90847 CPT Code and 90846 CPT Code: Billing the right way
The 90847 CPT code and the 90846 CPT code are used by therapists for billing couples and families receiving counseling services. But it isn’t as straightforward as it sounds. Ask any therapist who does couples or family therapy work about billing and you’re likely to get a string of billing stories. Used. Not used. Sort of covered. Is there a CPT code for couples counseling? Is couples therapy something that you can legitimately bill for using the 90847 CPT code and the 90846 CPT code? What IS the CPT code for a couples session then?
The answer is, it depends.
Couples work is historically one of the most confusing services for therapists to bill. Couples therapy, marital therapy, couples counseling and all its iterations is a continuum that ranges from the highly clinical intervention to non-clinical enrichment and education. It’s not what most people specifically think of as family therapy. It’s not individual therapy. There isn’t even a specific CPT code just for “couples therapy”.
For years, third party payors generally excluded it from coverage. In fact, when you call to verify benefits, you will sometimes get a “NO” (even if 90847 CPT code and 90846 CPT code are used/covered) simply because not everyone understands that couples therapy is more than just communication skills. No wonder therapists are confused!
Is couples therapy covered?
Historically, couples therapy, and sometimes even family therapy, wasn’t covered by most insurance and other third party payors. In fact, those services were often specifically listed as exclusions in the coverage of benefits. Along came mental health parity and with it, more services that were covered.
Today, many health plans cover family and couples therapy but it varies from plan to plan and there is variance among groups within the plan. However, just because a CPT code exists, doesn’t mean something is automatically covered. It is always best practice to verify coverage before you provide the service. And the question you want to ask is, “Does this person’s coverage need the 90847 CPT code or the 90846 CPT code?”
Being a covered benefit isn’t the whole story though. As with any covered service, there are standard criteria that must be met. In most cases, in order for couples/family therapy to be covered, the payor (usually an insurance company) must have sufficient evidence that the service is medically necessary to treat a diagnosis of one of their members in the covered family. One person in the session must be your identified patient (IP) and have a legitimate clinical diagnosis. Z-codes are not sufficient and those are usually specifically excluded in the coverage exclusions.
The couples therapy must be clinically focused and not focused solely on things like communication skills, personal/couples growth or parenting issues although those topics may certainly be part of the overall clinical process.
How do I code couples therapy correctly?
Your initial session would be billed as you would any initial session with an IP present. For ongoing couples therapy, it is appropriate to use the 90847 CPT code for couples/family therapy with the IP present and the 90846 CPT code with couples/family therapy without the IP present.
What happens when you need to see one of the parties individually for a session? This is where it can get confusing and another reason you need to determine the IP at the start. If you’re seeing the IP for a session apart from other family members, including a spouse or partner, you would use an individual therapy code. If you need to see the non-IP family member (in this case a spouse or partner) for a session, you would use the 90846 CPT code (couples/family therapy without the IP present).
To break it down even further, according to the National Association of Social Workers, the 90846 CPT code identifies family psychotherapy services without the patient present. This particular code is used when an individual psychotherapy service is on the same day but is separate and distinct for the patient. The time range is 26 minutes or more and the session is for 50 minutes.
The 90847 CPT code is family psychotherapy with the patient present and is known as conjoint psychotherapy. The 90847 CPT code may be used on the same day as an individual psychotherapy service is provided if the services are separate and distinct for the patient. The time is a 50-minute session and the total duration for the therapy is 26 minutes or more.
Can I bill a couples session as two individual sessions?
The short answer is no. The billable service is the session. And that requires an IP. Billing for the same session twice is double-dipping and considered fraudulent.
What if there are two plans with shared benefits?
Again, you can only bill for the session – one service. If the IP is covered by both plans, you have to do a little research to determine which would be considered primary and which would be considered secondary. You cannot bill each plan for a full session or for two individual sessions. It is fraudulent and places you at risk.
Billing couples therapy doesn’t have to be hard but you do need to be sure you understand the importance of having an IP and a clear clinical justification if/when using 90847 CPT code and 90846 CPT code. Audits can and do happen. You want to be fully prepared to demonstrate compliance should questions or even billing issues arise.
As with any billing/benefits, it is always in your best interest to stay up to date on CPT changes, check your contracts periodically for changes to contracted services and verify benefits for your clients. Benefits can vary widely even within health plans and often change at the annual benefits renewal.
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