CPT Code 90846: Family Psychotherapy Billing Guide
A therapist is treating a teenager for anxiety. One week, the therapist meets only with the parents. They talk about how the family responds when anxiety spikes, what may be making it worse, and what the parents can do differently at home.
The teenager is not in the session. But the session still supports the teenager’s treatment.
That is where CPT code 90846 may fit.
The code is simple in name, but mistakes often happen around three details: who the identified patient is, whether the meeting was actually psychotherapy, and whether the patient took part in the session.
Key Takeaways
- CPT 90846 is used for family psychotherapy when the identified patient is not present.
- The code describes a 50-minute family psychotherapy session.
- Medicare guidance says 90846 should not be reported for services lasting less than 26 minutes.
- The family session must support the identified patient’s treatment.
- Use 90847 when the identified patient is present for family psychotherapy.
- Routine parent updates, scheduling calls, and simple history gathering do not by themselves support 90846.
- Document who attended, the actual session time, the treatment issue, interventions, response, and next steps.
- Telehealth may be allowed, but payer rules still need to be checked.
What Is CPT Code 90846?
CPT 90846 reports family psychotherapy without the identified patient present.
The clinician may meet with family members, caregivers, live-in companions, or significant others involved in the patient’s care. Professional caretakers or facility staff do not qualify as family participants for this purpose. The work is still tied to the identified patient’s condition and treatment goals.
CMS describes 90846 as family psychotherapy when the patient is not present. The code represents a 50-minute service.
Family psychotherapy is one of several psychiatric CPT codes used to report behavioral health evaluations and therapy services.
For example, a therapist may meet with the parents of a child with ADHD to work on behavior strategies, routines, and ways to respond to difficult situations at home. The child does not attend, but the session remains part of the child’s treatment.
The same approach can apply when a therapist meets with a spouse or caregiver to address patterns that affect a patient’s anxiety, depression, trauma symptoms, or other mental health needs.
Who Is the Identified Patient?
The identified patient is the person whose condition is being treated, even though that person does not attend the 90846 session.
Their condition and treatment plan remain the reason for the family psychotherapy.
That matters for both the note and the claim. The clinician should be able to show how work with the parent, spouse, or caregiver is expected to help the identified patient’s treatment.
If the session is primarily treating the family member’s own mental health condition, 90846 does not describe that service.
When Should CPT 90846 Be Used?
90846 may be appropriate when the patient is absent, and the therapist provides family psychotherapy that supports the patient’s care.
For Medicare, the primary purpose of the session must be treatment of the identified patient’s condition. Family psychotherapy may be appropriate when family interactions are worsening symptoms, interfering with treatment, or when family members need therapeutic help managing the patient’s behavior.
Common examples include:
- Teaching parents how to respond to a child’s behavior without reinforcing it
- Helping caregivers support a patient’s treatment plan at home
- Working with a spouse on communication patterns that affect the patient’s symptoms
- Addressing family conflict that is slowing treatment progress
- Helping family members understand how to respond to a patient’s symptoms
- Preparing caregivers to use coping or behavior strategies between sessions
One useful check is to ask:
If the patient is not in the room, is this still a psychotherapy session aimed at helping that patient’s treatment?
If yes, 90846 may be appropriate when the session also meets the applicable time, medical necessity, documentation, and payer requirements.
When Should You Not Use CPT 90846?
Not every meeting with a parent, spouse, or caregiver is family psychotherapy.
Do not use 90846 just because the patient is absent.
A five-minute call about scheduling is not psychotherapy. A short parent update may not qualify either. The same applies when the main purpose of the conversation is collecting family history or handling routine administrative matters.
CMS states that 90846 and 90847 represent family psychotherapy and should not be used when the service is limited to family history taking or E/M counseling.
The note should show that therapeutic work took place and explain how it relates to the patient’s treatment.
How Long Is a CPT 90846 Session?
CPT 90846 describes a 50-minute family psychotherapy service.
