there.

Can CPT 90847 and Individual Psychotherapy Be Billed on the Same Day?

For Medicare, they may sometimes be reported on the same date.

CMS states that family psychotherapy such as 90846 or 90847 may be reported separately from individual psychotherapy codes 90832 through 90838 when the family psychotherapy is a separate and distinct service performed during a separate time interval.

For example:

Individual Psychotherapy: 1:00 PM to 1:45 PM

Family Psychotherapy: 3:00 PM to 3:50 PM

The same minutes should not be counted toward both services.

The documentation should make the separation clear.

CMS also states that psychiatric diagnostic evaluation codes 90791 and 90792 are not separately reportable with family psychotherapy on the same date of service under Medicare NCCI rules.

Can CPT Code 90847 Be Used for Telehealth?

CPT 90847 may be billed through telehealth when applicable Medicare requirements are met. The service is recognized for family psychotherapy with the patient present for sessions lasting 26 minutes or longer. Providers should verify payer-specific requirements, including modifiers, place of service, and licensure rules.

Providers should still confirm current requirements for:

• Payer Coverage
• Place Of Service
• Telehealth Modifiers
• Patient Location
• Provider Licensure
• Telehealth Billing Requirements

Do not assume that every commercial payer follows Medicare’s telehealth rules.

CPT Code 90847 Reimbursement: What Providers Should Know

There is no single reimbursement rate for CPT code 90847 that applies to every claim.

Payment can vary based on:

• Payer
• Geographic Location
• Provider Type
• Network Contract
• Place Of Service
• Medicare Fee Schedule Rules

For Medicare, providers should check the current Medicare Physician Fee Schedule for the applicable payment amount.

CMS also states that Medicare Part B pays enrolled marriage and family therapists and mental health counselors at 75% of the amount paid to a clinical psychologist under the Medicare Physician Fee Schedule. Commercial insurance reimbursement may differ significantly.

Common CPT 90847 Billing Mistakes

Common Mistake	What To Do Instead
Using 90847 When the Patient Is Absent	Review whether 90846 better matches the service.
Billing Based Only on Family Attendance	Confirm that family psychotherapy was actually performed.
Using 90847 for an Informant Only	Individual psychotherapy may already include family members who are present only to provide information.
Missing the Time Requirement	Document actual psychotherapy time and remember Medicare’s 26-minute minimum.
Weak Medical Necessity	Connect the family work directly to the patient’s condition and treatment goals.
Overlapping Same-Day Services	Keep individual and family psychotherapy time separate when both are reported under Medicare rules.
Assuming All Payers Follow Medicare	Verify the patient’s specific plan requirements before billing.

Make Family Psychotherapy Documentation Easier

Accurate documentation makes it easier to support the claim if it is reviewed.

The note should clearly document who attended, how long the session lasted, why family psychotherapy was needed, what the clinician did, and how the service supported the patient’s treatment.

Vozo EHR keeps behavioral health documentation, treatment plans, scheduling, telehealth, and billing workflows connected, so clinicians and billing teams have the details they need without piecing them together later.

Frequently Asked Questions

Can a parent or spouse attend an individual therapy session and make it CPT 90847?

No. A family member joining an individual psychotherapy session does not automatically make it family psychotherapy. CPT 90847 applies when the session focuses on family interactions as part of treating the identified patient’s condition. If family members only provide information, individual psychotherapy codes may still apply.

Who can bill CPT code 90847?

A qualified mental health professional may bill 90847 if licensed, within scope of practice, credentialed by payer and enrolled to perform the procedure. There are several professionals who are recognized as eligible to provide behavioral health services for Medicare.

The following professionals are recognized and eligible for Medicare behavioral health services: Physician, Psychologist, Clinical Social Worker, MFT, MHC, NP, CNS, PA.

What documentation is required to support CPT 90847?

A CPT 90847 note should document who participated, the psychotherapy time, the family issue addressed, interventions provided, patient and family response, and how the session supported the patient’s treatment plan. The documentation should clearly show that family psychotherapy was medically necessary.

What is the difference between CPT 90846 and 90847?

The main difference is patient participation. CPT 90847 is used for family psychotherapy when the identified patient is present, while CPT 90846 is used when the patient is not present.

Can CPT 90847 and 90837 be billed on the same day?

Yes, under Medicare rules, both services may be reported on the same date when they are separate and distinct services performed during different time intervals. The documentation should clearly support that each psychotherapy service was separately provided.

Can CPT 90847 be billed for telehealth?

Yes. HHS lists CPT 90847 as a telebehavioral health service for family psychotherapy with the patient present. Providers should verify payer requirements related to telehealth technology, modifiers, place of service, and licensure before billing.

Can CPT 90847 be used for couples therapy?

Yes, CPT 90847 may apply when a couple participates in psychotherapy focused on treating the identified patient’s condition. The service should be documented as family psychotherapy connected to the patient’s treatment goals rather than general relationship counseling.

Sources

Centers for Medicare & Medicaid Services. Billing and Coding: Psychiatry and Psychology Services (A56937)

Centers for Medicare & Medicaid Services: Medicare NCCI Policy Manual, Chapter XI

Centers for Medicare & Medicaid Services: Medicare & Mental Health Coverage

U.S. Department of Health and Human Services: Billing for Telebehavioral Health