Billing Reference
90846 vs 90847: the family and couples therapy codes
Bill CPT code 90847 for family or couples psychotherapy when the identified client is in the room, and 90846 when you meet with family members without the client present. That one distinction is the entire difference between the two codes. Everything else matches: both carry a minimum of 26 minutes under CMS guidance, both require treatment of the client to be the primary purpose of the session, and neither covers consultation with facility staff.
What CPT codes 90846 and 90847 cover
Family psychotherapy has two codes, and they split on a single question: is the identified client in the room? 90847 is family psychotherapy with the client present. 90846 is family psychotherapy without the client present. Same kind of service, same minimum time, one seat filled or empty.
Most couples therapy is billed under 90847, because the identified client is one of the partners sitting in the session. 90846 covers the sessions where you work with the people around your client, a partner or parents or other family members, with the client not present.
In both cases the session is treatment of the identified client. CMS guidance covers family psychotherapy with or without the client present when it is medically reasonable and necessary and treatment of the client is the primary purpose. A conversation that is really a consultation with facility staff is not family psychotherapy under either code.
The CMS Notes
90846 and 90847, side by side
90846: Family psychotherapy without the client present
A family therapy session where the identified client is not in the room.
- CMS: code 90846 is used when the patient is not present.
- Minimum of 26 minutes.
- Not for consultation with facility staff.
- Covered with or without the patient present when medically reasonable and necessary, with treatment of the patient as the primary purpose.
90847: Family psychotherapy with the client present
A family therapy session with the identified client in the room. The code most couples therapy is billed under.
- CMS: code 90847 is used when the patient is present.
- Minimum of 26 minutes.
- Not for consultation with facility staff.
- Covered with or without the patient present when medically reasonable and necessary, with treatment of the patient as the primary purpose.
On documenting the time: CMS guidance on psychotherapy services accepts either start and stop times or the total time spent. With a 26 minute floor on both family codes, record session time the same way you would for an individual session. Source: CMS A57520 · CMS A56937
Close Calls
How to choose between 90846 and 90847
A couples session with your client and their partner
The identified client is in the room, so this is 90847, family psychotherapy with the client present. This is the shape most couples work takes.
Meeting a client’s partner or parents without the client
The client is not present, so this is 90846. Under CMS guidance the session is still treatment of your client: covered when medically reasonable and necessary, with treatment of the client as the primary purpose.
A family session shorter than 26 minutes
Not reportable under either code. Both 90846 and 90847 carry a minimum of 26 minutes in the CMS billing guidance behind this page.
A conversation with the staff at your client’s facility
Neither code. CMS guidance is explicit that the family psychotherapy codes are not for consultation with facility staff.
Common Questions
Questions therapists ask about 90846 and 90847
What is the difference between 90846 and 90847?
Whether the identified client is in the room. CMS guidance states that 90847 is used when the patient is present and 90846 is used when the patient is not present. Both require a minimum of 26 minutes, and neither is for consultation with facility staff.
Which CPT code do I bill for couples therapy?
Most couples therapy is billed under 90847, family psychotherapy with the client present, because the identified client is in the room with their partner. When you meet with a client’s partner without the client there, that client-not-present session maps to 90846. Both codes carry a minimum of 26 minutes.
Does Medicare cover family therapy when the client is not present?
Yes. CMS guidance covers family psychotherapy with or without the patient present when the session is medically reasonable and necessary and treatment of the identified client is its primary purpose. 90846 is the code for those client-not-present sessions, with the same 26 minute minimum as 90847.
Is there a minimum session length for 90846 and 90847?
Yes. Under CMS guidance both family psychotherapy codes carry a minimum of 26 minutes. A shorter family session is not reportable under 90846 or 90847.
Can I bill 90846 or 90847 for talking with staff at a client’s facility?
No. CMS guidance states that the family psychotherapy codes are not for consultation with facility staff. A conversation with the paid staff at a client’s facility is not family psychotherapy under either code.
Why are there no reimbursement rates on this page?
Reimbursement varies by payer, locality, and year, so a single national number would be wrong for most readers. Check your payer contracts for your actual rates, or the CMS Physician Fee Schedule lookup tool for Medicare amounts in your locality.
Keep Going
Related codes and tools
The code is the easy part. The note has to hold up too.
Time-based codes only survive an audit when the documentation behind them does. Generate a structured progress note in SOAP, DAP, BIRP, GIRP, PIRP, or Narrative format from a short session summary. Free, no account required.
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This is an informational tool, not billing, legal, or clinical advice. You are responsible for selecting the correct codes for your services and for verifying coverage, code definitions, and documentation requirements against your payer contracts and the current code set.
CPT is a registered trademark of the American Medical Association. This page does not reproduce the CPT code set or its official descriptors. Every description here is a plain-English summary written by Reframe Practice and checked against the CMS public billing documents linked above.