For Medicare, the service should not be reported if it lasts less than 26 minutes. That gives you a simple Medicare reference point:
| Session Time | Medicare Coding Consideration |
| Less than 26 minutes | Do not report 90846 |
| 26 minutes or more | May qualify when other requirements are met |
| 50 minutes | Matches the CPT code descriptor |
Do not enter 50 minutes automatically because it appears in the code description. Record the actual psychotherapy time.
Commercial insurers and Medicaid plans may have their own coverage, authorization, and documentation rules. Check the patient’s payer before applying Medicare rules to every claim.
CPT 90846 vs. CPT 90847
The difference between these codes comes down to whether the identified patient is present during family psychotherapy.
| CPT Code | Service | Identified Patient |
| 90846 | Family psychotherapy | Not present |
| 90847 | Family psychotherapy | Present |
CMS makes the distinction directly: 90846 is used when the patient is not present, while 90847 is used when the patient is present.
For example, a therapist meets only with the parents of a child with anxiety. They work on how the parents respond during panic episodes. The child does not attend. That may support 90846.
At another visit, the child and both parents attend and work together on communication and coping strategies. That may support 90847.
Code what actually happened during the visit, not what was originally booked on the schedule.
CPT 90846 vs. Individual Psychotherapy
A family member can take part in an individual therapy visit without turning the service into family psychotherapy.
Suppose a therapist is conducting individual psychotherapy with a teenager. The parent joins for a few minutes to provide an update, but the main service remains individual psychotherapy with the teenager.
That does not automatically become 90847.
The 2026 Medicare NCCI Policy Manual states that psychotherapy codes 90832 through 90838 include psychotherapy provided to the patient when family members are present as informants.
For individual psychotherapy, CPT code 90834 applies to 38–52 minutes of psychotherapy when the documented service supports the code.
The coding choice should follow the service being provided, not simply the number of people in the room.
Can 90846 and Individual Psychotherapy Be Billed on the Same Day?
Yes, under Medicare NCCI rules, but only when the services are separate and distinct.
Family psychotherapy such as 90846 may be reported with individual psychotherapy on the same date when the two are separate services performed during separate time periods.
For example:
A therapist sees the patient for an individual psychotherapy session in the morning.
Later that afternoon, the therapist meets with the parents for a separate family psychotherapy session without the patient.
Those are different from one long session being split between two codes.
The note should clearly show the separate service times and the work performed during each session.
Medicare also states that psychiatric diagnostic evaluation codes 90791 and 90792 are not separately reportable with family or other psychotherapy on the same date.
Commercial payer rules may differ, so check the plan before billing multiple psychotherapy services on the same day.
What Should Be Documented for CPT 90846?
A 90846 note should make it clear why the family session was needed and how it supported the patient’s care.
A strong 90846 note should capture:
- Identified patient and confirmation that the patient was not present
- Family member, caregiver, or significant other who attended
- Actual psychotherapy time or start and stop times, based on payer requirements
- Treatment goal or problem addressed
- Family issue connected to the patient’s symptoms
- Therapeutic interventions used
- Family member’s response
- Progress or barriers discussed
- Plan for follow-up
Avoid notes that only say:
Met with the patient’s mother to discuss anxiety.
That does not tell a reviewer what therapeutic work took place.
A stronger note could explain that the therapist worked with the parent on reducing reassurance behaviors that were feeding the patient’s anxiety, practiced different responses, and agreed on how those strategies would be used before the next visit.
The note does not need to be long. It needs to show what was addressed, what the therapist did, and how the work relates to the identified patient.
Less Time Reconciling Notes and Billing
Keep the clinical details from each session connected to treatment plans and billing in one behavioral health EHR.
Can CPT 90846 Be Used for Telehealth?
Yes. 90846 can be delivered through telehealth when the payer’s requirements are met.
Current HHS telebehavioral health guidance lists 90846 as eligible for telehealth and identifies the service as family psychotherapy without the patient for 26 minutes or more.
