Overview
Behavioral health providers may provide individual psychotherapy, family psychotherapy, or both depending on the patient’s treatment needs. While these services can involve overlapping participants and therapeutic goals, individual psychotherapy and family psychotherapy are distinct services and must be reported accurately based on the service rendered.
Incorrect billing can occur when a provider reports an individual psychotherapy code in addition to family psychotherapy for the same patient and date of service, even though only one family therapy session was performed. Another billing concern occurs when a provider submits a separate claim for CPT code 90847 for each family member who participated in the same family therapy session.
Understanding the distinction between these services is important for accurate claims processing, appropriate reimbursement, and identification of potential overpayments.
Individual Psychotherapy
CPT codes 90832, 90834, and 90837 are used to report individual psychotherapy services based on the duration of the psychotherapy encounter. CMS describes these as psychotherapy codes and instructs providers to select the code corresponding most closely to the actual time of the psychotherapy service.
The individual psychotherapy codes are generally:
- 90832 – Psychotherapy, 30 minutes (16-37 minutes)
- 90834 – Psychotherapy, 45 minutes (38-52 minutes)
- 90837 – Psychotherapy, 60 minutes (53 or more minutes)
CMS guidance states that individual psychotherapy codes should be used when the focus of treatment involves individual psychotherapy.
The fact that a family member participates in an individual psychotherapy session does not, by itself, convert the service into a family psychotherapy service. CMS’s National Correct Coding Initiative (NCCI) Policy Manual explains that psychotherapy codes 90832–90838 include psychotherapy provided to the patient when family members are present as informants on the patient’s behalf.
Family Psychotherapy
CPT code 90847 represents family psychotherapy with the patient present. CPT code 90846 represents family psychotherapy when the patient is not present. The American Medical Association’s CPT resources identify 90847 as family psychotherapy/conjoint psychotherapy with the patient present. Family therapy requires a minimum of 26 minutes per CPT guidelines.
CMS further explains that family psychotherapy is covered when the primary purpose of the psychotherapy is treatment of the patient’s condition. Examples include situations in which the provider uses psychotherapeutic techniques to address the patient’s interactions with family members or works with the family to address conflicts or impediments affecting management of the patient’s condition.
Therefore, the presence of multiple family members does not mean that each person becomes a separate billable patient for the same family psychotherapy encounter.
The Identified Patient Is the Focus of the Family Therapy
A key distinction in family psychotherapy is that the treatment is directed toward the identified patient’s condition, even though other family members may participate in the session.
For example, consider a family therapy session involving:
- The identified patient
- The patient’s mother
- The patient’s father
- A sibling
If the provider conducts one family psychotherapy session focused on the identified patient’s mental health condition and the family’s interaction with or management of that condition, the provider has rendered one family psychotherapy service.
The provider should not automatically submit a separate 90847 for the mother, another 90847 for the father, another 90847 for the sibling, and another 90847 for the identified patient.
The number of people participating in the session does not, by itself, determine the number of billable family psychotherapy services.
This principle is expressly reflected in Medicaid guidance from multiple states. For example, the Missouri Department of Social Services states that when family therapy with the patient present (90847) or without the patient present (90846) is provided, the session is billed as one service for one family unit regardless of the number of individuals present. Missouri further states that providers may not bill family therapy for each family member.
Minnesota Medicaid similarly states that family psychotherapy may be billed separately for each patient in a family group, but providers should not bill for each family member.
These state Medicaid examples reinforce an important billing concept: family therapy is not the same as providing an individual psychotherapy service to each person sitting in the room.
Improper Billing of Individual and Family Psychotherapy on the Same Date
Another potential billing issue occurs when a provider submits 90847 and 90832, 90834, or 90837 for the same patient on the same date of service, even though the medical record supports only one family therapy encounter.
For example:
A provider conducts a 50-minute family psychotherapy session with the patient and the patient’s parents. The medical record documents one family therapy encounter. The provider submits 90847 and submits 90834 for the same patient and date of service.
If there was only one 50-minute family psychotherapy encounter, reporting an additional individual psychotherapy service would not accurately represent the services rendered.
Importantly, however, CMS NCCI guidance does not prohibit these codes from ever appearing together on the same date.
CMS states that family psychotherapy codes 90846 and 90847 may be reported separately with individual psychotherapy codes 90832–90838 on the same date when the family psychotherapy is a separate and distinct service performed during a separate time interval.
Consequently, the critical issue is not simply whether both codes appear on the same claim or date of service. The critical questions are:
- Were two distinct psychotherapy services performed?
- Were the services provided during separate time intervals?
- Is there documentation supporting each service?
- Does each service have a distinct therapeutic purpose?
- Does the medical record support the time reported for each service?
- Was the individual psychotherapy provided to the identified patient?
- Was the family psychotherapy separately provided as a family-focused intervention?
If the answer is no, billing both services may result in an inappropriate duplicate and overlapping payment.
Example of Appropriate Same-Day Billing
There may be circumstances in which both individual and family psychotherapy are appropriately reported on the same date.
For example:
10:00–10:45 a.m.
90834 – Individual psychotherapy with the patient
11:00–11:50 a.m.
