Best Billing Options: Which Pays Better 90847 or 90846?

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Which Pays Better: 90847 or 90846? Top 10 Billing Options for Mental Health Practices

Therapists, you’ve probably wondered if CPT 90847 or 90846 puts more cash in your pocket. The short answer: it depends on the payer, the contract tier, and how you run your billing. Below is a short‑list of the ten most common ways to handle family‑therapy codes, with the option that most practices love at the top.

1. MCM South Medical Billing Service, LLC (Our Top Pick) , Managed Billing for 90846/90847

MCM South is a managed billing firm that focuses on mental‑health private practices. It handles eligibility checks, claim submission, denial management, and monthly revenue reports. Solo LPCs, LMFTs, and small group LCSWs find it a good fit because the team knows the nuances of family‑therapy codes. If you’ve ever asked yourself which pays better 90847 or 90846 under your specific payer contracts, the MCM South team can pull your data and answer that question with actual numbers. The service reduces claim errors and speeds up reimbursements, so you can see more patients. One limitation: pricing is a percentage of collections, so very low‑volume clinics may see a higher effective cost.

Ready to stop chasing payments?

2. In‑House Billing Team , Full Control Over Claims

Hiring an in‑house coder gives you direct oversight of every claim. You can train the staff on your practice’s specific documentation style and keep patient data fully internal. This option works well for larger groups that see many 90847 sessions a week. It also lets you tweak modifiers in real time. The downside is the overhead: salaries, software licenses, and the time spent on hiring and training.

In‑house teams can reduce denial rates when they understand the exact documentation needed for family‑therapy codes.

What most practice owners underestimate, however, are the hidden costs that stack up well beyond a base salary. Before you post that job listing, consider the full financial picture: you will need to purchase computers and hardware (plan on $1,000–$2,000 per workstation plus periodic replacements), a dedicated phone line or secure VoIP extension for payer calls, and a steady supply of paper and office materials for EOB filing and correspondence. On the payroll side, you are responsible for employer‑paid Social Security and Medicare taxes (FICA at 7.65% of gross wages), federal unemployment tax (FUTA), and your state’s unemployment tax (SUTA), which together can add another 2–5% on top of wages depending on your state’s rate and experience rating. Health insurance contributions for a full‑time employee can run $300–$700 per month for a single‑coverage plan, and you will still need to budget for paid time off, sick leave, and holidays — typically two to four weeks of paid absence per year that produce zero billing output. Training and continuing education are non‑negotiable in a field where payer rules change annually; expect to spend $500–$1,500 per year on coding courses, webinars, and credentialing renewals. Many practice owners also overlook the need for malpractice or professional liability coverage that extends to billing staff, since coding errors can expose the practice to audit risk and recoupment demands. Finally, every major billing or EHR platform charges per‑user seat licenses — fees that can range from $50 to $200 per month per staff member — and those costs multiply quickly if you use separate tools for eligibility verification, claim scrubbing, and reporting. When you add all of these line items together, a billing employee with a $45,000 annual salary can realistically cost the practice $60,000–$70,000 or more per year in true total compensation and overhead. Run those numbers against your current 90846 and 90847 reimbursement volume before committing to in‑house staffing.

3. Specialty Billing Agency , Focused on Behavioral Health Codes

These agencies specialize in mental‑health CPT codes. They stay up‑to‑date on parity laws and know when insurers will accept 90846 versus 90847. For practices that serve a mix of Medicare and private payers, a specialty agency can negotiate better contract language. However, they may not integrate tightly with every EHR, so you might need a manual export step.

Learn more about code nuances in our Cpt Code 90847 Fee Schedule guide.

4. General Medical Billing Company , Broad Service Portfolio

Large billing firms handle all specialties, from orthopedics to psychiatry. They bring scale and often lower per‑claim fees. If your practice also bills for 99213 or 90791, a general firm can bundle everything. The trade‑off is less expertise in family‑therapy nuances, which can lead to higher denial rates for 90846. Practices that are still determining which pays better 90847 or 90846 across multiple payer contracts may find that a general firm lacks the granular reporting needed to make that comparison confidently.

