CPT Code 90847 Demystified: A Clear and Concise Guide
As a mental health professional, it’s important to know about CPT Code 90847, which is used to bill for family or couples therapy sessions. Used in therapy for two or more individuals who are related or in a close relationship, and the therapy session can be conducted in person or via telemedicine
Demystified: A Clear and Concise Guide
As a mental health professional, it’s essential to understand the various CPT codes that apply to your practice. One such code is CPT Code 90847, which is used to bill for family or couples therapy sessions. In this comprehensive guide, we’ll cover everything you need to know about CPT Code 90847, including its definition, fee schedule, billing guidelines, and much more.
What is CPT Code 90847?
CPT Code 90847 is used to bill for family or couples therapy sessions. It’s typically used when a therapist provides therapy services to two or more individuals who are related or in a close relationship. These therapy sessions can be conducted in person or via telemedicine, depending on the circumstances.
CPT Code 90847 Description
The CPT Code 90847 description is “Family psychotherapy for 50 minutes.” This means that the therapist is providing therapy to family members or couples with the patient present for 50 minutes.
Which Providers can use CPT 90847?
Psychiatrists (MD)
Medical doctors (MDs) who specialize in mental health and have completed a residency in psychiatry.
Psychologists (Ph.D. or Psy.D)
Doctoral-level mental health professionals who hold either a Ph.D. (Doctor of Philosophy) or Psy.D (Doctor of Psychology) degree.
Licensed Clinical Social Workers (LCSW)
Master’s-level mental health professionals who have a master’s degree in social work (MSW) and are licensed by their state to provide mental health services.
Licensed Professional Counselors (LPC, LCSW, LMFT)
Master’s-level mental health professionals who have a master’s degree in counseling or a related field and are licensed by their state to provide mental health services.
Nurse Practitioners (NP) and Physician Assistants (PA):
Advanced practice clinicians who have completed a master’s degree or higher in nursing or physician assistant studies, respectively, and are licensed to practice under the supervision of a licensed physician or psychiatrist.
List of major Healthcare private insurance companies in the US
Aetna (a subsidiary of CVS Health), Beacon Health Options, BCBS, or Blue Cross (Anthem, Inc, Empire BlueCross BlueShield, Carefirst, Health Care Service Corporation, Highmark, Premera, Cambia, Wellmark), Bright Health, Centene Corporation, Cigna or Evernorth Health, Harvard Pilgrim Health CareHealthfirst, Humana, Kaiser Permanente, Meridian Health Services, Molina Healthcare, Oscar Health, Tufts Health Plan, United Healthcare (Optum or UHC), WellCare Health Plans.
CPT Code 90847 Fee Schedule
The fee schedule for CPT Code 90847 varies depending on the location and insurance provider. The allowed rate for this code can range from around $70 to $150 per session. However, it’s essential to note that insurance providers may have their fee schedules for CPT Code 90847, which can affect reimbursement rates.
Billing Guidelines for CPT Code 90847
To bill for CPT Code 90847, the following documentation is required:
- A detailed description of the therapy session, including who was present and what was discussed
- The date and time of the therapy session
- The length of the therapy session
- The therapist’s credentials and license number
- The name and address of the patient
- The diagnosis code for the patient’s condition
It’s also essential to ensure that the therapy session meets the qualifications for CPT Code 90847. For example, the therapy session should be focused on the family or couple’s dynamics rather than individual therapy.
Limitations for CPT code 90847
There are several limitations to keep in mind when using CPT code 90847. One limitation is that this code can only be used for family and couples therapy sessions that last at least 26 minutes. Sessions that are shorter than this duration may not qualify for reimbursement under this code.
Another limitation of CPT code 90847 is that it cannot be used for individual therapy sessions. If a therapist is providing therapy services to an individual, they must use a different code, such as CPT codes 90832, 90834, or 90837, depending on the length of the session and the complexity of the treatment.
It’s also important to note that CPT code 90847 is typically only covered by insurance plans for certain diagnoses. For example, many insurance plans only cover this code for family and couples therapy sessions that are used to treat a diagnosed mental health condition, such as depression, anxiety, or bipolar disorder.
What is the Difference Between CPT Code 90847 and 90837?
CPT Code 90837 is used for individual therapy sessions that are longer than 60 minutes. In contrast, CPT Code 90847 is used for family or couples therapy sessions that are typically 50 minutes in length. The two codes are not interchangeable and should be used based on the type of therapy session being provided.
Telehealth and CPT Code 90847
CPT Code 90847 can be used for telehealth sessions, provided that the therapy session meets the same qualifications and documentation requirements as in-person therapy sessions. However, it’s important to note that not all insurance providers cover telehealth sessions or CPT Code 90847 for telehealth sessions. It’s essential to check with the patient’s insurance provider to ensure that telehealth sessions are covered and that CPT Code 90847 can be billed for these sessions.
Common Insurance Providers for CPT Code 90847
CPT Code 90847 is covered by most insurance providers, including Medicare, Medicaid, Cigna, Aetna, Blue Cross Blue Shield, Connecticare, Molina Healthcare, and United Healthcare. However, it’s important to note that insurance providers may have different fee schedules and coverage policies for CPT Code 90847.
CPT Code 90847 is an essential code for mental health professionals who provide family or couples therapy sessions. Understanding the definition, fee schedule, and billing guidelines for this code can help you ensure that your therapy sessions are
CPT Codes for Psychology (Non-E/M)
90791 – Psychiatric Diagnostic Examination without medical services
90832 – Individual psychotherapy (time range 16 – 37 minutes)
90834 – Individual psychotherapy (time range 38 -52 minutes)
90837 – Individual psychotherapy (time range 53 – 60 minutes) **
*** There is no code for a 75-minute session ***
*** There is no code for a 90-minute session ***
90853 – Group therapy
90846 – Family psychotherapy (without the patient present)
90847 – Family psychotherapy (conjoint psychotherapy) (with patient present).
ADDON CODES
+90785 Interactive complexity
+90839 Patient in crisis
+90840 Patient in crisis (each additional 30 minutes)
* 90837 may require special authorization by the individual insurance payer.
** Family visits can consist of spouses, parents and children, patients, and other family members.
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At MCM South Medical Billing Service, LLC, we understand the importance of ensuring that your medical claims are accurate, complete, and timely submitted. We work with various providers, including psychiatrists, psychologists, clinical therapists, and female therapists with specialties such as LPC, LMFT, LCSW, Ph.D., and Psy.D to ensure that their claims meet the specific payer guidelines.
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Copayment (co-pay), deductible amount, deductible accumulations, co-insurance, and (OOP) out-of-pocket maximum
Our therapists specialize in various areas, including anxiety, trauma, cognitive-behavioral therapy, child behavior, couples therapy, family therapy, play therapy, sports therapy, ADHD, and psychological testing. By providing comprehensive billing services, we can help providers focus on their areas of expertise while ensuring that their claims are submitted accurately and efficiently.
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