CPT Code 90847: Family Therapy Billing Guide (2026)

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• 90847

CPT Code 90847: Family Therapy Billing Guide (2026)

90847 billing for family therapy with the patient present — 2026 rates, 90846 vs 90847, documentation, modifiers, and facility billing scenarios.

Quick Reference

Code

90847

Code System

CPT

Category

CPT Codes

Published

Mar 4, 2026

Updated

Jun 12, 2026

Reading Time

19 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.

Overview of CPT Code 90847

CPT code 90847 describes family psychotherapy with the patient present. This code is used when a qualified mental health professional conducts a therapy session that includes both the identified patient and one or more family members. Family therapy is a cornerstone of behavioral health treatment, particularly in addiction recovery, where the involvement of family members can directly influence treatment outcomes and long-term recovery.

In residential and outpatient behavioral health settings, 90847 is one of the most commonly billed family therapy codes. Treatment centers serving patients with substance use disorders, eating disorders, mood disorders, and other behavioral health conditions routinely incorporate family sessions into the treatment plan — structured family weekends in residential care, weekly family components in IOP, and discharge-planning sessions all generate 90847 claims. For a facility biller, 90847 rarely appears alone: it lands on claims alongside group therapy ( 90853 ), individual therapy ( 90834 or 90837 ), and its sibling code 90846 for sessions held without the patient.

Definition and Purpose

CPT 90847 covers a family psychotherapy session — sometimes called conjoint therapy — in which the identified patient takes part alongside one or more family members, with a typical service time of around 50 minutes. The session involves therapeutic interventions directed at the family system, with the patient as an active participant.

The purpose of 90847 is to address relational and systemic factors that contribute to the patient’s behavioral health condition. Unlike individual therapy, which focuses on the patient alone, family psychotherapy examines patterns of communication, family roles, boundaries, and dynamics that may perpetuate or worsen the patient’s symptoms. The patient’s presence in the session is clinically significant because it allows the therapist to observe and intervene in real-time family interactions.

90847 is distinct from 90846 (family psychotherapy without the patient present), which is used when the therapist meets with family members to provide psychoeducation, support, or collateral information gathering without the patient in the room. The choice between 90846 and 90847 depends on the clinical goals of the session and whether the patient’s participation is therapeutically indicated. When multiple families attend a single group session, the multi-family group code 90849 applies instead.

Time Rules for Reporting 90847

90847 is described as a service of approximately 50 minutes, but it is not banded into minute ranges the way the individual psychotherapy codes (90832/90834/90837) are. Under the CPT convention for time-defined services, a code with a stated typical time may be reported once the midpoint of that time has been passed — for a 50-minute service, that means at least 26 minutes of face-to-face family psychotherapy must be furnished and documented before 90847 can be billed.

Practical implications:

• A 20-minute family check-in does not meet the threshold and should not be billed as 90847.
• Sessions need documented start and stop times even though there is no upper band — the record must support that the midpoint was passed.
• A session that runs well beyond 50 minutes is still one unit of 90847; there is no extended-session add-on for family psychotherapy.

When to Use in Behavioral Health

Family psychotherapy with the patient present is used extensively across behavioral health treatment settings. The following clinical scenarios commonly call for 90847.

Addiction treatment and family involvement. Family therapy is considered a best practice in substance use disorder treatment. Sessions billed under 90847 often focus on helping family members understand addiction as a disease, establishing healthy boundaries, addressing enabling behaviors, and developing a family-based relapse prevention plan. Research consistently shows that family involvement improves treatment retention and long-term recovery outcomes.

Communication skills training. Many family sessions focus on improving communication patterns between the patient and family members. This includes teaching active listening, assertive communication, conflict resolution, and emotional regulation skills within the family context.

Relapse prevention planning with family. Before a patient discharges from residential treatment or steps down from intensive outpatient, family sessions often focus on creating a structured relapse prevention plan that the entire family understands and supports. These sessions typically involve identifying triggers, establishing post-treatment routines, and defining how family members should respond if signs of relapse emerge.

Trauma and family systems work. When a patient’s trauma history involves family-of-origin dynamics, conjoint family therapy can address intergenerational trauma patterns, repair ruptures in family relationships, and create a safer family environment for the patient’s recovery.

Adolescent treatment. Family therapy is particularly important in adolescent behavioral health treatment, where family dynamics play a central role in the young person’s presenting concerns. Most evidence-based adolescent treatment models, including multisystemic therapy and functional family therapy, require the patient to be present during family sessions.

Couples therapy with an identified patient. Couples counseling is reported with the family psychotherapy codes when it is medically necessary treatment for one partner’s diagnosed condition. The treated partner is the identified patient, and the claim goes under that partner’s insurance. Some commercial plans carry explicit marital-counseling exclusions, so verify the benefit before the first session.

Discharge and transition planning. Family sessions near the end of treatment often focus on preparing the family for the patient’s return home, setting expectations, and establishing ongoing support structures.

