CPT Code 90846: Family Therapy Billing (2026)

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• 90846

CPT Code 90846: Family Therapy Billing (2026)

90846 for family therapy without the patient present — 2026 rates, 90846 vs 90847, payer coverage variance, documentation, and facility scenarios.

Quick Reference

Code

90846

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Updated

Jun 12, 2026

Reading Time

18 min

CPT® is a registered trademark of the American Medical Association. All CPT code descriptions on this page are paraphrased in original wording; consult the current CPT® codebook published by the AMA for authoritative descriptors.

Understanding CPT Code 90846: Family Psychotherapy Without Patient Present

CPT code 90846 represents family psychotherapy conducted without the patient present. This code captures the clinical work of therapists who meet with a patient’s family members, significant others, or other responsible parties to address family dynamics, provide psychoeducation, develop support strategies, and work through issues that directly impact the patient’s treatment and recovery.

In behavioral health and addiction treatment settings, family involvement is widely recognized as a critical factor in treatment outcomes and sustained recovery. CPT 90846 ensures that the important clinical work of engaging families — even when the patient cannot or should not be in the room — is properly documented and reimbursed. It is the patient-absent sibling of 90847, and in facility family programs the two codes usually travel together across a single treatment week.

Definition and Purpose

CPT 90846 is defined as family psychotherapy without the patient present. This service involves a therapeutic session conducted by a qualified mental health professional with one or more family members or other individuals significantly involved in the patient’s life, where the patient does not participate in the session.

The purpose of 90846 is to support and reimburse the therapeutic engagement of family systems as part of a patient’s overall treatment. Family dynamics, communication patterns, enabling behaviors, codependency, boundary issues, and caregiver burden are all therapeutic targets that can be effectively addressed in sessions where the patient is not in attendance.

There are several clinical reasons why family therapy may be conducted without the patient:

• Early treatment engagement — Family members may need psychoeducation and support before the patient is ready or able to participate in family sessions
• Safety concerns — In cases involving domestic violence, severe family conflict, or active psychosis, it may be clinically appropriate to work with family separately
• Patient refusal — The patient may decline to participate in family sessions while still consenting to their family receiving therapeutic support
• Logistical factors — In residential treatment, family members may visit on days when conjoint sessions are not clinically scheduled
• Treatment planning — Clinicians may meet with families to coordinate discharge planning, aftercare support, and relapse prevention strategies

Time Rules for Reporting 90846

Like its sibling, 90846 is described as a service of approximately 50 minutes. It is not banded into minute ranges the way the individual psychotherapy codes are, but under the CPT convention for time-defined services, a code may be reported once the midpoint of its stated time has been passed — meaning at least 26 minutes of family psychotherapy should be furnished and documented before 90846 is billed. A 15-minute phone update to a parent does not meet the threshold (and is not psychotherapy in any case). Document start and stop times in every family note even though there is no upper band.

90846 Reimbursement Rates by Year

Rates reviewed: June 2026. The table below tracks the Medicare national non-facility payment amount for 90846 and its patient-present sibling 90847 — the same table that appears on the 90847 page, because the two codes should always be priced and verified together. National amounts are a baseline only; actual payment varies by locality under GPCI adjustment. Pull current figures from the CMS Physician Fee Schedule lookup tool ↗.

90846 has typically paid slightly less than 90847, and both codes have benefited from the work-value increases the CY 2024 Physician Fee Schedule final rule phased in for the psychotherapy family, per the American Psychological Association’s summary ↗, plus the CY 2026 conversion-factor increase ↗. Medicaid rates vary by state — historically roughly $60–$130 where the code is covered at all — and commercial rates depend on the contract, with the important caveat that some plans simply do not cover 90846 (see coverage variance below).

90846 vs 90847: Quick Comparison

One observable fact — whether the identified patient was in the room — selects the code, with a handful of downstream differences:

The full guide to the patient-present code — including a worked residential family-week billing scenario — lives at 90847. When multiple families meet in one group session, the multi-family group code 90849 applies instead of either sibling.

Whose Insurance — and Why the Patient Doesn’t Need to Be There

The question that drives most 90846 searches: how can a session be billed to someone who wasn’t in the room?

The answer is that the identified patient is still the one receiving treatment. A 90846 session is a planned intervention within the patient’s treatment plan — the family system is the therapeutic target because the family system affects the patient’s condition and recovery. The family members in the room are participants in the patient’s care, not patients themselves. Accordingly:

If a family member needs ongoing therapy in their own right, transition that care to its own treatment relationship and billing identity — repeated 90846 sessions that are really the family member’s individual therapy are a recurring audit finding.