90847 – Family psychotherapy with the patient and family members
In this example, the services occurred during separate time intervals and represent distinct encounters. The medical record would need to support both services, including the therapeutic purpose and time associated with each encounter.
CMS’s NCCI guidance specifically recognizes this possibility.
Therefore, a claims review should not automatically deny or classify every 90847 + 90832/90834/90837 combination as an overpayment. Instead, the combination should be evaluated for separate and distinct services.
Example of Potentially Incorrect Billing
Consider a different scenario:
A provider conducts one 50-minute family therapy session with a patient and the patient’s parents. The provider documents family dynamics, communication issues, and interventions directed toward the patient’s treatment. The provider then submits 90847 and 90834 for the same patient and date of service.
If there was no separate individual psychotherapy encounter, the additional 90834 may represent an inappropriate duplicate or overlapping charge.
The documentation should demonstrate that a separate individual psychotherapy service occurred before a payer considers reimbursement for both services.
Billing 90847 for Each Family Member
A separate but related issue occurs when providers submit multiple units of 90847 based solely on the number of family members participating in one session.
For example:
One 50-minute family therapy session
Participants:
- Patient
- Mother
- Father
- Brother
Potentially inappropriate billing:
- 90847 – Patient
- 90847 – Mother
- 90847 – Father
- 90847 – Brother
This treats the family therapy session as though the provider delivered four separate psychotherapy services.
That is generally inconsistent with the concept of family psychotherapy when the provider conducted one family session focused on treatment of the identified patient.
Missouri Medicaid provides particularly clear language on this issue, stating that family therapy is treatment of family members as a family unit and that 90846/90847 is billed as one service for the family unit regardless of the number of individuals present.
A Minnesota Medicaid provider resource similarly states that providers should not bill family psychotherapy for each family member.
Family Therapy Is Different From Group Therapy
It is also important not to confuse family psychotherapy with group psychotherapy.
90847 is family psychotherapy with the patient present.
90849 represents multiple-family group psychotherapy.
90853 represents group psychotherapy other than multiple-family group psychotherapy.
The appropriate code depends on the nature of the service and who is being treated.
For example, a single family consisting of a patient and several relatives participating in one family therapy session does not become a group psychotherapy session simply because several people are present.
Likewise, billing multiple 90847 services based on the number of family members present does not convert one family therapy encounter into multiple individual psychotherapy encounters.
Documentation Is Critical
The medical record should support the service that was billed.
For individual psychotherapy, documentation should support the individual psychotherapy service, the therapeutic interventions, medical necessity, and the time associated with the service.
CMS guidance states that psychotherapy services are time-based and that documentation should support the time reported for psychotherapy codes.
For family psychotherapy, the record should demonstrate that the service was directed toward treatment of the identified patient’s condition and explain the role of the family intervention in the patient’s treatment.
CMS describes family psychotherapy as appropriate when the purpose is treatment of the patient’s condition, including addressing the patient’s interactions with family members or family conflicts affecting management of the patient’s condition.
Claims Review Considerations
From a payment-integrity perspective, claims containing 90847 and 90832, 90834, or 90837 for the same patient and date of service may warrant additional review.
A claims review could evaluate:
- Whether 90847 and the individual psychotherapy code were billed for the same patient.
- Whether the services occurred on the same date of service.
- Whether separate start and stop times are documented.
- Whether the services occurred during separate time intervals.
- Whether separate clinical documentation supports each service.
- Whether the treatment objectives differ between the individual and family encounters.
- Whether the total reported psychotherapy time is clinically and operationally plausible.
- Whether multiple 90847 claim lines were submitted for the same family therapy encounter.
- Whether the same rendering provider billed multiple 90847 services for the same patient/date.
- Whether different family members were incorrectly treated as separate billable patients for one family session.
Conclusion
Individual psychotherapy and family psychotherapy are distinct services. The appropriate CPT code should reflect the actual service performed, the focus of treatment, the participants involved, and the documented time and medical necessity.
When a provider conducts a family psychotherapy session using 90847, the participation of multiple family members does not automatically justify billing a separate 90847 for each person. The family session is generally reported as a service directed toward treatment of the identified patient’s condition.
Similarly, providers should not report 90832, 90834, or 90837 in addition to 90847 merely because an individual psychotherapy code generates additional reimbursement. Same-day reporting of family and individual psychotherapy may be appropriate when the services are separate, distinct, separately documented, and performed during separate time intervals.
The distinction is therefore not simply “one patient versus multiple people in the room.” The appropriate billing determination depends on what service was rendered and who or what the treatment was directed toward.
References
CMS / Medicare NCCI Policy Manual https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-11.pdf?utm.com
CMS Outpatient Psychotherapy Guidance Article – Billing and Coding: Outpatient Psychotherapy (A59723)
CMS Psychiatry/Psychology Billing and Coding Article Article – Billing and Coding: Psychiatry and Psychology Services (A57480)
AMA/CPT Behavioral health coding guide
CPT Coding Guidelines
Missouri Medicaid Psychotherapy FAQs | Missouri Department of Social Services
Minnesota Medicaid