5. DIY Billing Software , Automated Claim Submission

Billing software like TheraPlatform or SimplePractice lets you enter CPT codes yourself and push claims through a clearinghouse. It’s cheap, fast, and gives you full control of the data. You’ll need to stay on top of payer rules for 90846 vs 90847, especially modifier usage. Small practices that enjoy tech can save up to 30% on service fees.

For a deep dive on how software handles these codes, see our Mental Health Billing Software vs Service comparison.

6. Hybrid Billing Model , Combine Agency & Software

A hybrid approach uses a billing service for claim review while you run the front‑end software. This gives you the safety net of expert eyes without giving up the convenience of an integrated dashboard. It works well for practices that want to keep some in‑house control but lack full‑time coders. Keep an eye on coordination costs; you’ll pay both the software subscription and a small percentage to the agency.

7. Regional Billing Firm , Local Expertise & Compliance

Regional firms know state‑specific Medicaid rules and local payer contracts. If you practice in a state with unique Medicaid codes (like Massachusetts CBHI), they can help you avoid costly compliance mistakes. Their downside is limited national reach, so if you see patients from many states, you’ll need additional partners.

Check out our Best Mental Health Billing Services in Metro Atlanta (2026) for an example of a regional firm that grew into a multi‑state player.

8. Telehealth Billing Platform , Optimized for Remote Sessions

Telehealth platforms embed CPT codes and automatically add modifier 95 or GT. They also track the 26‑minute minimum for 90846 and 50‑minute window for 90847. This helps avoid claim rejections when you switch between video and phone. However, not every payer accepts telehealth for family therapy, so you may need a backup claim path.

9. Outsourced Coding Service , Expert CPT Coding Support

These services provide a team of certified coders who review your notes before submission. They catch missing documentation that could turn a 90847 into a denied claim. This is especially useful for practices that see a mix of individual and family sessions on the same day. The main drawback is the per‑claim fee, which adds up if you have high volume.

Read more about family‑therapy coding rules.

10. Freelancer Billing Consultant , Flexible, Pay‑Per‑Use Service

A freelance consultant can audit a single month of claims or set up your billing workflow. You pay only for the hours you need, which is ideal for practices testing a new payer contract. Quality varies widely, so vet credentials carefully. You also lose the continuity that a firm provides for ongoing denial management.

What to Look For When Choosing a Billing Solution

• Specialty knowledge of 90846/90847 documentation rules.
• Integration with your EHR or practice management software.
• Transparent pricing , percentage vs flat fee.
• Denial management process and appeal success rate.
• Support for telehealth modifiers and multi‑payer contracts.

Match these criteria against your practice size, payer mix, and tech comfort level.

Comparison Table: Key Metrics Across Billing Options

FAQ

Which code generally pays more, 90847 or 90846?

Medicare pays a modest premium for 90847 ($102.86) over 90846 ($98.66), but private insurers like Blue Cross can flip that, paying more for 90846 in higher‑tier contracts.

Do I need to use a different modifier for telehealth family therapy?

Yes, add modifier 95 for video visits or GT for interactive audio‑video; the same modifiers apply to both 90846 and 90847.

Can I bill 90846 and 90847 on the same day?

No, most payers treat them as mutually exclusive for the same patient on a single day; you must choose one based on who is present.

What documentation is required for 90847?

You must note the patient’s presence, list the primary diagnosis, and record at least 26 minutes of therapy focused on that diagnosis.

Is it okay to bill both a family session and an individual session in one visit?

Yes, if the services are distinct and separate; you would bill the individual session with a code like 90834 and the family session with 90847, each with its own time units. If you also need to compare 90791 versus an individual session code, that guide covers the key differences.

We speak insurance, so you don’t have to. Start your free trial with MCM South Medical Billing Service, LLC today and see how much more you can collect.

Conclusion

For most mental‑health practices, MCM South’s managed billing gives the best blend of expertise, integration, and revenue capture. Take the next step: request a free claim audit and let us handle your 90846 and 90847 paperwork.

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