90847 or 90846: Which Family Therapy Code Should You Bill?

90847 or 90846? CPT 90846 is family psychotherapy without the patient in the session. CPT 90847 is family psychotherapy with the patient present. You choose the code by who attended and why, not by which one pays more. This guide covers the difference, the documentation, the same-day rules and what changes for psychotherapists and psychiatrists. For the full code reference, see the family psychotherapy guide in our CPT & E/M Code Guide.

What is the difference between 90847 and 90846?

Both codes describe family or couples psychotherapy delivered by a licensed clinician. The only difference in the descriptor is whether the patient is present. Medicare describes both in its Medicare Mental Health booklet (MLN1986542).

Code	Who is in the session	Use it when
90846	Family member(s) or caregiver(s), patient not present	The work is about the family’s role in the patient’s treatment
90847	Patient plus family member(s) or caregiver(s)	The work includes the patient’s interactions with the family

Which pays better, 90847 or 90846?

Payment depends on each payer’s fee schedule. Medicare publishes its rates in the Physician Fee Schedule look-up tool. Commercial plans and state Medicaid programs set their own, and the numbers change every year. This page does not quote a rate for that reason. Look up both codes in your payer’s current schedule before you decide how to build your session mix.

Never choose 90847 because the patient was “technically” nearby. If the patient was not part of the session, 90846 is the accurate code. A mismatch between the note and the code is a common reason for denials and recoupments.

How should you document 90847 or 90846?

CPT does not define a time range for 90846 or 90847, so the payer decides whether it wants start and stop times. Our checklist asks for them on every timed service, and the Medicare contractor articles A57480 and A57520 set the base standard. A strong family-session note shows:

• Who attended, with relationship to the patient
• Whether the patient was present for all or part of the session
• Start and end time (or total time)
• The interventions used and the family’s response
• The treatment-plan goal the session supported
• Why the family work was medically necessary

The documentation requirements guide lists the Medicare sources line by line.

Can you bill 90847 or 90846 with another psychotherapy code?

Medicare’s NCCI Policy Manual, Chapter XI, allows 90847 on the same date as individual psychotherapy (90832 to 90838) only as a separate, distinct service in a separate time interval, focused on the patient’s interactions with family. Read the current text in the NCCI Policy Manual, Chapter XI (2026). Commercial payers may apply stricter rules, so check before you bill both.

What psychotherapists and psychiatrists should know about 90847 or 90846

• Psychotherapists: 90846 and 90847 are stand-alone codes. Pair them with the right diagnosis and keep family sessions separate from individual session notes.
• Psychiatrists: the add-on psychotherapy codes (+90833, +90836, +90838) go with an E/M visit. 90846 and 90847 are not add-ons. If you bill an E/M and a family session on one day, confirm the payer’s same-day policy first.

90847 or 90846 and Medicare, private payer and state rules

• Medicare (CMS.gov): follows the sources above. Rules can differ by Medicare contractor.
• Private payers: each sets its own fee schedule, prior authorization rules and same-day edits. Ask for the written policy.
• State law and Medicaid: varies by state, and managed care plans can differ inside one state. Never apply one state’s rule to another.

90847 or 90846: common questions

Common 90847 or 90846 billing mistakes

• Choosing the code by rate instead of by who attended the session
• Writing “family session” in the note without naming who attended and how they relate to the patient
• Not recording whether the patient was present for all or part of the session, then following the payer’s guidance on partial attendance
• Billing family and individual psychotherapy on one date without showing two separate time intervals
• Assuming a commercial payer follows Medicare’s same-day rule

Monday-morning 90847 or 90846 checklist

• Pull your last ten family-session notes and confirm each names the attendees
• Match every 90847 to a note showing the patient was in the session
• Check each payer’s written policy on same-day individual and family sessions
• Compare your fee schedule entries for both codes against the current schedule
• Keep start and end times on every note, even where the payer does not ask

How MCM South handles these claims

MCM South Medical Billing Service works only in mental and behavioral health, with solo and mid-size practices run by psychotherapists and psychiatrists. We verify insurance benefits, submit claims electronically, follow up on denied and rejected claims, file secondary claims and bill out-of-network claims for clients. Clean code selection and complete notes at the front end keep that work simple, so most of the checklist above is what we review first. If you want a second pair of eyes on 90847 or 90846 in your own claims, we can walk through it with you.

Where this applies

MCM South Medical Billing Service bills mental and behavioral health claims for psychotherapists and psychiatrists in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Payer rules differ by state and by plan, so confirm each rule with the payer before you bill. Ready for help? Get a free quote or schedule a consultation.

For quick reference only: verify against the current AMA CPT manual and each payer’s policy before billing. Operational billing guidance, not legal advice. Current as of last search (sources checked 9/29/26).

Related guides: CPT 90847, CPT 90846, CPT 90834 and CPT 90837.