90847 Reimbursement Rates by Year

Rates reviewed: June 2026. The table below tracks the Medicare national non-facility payment amount for 90847 and its patient-absent sibling 90846. 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 ↗ rather than relying on any third-party table.

Two structural trends are worth knowing when reading multi-year rate tables. First, the CY 2024 Physician Fee Schedule final rule adopted work-value increases for the psychotherapy code family — including 90846 and 90847 — phased in over several years, per the American Psychological Association’s rule summary ↗. Second, the CY 2026 final rule ↗ raised the conversion factor (to a final $33.5675 for qualifying APM participants and $33.4009 for other clinicians, up from $32.3465 in 2025), lifting most behavioral health payment amounts.

Beyond Medicare:

• Medicaid: varies by state, commonly in the $80–$140 range per session; some states route facility-based family therapy through HCPCS codes instead (see the H-code section below).
• Commercial insurance: contract-dependent, often $110–$180 per session.

90846 vs 90847: Quick Comparison

The two family psychotherapy codes are siblings, and choosing between them comes down to one observable fact — whether the identified patient was in the room — plus a handful of downstream differences.

For the full treatment of the patient-absent code — including why payers deny it more often and how to verify coverage before billing — see the dedicated 90846 guide.

Documentation Requirements

Proper documentation is critical for 90847 claims to withstand payer review. Each family therapy session note should include the following elements.

Participants identified. Document who attended the session by name and relationship to the patient. This is unique to family therapy documentation and is required to support the use of a family therapy code rather than an individual therapy code.

Patient presence confirmed. Explicitly state that the identified patient was present and participated in the session. This distinguishes 90847 from 90846.

Session duration. Record the start and stop times of the session. While 90847 describes a session of approximately 50 minutes, document the actual time to support the code and to show the reporting threshold was met.

Family dynamics and interactions. Document observations of family communication patterns, relational dynamics, and interactions that occurred during the session. This demonstrates the family therapy component and differentiates the service from individual therapy with a family member present as an observer.

Therapeutic interventions. Describe the specific family therapy techniques used, such as structural interventions, communication skills training, genogram work, boundary setting, psychoeducation, or experiential exercises. The interventions should be directed at the family system, not solely at the individual patient.

Treatment plan connection. Link the session to specific goals in the patient’s treatment plan that involve family participation, family dynamics, or relational functioning. Family therapy should be part of the documented treatment plan, not an ad hoc addition.

Clinical progress. Note the family’s response to interventions, any shifts in communication patterns or dynamics, and the patient’s engagement level during the session.

Plan for future sessions. Document whether additional family sessions are indicated and what topics or goals will be addressed in subsequent sessions.

Billing and Reimbursement

Medicare payment amounts for 90847 are listed in the rate table above; Medicaid and commercial rates vary by state and contract. The sections below cover the billing mechanics that determine whether those dollars actually arrive.

Authorization Considerations

Many payers require prior authorization for family therapy sessions, particularly when the sessions exceed a certain frequency or total number. Common authorization requirements include:

Facilities running scheduled family programming should fold family-therapy questions into verification of benefits at admission — coverage and session limits for 90846/90847 vary more than for individual therapy codes.

• A documented treatment plan that specifies family therapy as a clinically necessary component
• A diagnosis that supports the medical necessity of family involvement
• A defined number of authorized sessions, which may need to be re-authorized periodically

Whose Insurance Gets Billed

Family therapy is billed under the identified patient’s insurance — the person with the documented behavioral health diagnosis and active treatment plan — not under any family member’s policy. This holds even when the family members do most of the talking and visibly benefit from the session. The family members are participants in the patient’s treatment, not patients themselves. If a family member needs their own therapy, that care is a separate service under their own coverage and billing identity.

This rule matters most at facilities, where the family program is a scheduled component of one patient’s episode of care: every family session that week — with or without the patient in the room — lands on the patient’s claim history, counts against the patient’s benefit limits, and must trace back to the patient’s treatment plan.

Worked Example: A Residential Family-Program Week

Consider a fictional example. “Jordan” is an adult in residential SUD treatment at a facility that runs a structured family weekend in week three. Jordan’s clinical week includes:

If the facility bills these services fee-for-service, the claim lines for the week look like this:

Because no two psychotherapy services share a date of service in this example, no distinct-service modifiers are needed. If the Saturday schedule had instead stacked the 90847 session and a group session on the same day, the second service would need modifier 59 or XE with separate documentation and non-overlapping times, subject to NCCI procedure-to-procedure edits.

The bigger question for facilities is whether these lines are separately billable at all. If Jordan’s payer reimburses residential treatment on a per-diem or case rate, the contract usually bundles psychotherapy services — including family sessions — into the daily rate, and billing 90847 fee-for-service on top of the per diem is a double-billing error. Some contracts carve out professional services for separate billing while the per diem covers room, board, and milieu programming. The answer lives in the payer contract, not in the CPT book: before the family program runs, billing staff need to know which bucket each service falls into.

