What Is CPT Code 90847?
CPT 90847 is the billing code for family or couples psychotherapy conducted with the identified patient present. The session is billed under the patient’s insurance coverage, treats the relational dynamics affecting the patient’s diagnosed condition, and typically runs about 50 minutes. It is one of the two primary family therapy codes in the AMA CPT code set, alongside 90846.
- 90846 vs 90847: 90847 requires the patient to be present during the session, while 90846 is billed when the patient is not present. Both require the identified patient to have a diagnosis and active treatment plan.
- Session length: A 90847 session typically runs about 50 minutes, with a common minimum near 26 minutes required by most payers to bill the code.
- Same-day billing with 90837: Billing 90847 on the same day as individual psychotherapy (90837) is sometimes possible when both sessions are distinct, medically necessary, and separately documented, but payer rules vary.
What CPT Code 90847 Covers
90847 is family or couples psychotherapy with the patient present. The session is treatment oriented, working on the family or relational dynamics that affect the identified patient’s condition, and typically runs about 50 minutes. Payers generally expect a meaningful session length, with a common minimum around 26 minutes to bill the code at all.
The identified patient must have a diagnosis and a treatment plan, because 90847 is billed under that patient’s coverage. The family is treated in service of that patient’s care, which is what distinguishes a billable session from a general family meeting.
One question we hear constantly from practice managers is whether a family session where the therapist primarily addresses a spouse or parent still qualifies for 90847. It does, as long as the identified patient is physically present and the session content ties back to that patient’s treatment goals. The patient does not need to be the primary speaker for the code to apply.
For a broader look at how psychiatry CPT codes work together, see our psychiatry CPT code overview.
What Is the Difference Between 90846 and 90847?
The only difference between the two family therapy codes is whether the identified patient is present during the session. 90847 is billed when the patient attends; 90846 is billed when the patient does not attend. Both codes still require that the identified patient have a diagnosis and an active treatment plan, and both require documentation of who was in the room.
| Factor | 90847 (Patient Present) | 90846 (Patient Not Present) |
| Patient attendance | Patient must be present | Patient is not present |
| Billed under | Identified patient’s coverage | Identified patient’s coverage |
| Diagnosis required | Yes, on the identified patient | Yes, on the identified patient |
| Typical duration | About 50 minutes | About 50 minutes |
| Common denial cause | Billed when patient was absent | Billed when patient was present |
Billing 90847 for a session the patient did not attend is a classic denial, and so is the reverse. Record attendance explicitly in every family session note. Across the billing companies we vet, attendance documentation is the single most common gap on family therapy claims.
Documentation Requirements for 90847
A defensible 90847 note records who attended, the session time, the treatment-plan goals the session addressed, and the medical necessity tied to the identified patient’s diagnosis. The note should read as treatment of the patient’s condition through the family, not as a general family discussion.
Because the code hinges on attendance and purpose, those two elements are exactly what a payer will check. Make both unmistakable in the record.
Strong 90847 documentation includes these elements:
- Names and roles of all attendees. List the identified patient and every family member or participant by name and their relationship to the patient.
- Start and stop time of the session. Record the actual clock time, not just the code’s typical duration. Payers use this to confirm the session met the minimum threshold.
- Treatment plan goals addressed. Tie the session content to specific goals in the identified patient’s treatment plan. Generic notes about family communication do not meet the medical necessity standard.
- Clinical interventions used. Document the therapeutic approach applied during the session, such as family systems work, behavioral strategies, or psychoeducation directed at the family unit.
- Patient response and progress. Note how the identified patient responded to the session and any observable changes in the family dynamic.
In our experience matching providers with billing partners, the practices that consistently document attendance, time, and treatment-plan alignment on family sessions see significantly fewer 90847 denials than those that write general session summaries. If your practice is evaluating billing partners and wants to know what to look for, our guide on how to find the right psychiatry medical billing service covers the key criteria.
90846 and 90847 denials usually trace back to attendance gaps and documentation that does not tie back to the treatment plan. If your family therapy claims are getting rejected, a billing partner with behavioral health experience catches those patterns before revenue leaks. Get matched with vetted psychiatry billing companies, free.
Can 90837 and 90847 Be Billed Together?
Billing 90847 on the same day as individual psychotherapy such as 90837, or alongside an E/M service, is possible in limited circumstances when the services are distinct and separately documented, but payer rules vary and some bundle the services. When it is allowed, the documentation has to show two genuinely separate sessions with separate time and purpose.
Do not assume same-day billing will pay. Confirm each payer’s policy, and only bill both when the record clearly supports two separate, medically necessary services. The most common same-day denial we see across the providers who come to us is a claim where both sessions were documented but the time entries overlapped, which signals to the payer that the services were not truly separate.