• The claim is billed under the identified patient’s insurance, with the patient’s diagnosis, even though the patient is absent.
• The note must tie the session to the patient’s treatment plan. “Met with parents to discuss boundaries ahead of discharge, per treatment plan goal 3” is billable family psychotherapy; a freestanding support session for a struggling spouse, untethered from any patient’s plan, is not 90846 — it is that person’s own therapy, under their own insurance.
• Medical necessity framing matters more than for almost any other psychotherapy code. Payers reviewing 90846 want to see why the patient’s treatment required family work without the patient: safety concerns, psychoeducation before family engagement, discharge preparation, or the patient’s clinical inability to participate.

Payer Coverage Variance: Check Before You Bill

90846 is denied more often than 90847. Medicare covers it, but some commercial plans and state Medicaid programs restrict family therapy without the patient present — limiting frequency, requiring prior authorization, or excluding the code outright.

The operational fix is to treat 90846 as its own line item in verification of benefits, not as an assumed part of “outpatient mental health.” A VOB question list for family programming:

Run this list at admission for any patient whose plan includes family programming — a 90846 denied after family week is a write-off, not a correction.

• Is 90846 (family psychotherapy without patient) a covered benefit on this plan — distinctly from 90847?
• Does it require prior authorization, and is it included in the existing behavioral health auth or separate?
• Are there frequency limits (per week, per episode, per year) for family therapy codes?
• Is family therapy carved out to a behavioral health vendor with its own rules?
• For program levels of care (residential/PHP/IOP): is family therapy bundled in the per diem or separately billable?
• Is telehealth delivery of 90846 covered, and with which modifier/POS combination?

When to Use 90846 in Behavioral Health

CPT 90846 is appropriate across a range of behavioral health treatment settings. Common clinical scenarios include:

Do not use 90846 when the patient participates in the session — use CPT 90847 instead. Do not use 90846 for case management calls, brief check-ins, or administrative coordination with families — these are not psychotherapy and should not be billed as such.

• Addiction treatment family sessions where the therapist meets with family members to address enabling behaviors, set boundaries, and develop a family recovery plan while the patient continues with their individual and group programming
• Psychoeducation sessions where the clinician educates family members about the patient’s diagnosis, treatment process, expected recovery timeline, and how to be supportive without enabling
• Discharge planning conferences with family members to prepare for the patient’s transition from residential to outpatient care, including discussions about living arrangements, treatment plan coordination, and crisis planning
• Al-Anon-style therapeutic family sessions where the focus is on the family members’ own wellbeing, codependency patterns, and self-care while their loved one is in treatment
• Family therapy for adolescent patients where therapists meet with parents or guardians separately to address parenting strategies, family communication patterns, and environmental modifications
• Grief and loss processing when a patient’s family members need therapeutic support related to the impact of the patient’s illness on the family system

90846 in Facility Family Programs

Family-only sessions are a scheduled, recurring feature of facility care, and they create billing questions solo-practice guides never reach.

Where 90846 shows up in a program week. Residential family weekends typically open with family-only psychoeducation before the patient joins (90846 Friday, 90847 Saturday). Pre-visitation sessions prepare families for boundaries and expectations before an on-campus visit. Discharge-planning sessions often happen with family alone while the patient is in group ( 90853 ). Each is billable 90846 work when it is psychotherapy tied to the patient’s plan — and each lands on the patient’s claim history alongside that week’s individual ( 90834 ) and group sessions.

Same-week and same-day sequencing. 90846 and 90847 can both be billed within the same week — they are distinct services on distinct dates. On the same date of service, family codes billed alongside individual or group psychotherapy require separate encounters, non-overlapping times, and modifier 59 or XE where NCCI procedure-to-procedure edits apply; check the current NCCI Policy Manual ↗ psychiatric chapter. Billing 90846 and 90847 for the same family meeting on the same day — splitting one session into a patient-absent half and a patient-present half — is a denial magnet; pick the code that describes the session as a whole.

Per-diem bundling. Under residential, PHP, or IOP per-diem contracts, family therapy is frequently inside the bundled rate, making a separate 90846 line double billing; some contracts carve professional services out for fee-for-service billing. The payer contract — not the CPT book — decides. The worked claim-line example on the 90847 page walks a full residential family-program week.

42 CFR Part 2 consent. For SUD treatment programs, federal confidentiality rules at 42 CFR Part 2 sit on top of HIPAA: a Part 2 program generally needs the patient’s written consent before disclosing SUD treatment information to family members — which is precisely what a family-only session involves. Obtain Part 2-compliant consent that names the family members before the first 90846 session, and document it in the record. The 2024 Part 2 final rule aligned several consent mechanics more closely with HIPAA (including single consent for future uses and disclosures), but the consent-first baseline for SUD records remains.

