CPT Code 90846: Family Therapy Without the Patient Present

CPT 90846 covers family psychotherapy sessions conducted without the identified patient present. This is a critical code for clinicians who work with family systems, as there are many clinical situations where meeting with family members alone is therapeutically indicated.

Common scenarios include:

• Meeting with parents of a child or adolescent patient to provide psychoeducation and parent training
• Sessions with a partner to discuss how to support the patient's recovery
• Family sessions when the patient is unable to attend (hospitalized, refusing treatment)
• Collateral sessions to address family dynamics impacting the patient's treatment

N/A – billing code. Requirements:

• Must have an identified patient with a mental health diagnosis
• The session must be psychotherapeutic in nature (not just informational)
• The patient must NOT be present during the session
• Family members or guardians participate
• Session must address the identified patient's mental health condition

Critical documentation elements:

• Identify the patient (even though not present) and their diagnosis
• List who attended the session
• Clinical rationale for meeting without the patient
• Therapeutic interventions used (family systems work, psychoeducation, skill building)
• How the session content relates to the patient's treatment goals
• Family members' response and engagement
• Plan for integrating session content into the patient's overall treatment

N/A – billing code. Distinguish from:

• 90847 – family therapy WITH patient present
• 90837 – individual therapy (even if family topics are discussed)
• 90853 – group therapy
• 99366-99368 – care coordination/team conferences
• Collateral contacts that are brief and informational (not separately billable)

90846 is appropriate for:

• Parent management training (PMT) for child/adolescent patients
• Partner support sessions in addiction treatment
• Family psychoeducation about the patient's diagnosis
• Structural or strategic family therapy techniques
• Addressing family dynamics that maintain the patient's symptoms
• Crisis intervention with family when patient is unavailable
• Caregiver burnout prevention

Important billing considerations:

• The identified patient's diagnosis is used for billing, not the family member's
• Some payers require the patient to have been seen recently for individual therapy
• Verify coverage – not all plans cover 90846 equally
• Cannot bill 90846 and 90847 on the same date of service
• Cannot bill 90846 and individual therapy (90832/90834/90837) on the same date for the same patient
• Typical reimbursement: $90-130 depending on payer
• Document medical necessity clearly

Monitor:

• Payer-specific policies on family therapy coverage
• Changes in who qualifies as "family" for billing purposes
• Telehealth regulations for family therapy sessions
• State-specific requirements for family therapy documentation

Common mistakes:

• Billing 90846 for brief phone calls with family (not separately billable)
• Failing to connect the session to the identified patient's treatment
• Not documenting why the patient was not present
• Using 90846 when the session is primarily case coordination (not therapy)
• Billing both 90846 and 90847 on the same day
• Not obtaining proper consent/releases for family sessions