When same-day billing is supported, typical requirements include:
- Separate session notes. Each service must have its own clinical note with distinct start and stop times.
- Non-overlapping time. The individual session and the family session cannot share any time. A 50-minute individual session and a 50-minute family session on the same day must have 100 minutes of total documented face-to-face time.
- Distinct medical necessity. The individual session must address goals that are clinically separate from those addressed in the family session.
- Modifier use when required. Some payers require modifier 59 or an XE/XS modifier to indicate distinct services. Check the specific payer’s policy before appending.
How Long Is a 90847 Session?
A 90847 session typically runs about 50 minutes. Unlike the tiered individual psychotherapy codes (90832, 90834, 90837), which have strict time ranges that determine which code to bill, 90847 does not have formally tiered time thresholds. However, most payers expect a meaningful session length, and a common minimum across commercial and government payers is around 26 minutes to bill the code.
Sessions that fall significantly below 26 minutes face a higher audit and denial risk because the payer may determine the session did not constitute a full psychotherapy encounter. Sessions that run well beyond 50 minutes should be documented carefully to justify the extended time, particularly if the practice bills add-on codes or same-day services.
Across the billing companies we vet, one pattern stands out: practices that record actual start and stop times on every family session note have a meaningfully lower denial rate on 90847 than those that simply document ’50 minutes’ without clock times. Payers know the difference.
Why 90847 Gets Denied
Common 90847 denials come from predictable patterns. These are the issues that generate the most rejections, and they are the same patterns we look for when we vet billing companies for psychiatry practices.
- Wrong attendance code. Billing 90847 when the patient was not present. If the patient was absent, it should have been 90846.
- Insufficient session time. Sessions that fall below the payer’s minimum threshold without adequate justification.
- No diagnosis on the identified patient. 90847 requires a diagnosed condition and an active treatment plan on the patient whose coverage is being billed.
- Frequency limits exceeded. Some payers cap the number of family therapy sessions per benefit period, and Medicaid programs in particular often impose strict session limits for behavioral health services. Billing beyond the cap without prior authorization results in automatic denial. For state-specific details, see our Medicaid guide for behavioral health practices.
- Same-day conflicts. Billing 90847 alongside 90837 or an E/M without meeting the payer’s distinct-service requirements.
- Missing documentation. Notes that lack attendee names, session times, or a clear tie to the patient’s treatment-plan goals.
Prevention comes down to documenting attendance and time on every family session, tying the work to the patient’s treatment plan, and checking payer rules before billing family therapy alongside other services. A psychiatry-experienced billing partner builds these checks into the workflow so family sessions actually get paid.
For more on how to manage your practice’s revenue cycle and reduce denials, see our guide on improving revenue cycle management in psychiatry.
Frequently Asked Questions
CPT 90847 is family or couples psychotherapy conducted with the identified patient present. It is billed under that patient’s coverage and treats the family dynamics affecting the patient’s diagnosed condition. The patient-present element is what separates it from 90846.
It means a family psychotherapy session was delivered with the patient in the room, as part of treating that patient’s diagnosed condition. The identified patient must have a diagnosis and an active treatment plan, and the session must address goals within that plan.
A 90847 session typically runs about 50 minutes. Payers generally expect a meaningful session length, with a common minimum near 26 minutes to bill the code. Documentation should record actual start and stop times to support the claim.
Sometimes, when the individual session and the family session are distinct, medically necessary, and separately documented. Many payers restrict or bundle same-day billing, and some require modifier 59 or XE/XS. Confirm the specific payer’s policy before billing both on the same day.
90847 is family psychotherapy with the patient present; 90846 is family psychotherapy without the patient present. Both require the identified patient to have a diagnosis and treatment plan, and both require documenting who attended the session.
No. The patient must be physically present, but there is no requirement that the patient be the primary speaker. Sessions where the therapist works primarily with family members are billable as 90847 as long as the patient is present and the work ties to the patient’s treatment plan.
Yes. Many payers cover 90847 delivered via telehealth when the appropriate modifier (such as modifier 95 or the GT modifier, depending on the payer) is appended and the session meets the same documentation standards as an in-person encounter. Check payer-specific telehealth policies for coverage details.
90847 is most commonly paired with mood disorders (F32, F33 series), anxiety disorders (F41 series), adjustment disorders (F43 series), and substance use disorders (F10-F19 series). The diagnosis must be on the identified patient and must support the medical necessity of family psychotherapy.
Family therapy billing should not cost your practice revenue. If 90847 denials are adding up or same-day billing rules are unclear, a billing partner with psychiatry experience closes those gaps fast. Psychiatry Billers has connected more than 2,000 providers across all 50 states through our parent platform, Billing Service Quotes, with over 15 years of combined industry experience and rates starting as low as 2.95%. Finding a match is 100% free for providers.