Documentation Requirements

Documentation for 90846 must demonstrate that a therapeutic service was provided to the family in relation to the patient’s treatment. Required elements include:

• Patient identification — While the patient is not present, the note must clearly identify whose treatment this family session supports. The claim is filed under the patient’s insurance, not the family member’s
• Explicit patient-absent statement — State plainly that the identified patient was not present. The presence/absence statement is what separates 90846 from 90847 at audit, and notes that are silent on it are the most common family-code documentation failure
• Family members present — Document who attended the session by name and relationship to the patient
• Consent documentation — Note that appropriate consent or authorization for sharing patient information with family members has been obtained — including Part 2 consent in SUD programs
• Start and stop time — Document the session duration; the time must support the reporting threshold described above
• Therapeutic focus — Describe the specific clinical issues addressed during the session (e.g., family communication, boundary setting, psychoeducation about addiction, processing grief and loss related to the patient’s illness)
• Interventions used — Document the therapeutic techniques or modalities applied (e.g., structural family therapy interventions, psychoeducation, role playing, communication skills training)
• Family members’ responses — Note how family members responded to interventions, including emotional reactions, insights gained, and commitments made
• Connection to patient treatment plan — Explain how the family session relates to the patient’s overall treatment goals. This connection is essential for establishing medical necessity
• Plan — Document recommendations for future family involvement, homework assignments for family members, and topics for subsequent sessions

Billing and Reimbursement

Current Medicare amounts are in the rate table above. Key billing considerations:

• Billed under the patient’s insurance — Even though the patient is not present, 90846 is billed under the patient’s name and insurance policy. The service is provided for the benefit of the patient’s treatment, not as independent therapy for the family member
• Reporting threshold, no upper band — Unlike individual psychotherapy codes (90832, 90834, 90837), 90846 has no minute bands, but the midpoint convention applies: document start/stop times supporting at least 26 minutes of family psychotherapy
• Same-day billing — 90846 can be billed on the same date as other services for the same patient (e.g., individual therapy, group therapy), provided each service has distinct documentation with non-overlapping times — with modifier 59/XE where edits apply
• Frequency limitations — Some payers limit the number of family therapy sessions per treatment episode or per calendar year. Verify payer-specific policies, especially for Medicaid managed care plans
• Telehealth delivery — Many payers cover 90846 delivered via telehealth, which is particularly valuable when family members live far from the treatment facility. Apply modifier 95 and the correct POS (see Modifiers below)
• Authorization requirements — Some payers require prior authorization for family therapy services. This is especially common with Medicaid managed care and certain commercial plans

Common Modifiers

Modifiers applicable to CPT 90846 include:

• Modifier 95 — Synchronous telemedicine service. Required when the family session is conducted via telehealth, which is common when family members cannot travel to the treatment facility. Use POS 10 when the patient is at home and POS 02 when the patient is elsewhere — the old “always POS 02” habit predates the POS 10 split. Audio-only status for family psychotherapy should be confirmed on the current CMS telehealth services list ↗
• Modifier 59 or XE — Distinct procedural service or separate encounter. May be needed when billing 90846 on the same date as other therapy services for the same patient, to indicate the services are separate and distinct
• Modifier 52 — Reduced services. Used when the session is abbreviated for clinical reasons (e.g., family member becomes too distressed to continue)
• Modifier HE — Mental health program. Some Medicaid programs require this modifier for behavioral health services

Compliance Considerations

Family therapy billing carries unique compliance considerations because the service is rendered to non-patients but billed under the patient’s insurance:

HIPAA — and Part 2 — compliance is critical. Before conducting a 90846 session, ensure proper authorization exists for disclosing the patient’s protected health information to family members, and document the consent in the medical record. In SUD treatment programs, 42 CFR Part 2 consent requirements apply on top of HIPAA. Violations can result in penalties separate from any billing compliance issues.

The session must be therapeutic, not administrative. A phone call to update a family member on the patient’s progress, coordinate insurance paperwork, or discuss discharge logistics is not psychotherapy and should not be billed as 90846. The session must involve the application of psychotherapeutic techniques to address clinical issues related to the patient’s treatment.

Medical necessity must be established. Document why family therapy without the patient is clinically indicated. This is especially important when multiple 90846 sessions are billed during a single treatment episode. Payers may question the necessity of repeated family sessions without patient participation.

Billing under the correct patient is essential. All claims for 90846 are submitted under the patient’s insurance, not the family member’s. If a family member needs their own therapy (not related to the patient’s treatment), they should seek services under their own insurance and billing identity.

State-specific scope of practice rules apply. Some states restrict which provider types can bill family therapy. Verify that the rendering provider’s license authorizes family psychotherapy under state law and that they are credentialed with the payer to provide this service.

Addiction treatment context matters. In substance use disorder treatment, family involvement is considered a best practice and is supported by evidence. However, some payers may apply stricter medical necessity criteria to family therapy in addiction settings than in general mental health settings. Document the specific clinical rationale for family involvement in the patient’s recovery plan.

Related Billing Codes

• 90839
• 90840
• 90845
• 90847
• 90849
• 90853

Reference tables

Common questions

Official sources

• CMS Physician Fee Schedule lookup toolcms.gov
• CY 2026 conversion-factor increasecms.gov
• NCCI Policy Manualcms.gov
• CMS telehealth services listcms.gov