CPT Code for Couples Therapy: How to Bill 90847

CPT code 90847 is the code for couples therapy. It describes family psychotherapy, also called conjoint therapy, with the patient present. When the patient is not in the room, the code is 90846. This guide covers how to choose between them, what Medicare says, what to document, and what you cannot bill on the same day. It is written for psychotherapists and psychiatrists.

For the full code reference, see our family psychotherapy guide.

What CPT code 90847 and 90846 mean

CPT descriptors (AMA): 90846 is family psychotherapy without the patient present. 90847 is family psychotherapy (conjoint) with the patient present. Medicare contractor Article A57480 (CMS Coverage Database, WPS, rev. 1/1/2026) says “CPT Codes 90846 and 90847 represent family psychotherapy services for the treatment of mental disorders.”

How to choose between them

Question	90846	90847
Is the identified patient in the session?	No	Yes
Who attends?	Family members	Patient plus partner or family
Typical use	Work with family about the patient’s treatment	Conjoint couples or family session

For a couple, the claim goes under the partner being treated. Ask each payer how it wants couples billed.

What Medicare says

CMS lists “family psychotherapy with or without the patient present, as medically reasonable and necessary, with patient treatment as the primary purpose” as a covered service (CMS, Medicare & Mental Health Coverage, MLN1986542, March 2026). It also covers family counseling “whose primary purpose is treating a patient’s condition,” including counseling for caregivers. A CMS billing guideline adds that the codes “should not be used when the service performed is taking a family history or E/M counseling services” (L34616 attachment PSYCH014). The primary purpose has to be treating the patient.

Time and same-day billing

No time range is defined for 90846 or 90847. Ask each payer for its minimum, and record the date of service plus start and end time for every session.

CMS’s NCCI manual allows CPT code 90847 with 90832, 90833, 90834, 90836, 90837 or 90838 on the same date only as a separate, distinct service in a separate time interval, focused on the patient’s interactions with family. It is not reported with 90791 or 90792 on the same date (NCCI Medicare Policy Manual, Ch. XI, 1/1/2026). Individual and conjoint time must not overlap. See our individual psychotherapy guide for 90832, 90834 and 90837.

Who bills it

Psychotherapists: use CPT code 90847 when the patient joins the session, 90846 when not. State the treatment purpose in the note.

Psychiatrists: same codes. If you also bill an E/M code the same day, keep the time and content of each service separate. See the E/M and home-visit guide.

What to document

• Date of service, start and end time
• Who attended and each person’s relationship to the patient
• The treatment purpose tied to the patient’s diagnosis
• What you worked on and the plan

See documentation requirements.

Telehealth

Telehealth billing for CPT code 90847 depends on the payer and the modifier it requires. Our modifiers 93 and 95 guide explains the options. Confirm the payer’s current rule before billing.

Medicare vs private payers vs state rules

The rules above are Medicare. Private payers and state Medicaid programs set their own coverage, limits and authorization rules, and these vary by state. Check each payer.

FAQ

Where this applies

MCM South supports psychotherapists and psychiatrists in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. Payer rules differ by state. 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).