Before submitting a telehealth claim, check:
- Whether the payer covers 90846 through telehealth
- Required modifier
- Place of service
- Audio and video requirements
- Consent requirements
- Documentation requirements
Do not assume every commercial insurer follows Medicare rules.
Common CPT 90846 Billing Errors
Most 90846 billing problems come from a mismatch between the session, the note, and the code.
Using 90846 When the Patient Was Present
If the identified patient took part in the family psychotherapy session, review whether 90847 better describes the service.
Billing a Short Family Conversation as Psychotherapy
A routine update, scheduling call, or quick exchange of information does not become family psychotherapy simply because a family member was involved.
Weak Connection to the Treatment Plan
The note should explain how the family work supports the identified patient’s symptoms, treatment goals, or progress.
Missing Session Time
Duration matters for 90846. Record the actual psychotherapy time.
Overlapping Psychotherapy Services
When 90846 and another psychotherapy code are reported on the same date, Medicare requires separate and distinct services during separate time periods.
Assuming Every Payer Covers 90846 the Same Way
Coverage, authorization, frequency limits, telehealth rules, and reimbursement can differ by payer. Verify benefits instead of finding out after the claim is denied.
A connected revenue cycle management workflow can also help practices track claim status, denials, payments, and billing follow-up in one place.
A Simple CPT 90846 Billing Check
Before submitting the claim, confirm five things:
- Was the identified patient absent?
- Was family psychotherapy actually provided?
- Did the session support the identified patient’s treatment?
- Does the documented time meet the payer’s requirement?
- Does the note support the code being billed?
If one answer is unclear, review the note before sending the claim.
Keep Family Therapy Documentation and Billing Connected
90846 can be easy to miscode because the person sitting in the session is not the identified patient.
Clear documentation helps keep the service straight. Your treatment plan, therapy note, session time, telehealth information, and billing details should tell the same story.
With Vozo EHR, behavioral health practices can keep family therapy notes, treatment plans, session details, telehealth, and billing connected in one workflow.
Frequently Asked Questions
What does CPT code 90846 mean?
CPT 90846 is used for family psychotherapy without the identified patient present. The clinician works with family members or caregivers, but the session remains part of the identified patient’s mental health treatment.
What is the minimum time for CPT 90846?
The code describes a 50-minute family psychotherapy service. Medicare states that 90846 should not be reported for services lasting less than 26 minutes. Other payers may have different coverage and billing rules.
What is the difference between 90846 and 90847?
Use 90846 when the identified patient is not present for family psychotherapy. Use 90847 when the identified patient takes part in the family psychotherapy session.
Can a therapist bill 90846 for a parent-only session?
Yes, when the parent-only session is family psychotherapy that supports the identified patient’s treatment. Routine updates, scheduling discussions, and simple information gathering do not automatically qualify as family psychotherapy.
Can CPT 90846 be used for telehealth?
Yes, when the payer covers family psychotherapy through telehealth. Current HHS guidance lists 90846 as telehealth-eligible. Check the payer’s rules for modifiers, place of service, modality, consent, and documentation before submitting the claim.
Sources
Centers for Medicare & Medicaid Services. Billing and Coding: Psychiatry and Psychology Services (A56937)
Centers for Medicare & Medicaid Services. Billing and Coding: Psychiatry and Psychology Services (A57480)
Centers for Medicare & Medicaid Services. Medicare NCCI Policy Manual, Chapter 11: Medicine
U.S. Department of Health and Human Services. Telehealth.HHS.gov: Billing for Telebehavioral Health
About the author
Lara Dixit
Lara Dixit is a Senior Business Manager at Vozo Health, specializing in EHR platforms, practice management, billing, and revenue cycle optimization. She helps healthcare providers improve operational efficiency, streamline workflows, and drive sustainable practice growth. At Vozo Health, she focuses on business strategy, healthcare automation, and scalable growth for modern medical practices.