CPT Code 90847: Family Therapy With the Patient Present

CPT 90847 covers family or couples psychotherapy with the identified patient present. This is the primary code for conjoint therapy where the therapeutic focus involves the patient and family members working together to address the patient's mental health condition.

This code covers a wide range of family therapy approaches including structural, strategic, narrative, Emotionally Focused Therapy (EFT), and Gottman Method for couples. The key element is that the identified patient participates alongside family members.

N/A – billing code. Requirements:

• Identified patient must be present and participating
• At least one family member must participate
• Session must be psychotherapeutic (not just informational)
• Must address the identified patient's mental health diagnosis
• The family/relational component must be integral to the treatment

Document thoroughly:

• All participants listed by name and relationship
• The identified patient's diagnosis and how family dynamics relate
• Therapeutic interventions used (EFT cycles, structural interventions, communication training)
• Interactions and dynamics observed during session
• Each participant's engagement and response
• Progress toward treatment goals
• Safety assessment when applicable
• Plan for follow-up

N/A – billing code. Distinguish from:

• 90846 – family therapy WITHOUT patient present
• 90837 – individual therapy (even if family dynamics are discussed)
• 90853 – group therapy (unrelated individuals)
• 90832/90834 – should not be used for conjoint sessions

90847 supports:

• Emotionally Focused Therapy (EFT) for couples
• Gottman Method couples therapy
• Structural family therapy
• Strategic family therapy
• Narrative family therapy
• Multisystemic therapy (MST)
• Functional Family Therapy (FFT)
• Family-based treatment for eating disorders
• Family psychoeducation for psychotic disorders

Key billing points:

• Bill under the identified patient's name and diagnosis
• Cannot bill 90847 and 90846 on the same date
• Cannot bill 90847 and individual therapy for the same patient on the same date
• Typical reimbursement: $95-140 depending on payer
• Some payers limit the number of family sessions per year
• Couples therapy may require specific relational diagnoses with some payers
• Telehealth family sessions are generally covered post-pandemic

Watch for:

• Evolving payer policies on couples therapy coverage
• Telehealth regulations for multi-participant sessions
• Changes in covered diagnoses for family therapy
• New evidence-based family therapy protocols

Avoid:

• Billing 90847 when only the patient is present (use individual therapy codes)
• Not identifying all session participants
• Failing to connect family interventions to the patient's treatment goals
• Billing both family and individual therapy on the same date
• Not documenting the therapeutic nature of the session (vs. case coordination)
• Using 90847 for psychoeducation-only sessions without therapeutic intervention