90847 or 90846: Which Family Therapy Code Should You Bill?
Choosing 90847 or 90846 comes down to one question: was the patient in the room for the family session? Code 90847 is family psychotherapy with the patient present. Code 90846 is family psychotherapy without the patient present. You pick the code by who attended and why, not by which one pays more.
90847 or 90846: the difference in one table
The two codes describe the same kind of service, a session with family members to treat the patient’s condition. The only difference is whether the patient attends. The AMA owns the exact CPT wording, so this table paraphrases it.
| Question | 90847 | 90846 |
|---|---|---|
| Is the patient present? | Yes | No |
| Who is the focus? | The patient, with family members | The patient’s treatment, through family members |
| Add-on code? | No, stand-alone | No, stand-alone |
| Medicare telehealth list | Eligible | Eligible |
The telehealth row comes from the CMS Medicare Mental Health booklet (March 2026), which lists both codes as telehealth-eligible and says family psychotherapy is covered with or without the patient present when medically necessary and the main goal is treating the patient.
How to choose between 90847 or 90846
To choose between 90847 or 90846, ask who attended and whether the patient took part. If the patient was there, use 90847. If you met only with family members to treat the patient’s condition, use 90846. Do not choose a code because you expect it to pay more. Payment depends on each payer’s fee schedule, which changes. For Medicare, the CMS fee schedule look-up tool shows current amounts.
Pick the code: 90847 or 90846
Always confirm each payer policy, since rules can vary by payer and by state.
Note checklist for 90847 or 90846
Tick each item before you close the note. Nothing is saved or sent.
What your note must show for 90847 or 90846
The note has to prove who was there and why. The CMS booklet says Medicare will not pay for services without the specific sign, symptom or complaint behind them. Contractor guidance adds that time-based services should be documented with start and stop times or total time. The First Coast Service Options article A57520 says so. Check the AMA CPT book and each payer’s policy for any time threshold.
- Names or relationships of every attendee, and whether the patient was present for all or part of the session.
- Start and stop times.
- The treatment-plan goal the session served and how the interventions addressed it.
- Why family involvement was medically necessary.
Note that contractor article A57480 from Wisconsin Physicians Service says these codes are not for taking a family history or for counseling billed as an evaluation and management (E/M) service. These articles apply only in those contractors’ regions.
Same day as individual therapy: what the rules say
Medicare allows it only under a strict condition. Private payers may be stricter. Keep the two rule sets apart.
Private payers
Each commercial payer sets its own same-day policy and its own authorization rules. Read the contract and the payer manual, and check with the payer before you bill 90847 or 90846 with another psychotherapy code on one date.
Medicare and Medicaid
The 2026 Medicare National Correct Coding Initiative (NCCI) Policy Manual, Chapter 11 says 90847 can be reported with individual psychotherapy codes 90832 to 90838 on the same date only when the family session addresses interactions between the patient and family and is a separate service in its own time interval. That sentence names 90847 only, so do not assume 90846 follows the same rule. Medicaid rules are set by each state.
State rules
State Medicaid programs and state insurance laws differ, so check your state Medicaid manual and insurance department for rules in your state.
Psychiatrists: where 90847 or 90846 fits
Psychiatrists who bill an E/M visit can add a psychotherapy add-on code (+90833, +90836 or +90838) on the same visit when the payer’s rules and the note support it. Codes 90847 and 90846 are not add-ons. If you plan to report either one on the same date as an E/M visit, confirm the payer’s same-day policy first.
What to do Monday morning
- Pull your last ten family-session notes and check that each names the attendees and says whether the patient was present.
- Match each 90847 to evidence the patient attended, and each 90846 to evidence the patient did not.
- Check each payer’s same-day policy for family and individual sessions.
- Add start and stop times to your family-session note template.
- Review denials with the CARC and RARC code guide and watch your clean claim rate. Our underpayments guide covers short pays.
The short version: 90847 or 90846
Choose 90847 or 90846 by whether the patient attended. Document who was there, why family involvement was necessary and the times. Check each payer’s same-day rule before you bill with individual psychotherapy.
How MCM South helps
MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health, for psychotherapists and psychiatrists in solo and medium-size practices. We bill out-of-network claims for clients. Read the billing terms glossary for definitions, or ask us to review your family-therapy claims.
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Related reading
Want a second pair of eyes on your claims? We can talk through your practice.
FAQ
What is the difference between 90847 and 90846?
Code 90847 is family psychotherapy with the patient present, and 90846 is family psychotherapy without the patient present. Use the code that matches who attended.
Can I bill 90847 and an individual psychotherapy code on the same day?
Medicare’s 2026 NCCI manual allows 90847 with 90832 to 90838 only as a separate, distinct service in a separate time interval. Commercial payers may set stricter rules, so check the payer.
Are 90847 and 90846 add-on codes?
No. They are stand-alone codes. The psychotherapy add-on codes used with an E/M visit are +90833, +90836 and +90838.
Can I bill 90847 or 90846 by telehealth?
The CMS Medicare Mental Health booklet lists both codes as telehealth-eligible for Medicare. Other payers and states set their own telehealth rules, so verify them before the visit.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
