CPT Code 90847: Family Psychotherapy With the Patient Present

The family therapy code that confuses almost every new biller — when to use it, how to document it, and how it differs from 90846.

CPT code 90847 is used to bill for family or couples psychotherapy with the identified patient present. It is one of the most commonly mis-billed codes in outpatient mental health, and the confusion almost always comes from the same place: the distinction between 90847 (patient present) and 90846 (family therapy without the patient).

This guide covers exactly when 90847 is appropriate, what documentation Medicare and commercial payers expect, and how to handle the unique billing situations that come up in family and couples work.

What 90847 actually means

The CPT description for 90847 is “Family psychotherapy (conjoint psychotherapy) with the patient present, 50 minutes.” Two things are worth unpacking in that description.

First, 90847 is billed under the identified patient’s insurance. In family therapy, one member of the family is designated as the identified patient — the person whose clinical condition is being treated. The other participants (spouse, children, parents, siblings) are participating in the treatment of that person’s diagnosis.

Second, the 50-minute reference is a typical session length, not a strict time requirement in the way 90834 and 90837 require specific minute thresholds. That said, payer policies increasingly expect documentation of session length, and sessions substantially shorter than 50 minutes may not qualify.

When to bill 90847 vs. 90846

Documentation requirements

A defensible 90847 note should include:

• Date of service and total session time (start/stop or total face-to-face minutes)
• Identified patient clearly named
• All participants in the session by relationship to the patient (e.g., “patient and spouse”)
• Active diagnosis for the identified patient that supports medical necessity for family therapy
• Therapeutic interventions used during the session (systemic interventions, communication training, attachment work, behavioral interventions, etc.)
• Response of the patient and family to the interventions
• Connection to the treatment plan for the identified patient
• Plan for the next session

The couples therapy billing question

One of the most common billing questions in outpatient therapy is whether 90847 can be used for couples who are seeking therapy as a couple without one partner being the “patient.” The short answer under Medicare and most commercial payer rules is: 90847 requires an identified patient with a covered mental health diagnosis. The couple context is the modality; the diagnosis is what triggers coverage.

If one partner meets criteria for a covered diagnosis, that person is the identified patient, and 90847 is billed under their insurance. If neither partner has a billable diagnosis — for example, a couple seeking enrichment or premarital work — the service is generally not covered and should be billed privately rather than submitted to insurance.

V-codes and Z-codes (marital conflict, partner relational problem) are not generally sufficient to support insurance coverage for couples therapy under most payer policies.

Medicare coverage of 90847

Medicare covers 90847 when it is medically necessary for the treatment of the identified patient’s mental health diagnosis. LCSWs, LPCs, LMFTs, and psychologists are all eligible to bill 90847 under Medicare.

Medical necessity for family therapy is documented by showing that family involvement is clinically important to the treatment — for example, because the patient’s family system is a significant part of the presenting problem, because the family’s understanding of the condition affects treatment adherence, or because family dynamics directly contribute to the symptoms being treated.

Common 90847 denials

Wrong code used

The most common error is billing 90847 when the identified patient was not in the session. This is a straightforward documentation audit finding — the note lists who was present, and if the patient wasn’t there, 90846 was the correct code. The fix is strict attention to who is actually in the room at the time of the session.

Diagnosis does not support family therapy

Medicare and commercial payers require a diagnosis that reasonably supports family intervention. Conditions like major depression, anxiety disorders, substance use, trauma, and adjustment disorders commonly support family therapy. V-codes alone generally do not.

Frequency concerns

Billing 90847 every session for an extended period without documented clinical justification can trigger review. The treatment plan should show why family involvement remains clinically necessary as treatment progresses.

Missing participant documentation

Notes that do not list who was present or that refer only generically to “family members” are weaker on audit than notes that specify “patient, spouse, and adult daughter.”