CPT Code 90846: Family Psychotherapy Without the Patient Present
The family therapy code used when the identified patient is not in the room — when it applies, when it doesn’t, and how to document it.
CPT code 90846 is used to bill for family psychotherapy without the identified patient present. It is the less commonly billed of the two family therapy codes (the other being 90847), but it serves a specific and legitimate clinical purpose: working with family members on the treatment of the identified patient’s mental health condition when the patient is not present in that session.
Because 90846 sits in a unique billing position — a service provided to family members, billed under the patient’s insurance — the documentation standard is high. This guide covers how to bill 90846 correctly and when it is and isn’t appropriate.
What 90846 covers
The CPT description for 90846 is “Family psychotherapy (without the patient present), 50 minutes.” The code describes a session with one or more family members in which the focus is the treatment of the identified patient’s mental health condition.
Common clinical scenarios for 90846 include:
- A parent session focused on managing the behavioral or emotional challenges of a child who is the identified patient
- A spouse session focused on supporting a partner’s recovery from a mental health or substance use condition
- A family meeting about how to respond to a patient’s clinical decompensation, when the patient is not present
- Psychoeducation with family members about the patient’s diagnosis, treatment, and prognosis
The patient-centered requirement
90846 is not collateral counseling for the family member. It is a family therapy session that is part of the identified patient’s treatment, delivered without the patient physically present. The documentation must make clear that the service was focused on the patient’s treatment.
The critical distinction: 90846 is billed under the identified patient’s insurance because the service is part of the patient’s treatment plan. If the session is actually about the family member’s own mental health (and the family member is not your identified patient), 90846 is not the correct code — and the session may not be covered at all under the patient’s insurance.
Documentation requirements
A defensible 90846 note should include:
- Date of service and total session time
- Identified patient named, even though not present
- Family members who participated, listed by relationship
- Active diagnosis for the identified patient that supports medical necessity
- Clinical rationale for conducting the session without the patient present
- Therapeutic content focused on the patient’s treatment — psychoeducation, systemic interventions, coping strategies for family members supporting the patient, etc.
- Connection to the treatment plan for the identified patient
- Plan for the next session, including any plan for the patient’s involvement going forward
The clinical rationale for the patient’s absence is an important piece of documentation. Explain why this session, focused on the patient’s treatment, appropriately took place without the patient. Reasons might include: a young child whose developmental level made their presence unproductive, a patient whose clinical condition precluded participation, or a specific therapeutic purpose (such as parent-only psychoeducation) that required the patient’s absence.
Billing 90846 vs. 90847
| Code | Patient Present? | Example |
|---|---|---|
| 90847 | Yes | Family session with patient, spouse, and children |
| 90846 | No | Parent session about child patient’s treatment |
| 90847 | Yes | Couples session with both partners |
| 90846 | No | Psychoeducation with family of adult patient |
The distinction is binary. Whether the patient is in the room determines which code applies. No other factor changes this.
What 90846 is not
It is not collateral contact
A brief check-in call with a parent about their child’s progress is not 90846. It is collateral contact, which is generally not separately billable unless it meets the full criteria of a family therapy session (sufficient length, therapeutic content, treatment plan connection).
It is not individual therapy for the family member
If the parent of your patient is struggling emotionally and needs their own therapy, that is not 90846 under the child’s insurance — that is a separate clinical need that should be handled through a referral to another provider or by establishing the parent as their own patient with their own insurance billing.
It is not case consultation
Meeting with a patient’s family members as part of a clinical consultation with a referring provider is not 90846. Case coordination activities are generally not separately billable under mental health codes.
Common 90846 denials
Wrong code used when patient was present
Billing 90846 when the patient was actually in the session is an audit finding. If the patient joined part of the session, 90847 is generally more appropriate — any patient presence during the session typically means 90847 is the correct code.
Diagnosis does not support family therapy
The identified patient must have a covered mental health diagnosis that supports the medical necessity of family intervention. A V-code or Z-code alone is typically not sufficient.
Frequency and pattern issues
Repeated 90846 billing without documented clinical justification or without corresponding 90847 sessions that include the patient can raise questions on review. The treatment plan should show how family-without-patient sessions fit into the overall plan for the patient’s care.
Focus drift
Notes that document a session clearly focused on the family member’s own concerns rather than the patient’s treatment are a compliance risk. If the session is genuinely about a family member’s struggles separate from the patient’s care, 90846 is not the right code.
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