• Monday: individual therapy, 45 minutes ( 90834 )
• Tuesday and Thursday: group therapy ( 90853 )
• Friday: family session with Jordan’s parents, Jordan not present — boundaries psychoeducation before the weekend ( 90846 )
• Saturday: conjoint family session with Jordan and both parents (90847)

Medicaid and H-Code Interplay

State Medicaid programs frequently do not pay facility-based family therapy through CPT 90847 at all. In PHP, IOP, and residential program billing, many states route family counseling through HCPCS Level II codes — H-codes and T-codes defined in the state’s behavioral health fee schedule — or bundle it into a program per diem such as H0015 (intensive outpatient). Whether you bill 90847, an H-code, or nothing separately depends on the state, the program level of care, and the provider type.

The operational rule: check the state Medicaid behavioral health fee schedule and the managed-care plan’s billing manual for your level of care before assuming the CPT code applies. The CMS Medicare & Mental Health Coverage booklet ↗ governs Medicare; Medicaid is fifty different rulebooks.

License-Level Requirements

90847 can be billed by qualified mental health professionals operating within their state scope of practice, typically including:

Medicare additionally recognizes marriage and family therapists and mental health counselors as billable provider types — a relatively recent expansion that matters for family-therapy claims specifically. State scope-of-practice rules still control: some states restrict family psychotherapy billing to specific license types or require family-therapy training, and provisionally licensed clinicians usually must bill under a supervisor per payer rules. Verify both state licensure and payer credentialing for every rendering provider.

• Psychiatrists and other physicians
• Licensed psychologists
• Licensed clinical social workers (LCSW)
• Licensed marriage and family therapists (LMFT)
• Licensed professional counselors (LPC/LMHC)
• Psychiatric nurse practitioners and clinical nurse specialists

Telehealth

Family psychotherapy is commonly delivered by telehealth, particularly when family members are geographically scattered while the patient is in residential care. Current mechanics:

• Modifier 95 for synchronous audio-video sessions (some payers still want GT — check the payer).
• Place of service: POS 10 when the patient is at home, POS 02 when the patient is at another location. POS affects the facility/non-facility rate applied.
• Audio-only: Medicare permits audio-only telehealth for mental health services when the patient is at home and either cannot use or does not consent to video, subject to documentation requirements. Confirm 90847’s current status on the CMS telehealth services list ↗ — post-2025 telehealth policy has been extended and revised repeatedly, and the list is the source of truth.

Common Modifiers

Several modifiers may be used with CPT code 90847.

Modifier 95 — Synchronous telemedicine. Used when the family therapy session is conducted via real-time audio and video telehealth. Telehealth family therapy has become increasingly common, particularly when family members are geographically dispersed.

Modifier GT — Via interactive audio and video. Some payers require modifier GT for telehealth claims. Verify payer-specific requirements.

Modifier 59 — Distinct procedural service. Used when 90847 is billed on the same day as another therapy service to indicate the family session was a separate and distinct encounter.

Modifier XE — Separate encounter. A more specific version of modifier 59, indicating the services were provided during separate encounters on the same day.

Modifier HQ — Group setting. In rare situations where multiple families participate in a multi-family therapy session, some payers may require modifier HQ. However, multi-family group therapy is more commonly billed under 90849.

Compliance Considerations

Accurate billing of 90847 requires attention to several compliance areas specific to family therapy.

Patient presence requirement. The most common compliance issue with 90847 is billing the code when the patient was not actually present for the session. If the therapist meets with family members without the patient, the correct code is 90846. Documentation must clearly confirm patient participation.

Family therapy versus individual therapy with collateral contact. A session in which a family member briefly joins an otherwise individual therapy session does not automatically qualify as family therapy. For 90847, the session must be structured as family psychotherapy, with interventions directed at the family system. A brief collateral contact at the end of an individual session should not be billed as a separate family therapy encounter.

Credential and scope of practice requirements. Verify that the rendering provider is credentialed and licensed to provide family therapy in the state where services are delivered. Some states require specific family therapy licensure (such as LMFT) or additional training beyond a general mental health license to bill family therapy codes.

Medical necessity documentation. Payers may question the necessity of family therapy, particularly for adult patients or for conditions not traditionally associated with family treatment. Ensure the treatment plan clearly articulates why family involvement is clinically necessary for the patient’s specific condition and recovery.

Confidentiality and consent. When the patient is present during family therapy, the therapist must navigate confidentiality boundaries carefully. Document informed consent for family therapy, including what information may be shared during sessions and any limits on confidentiality.

Frequency limitations. Some payers limit the number of family therapy sessions per week, per month, or per treatment episode. Review payer policies and authorization requirements to avoid claim denials due to frequency overages.

Common 90847 Denial Reasons

Related Billing Codes

• 90840
• 90845
• 90846
• 90849
• 90853
• 90863

Reference tables

Common questions

Official sources

• CMS Physician Fee Schedule lookup toolcms.gov
• CY 2026 final rulecms.gov
• CMS Medicare & Mental Health Coverage bookletcms.gov
• CMS telehealth services listcms.gov