CPT Codes for Family Therapy Billing

Introduction to CPT codes

As a healthcare professional, you know that navigating the complexities of the billing processes is crucial for the smooth operation of your practice. One essential tool that simplifies this process is the Current Procedural Terminology (CPT) codes. These standardized codes accurately identify and bill for specific medical services and procedures, including family therapy sessions.

Understanding and correctly applying CPT codes streamline your billing process and ensure compliance with insurance providers. This helps you get reimbursed efficiently and accurately, especially for family psychotherapy services.

Understanding categories of CPT codes

To effectively navigate the billing process and ensure you’re appropriately reimbursed for the care you provide, it’s essential to have a solid understanding of these categories of CPT codes. These codes are the backbone of medical, billing, and reimbursement processes, used to categorize and track the vast array of services and procedures you perform (American Medical Association, 2019):

• Category I codes represent most CPT codes and cover the procedures and services most commonly performed in clinical practice. These codes are regularly updated to reflect the latest medical technology and practice advancements, ensuring your billing stays current.
• Category II codes are alphanumeric supplemental and provide additional information on performance measures, such as quality of care. While they aren’t required for billing, using them can enhance the documentation of your services and improve your practice’s performance tracking.
• Category III codes are alphanumeric temporary codes that track new and emerging technologies and procedures. They are valid for up to five years and provide critical data that can influence adopting new practices. If a Category III procedure becomes widely accepted, it may eventually be assigned a permanent Category I code.
• Proprietary Laboratory Analyses (PLA) codes have recently been added to the CPT code set. These codes specifically describe proprietary clinical laboratory analyses, which can be provided by a single “sole-source” laboratory or licensed to multiple laboratories that are cleared or approved by the Food and Drug Administration (FDA).
• This category encompasses a range of tests, including advanced diagnostic laboratory tests (ADLTs) and clinical diagnostic laboratory tests (CDLTs), as defined under the Protecting Access to Medicare Act of 2014 (PAMA).

Knowing these categories will help you accurately document and bill for the services you provide, ultimately supporting the financial health of your practice.

Using the correct CPT Codes for Family Therapy Billing

As mentioned, using the correct CPT codes is essential for ensuring that your services are accurately represented, and you receive proper reimbursement. Each CPT code is designed to categorize specific types of therapy sessions, making it easier for insurance companies to process claims and for you to manage your billing efficiently. Let’s break down the key CPT codes you need to know for family therapy.

CPT code 90847: Family therapy with the patient present

CPT code 90847 is used when you conduct a group psychotherapy or service as a family therapy session with the patient present. This code is vital because it signifies that the mental health family therapy session involves direct interaction with the patient and their family members. The patient's presence allows for a more integrated approach to therapy, where family dynamics and individual concerns can be addressed simultaneously.

CPT code 90846: Family therapy without the patient present

For family therapy sessions where the patient is not present, you’ll use CPT code 90846. This code is used when the session focuses solely on the family members of the identified patient, discussing issues related to the patient’s care without the patient being part of the conversation. Including multiple family members in these sessions is crucial to address the dynamics of their relationships. This distinction helps insurance providers understand the specific nature of the psychotherapy service and ensures that your billing is precise and compliant.

CPT Codes 90834 and 90837: Individual psychotherapy sessions

In addition to mental health billing due to family therapy, you may conduct individual therapy sessions requiring accurate coding. 90834 is used for a 45-minute individual psychotherapy session, while 90837 applies to sessions lasting 60 minutes. These codes are crucial for billing individual sessions that may occur alongside or separate from family therapy. Selecting the correct code based on the particular session and length ensures proper reimbursement and maintains the integrity of your billing practices.

Reimbursement rates for family therapy CPT codes

Now that you've learned about the CPT codes used in family therapy let's discuss reimbursement rates. Medicare sets these rates, which can vary yearly due to factors such as Medicare Physician Fee Schedule adjustments. The reimbursement rates for family counseling CPT codes 90847 and 90846 over the last few years are shown below.

CPT code 90847

• 2024: $100.53
• 2023: $99.63
• 2022: $111.15
• 2021: $102.59
• 2020: $107.19

CPT code 90846

• 2024: $95.94
• 2023: $95.56
• 2022: $107.37
• 2021: $99.10
• 2020: $103.58

These rates are based on Medicare reimbursements and serve as a benchmark for the amount of national payment that can be expected when billing for family therapy services. Verifying coverage with the insurance company is critical to ensuring that the services provided by family therapists are deemed medically necessary so you can be reimbursed accordingly.

Family therapy insurance billing example

In family therapy, it’s often not just one individual who needs support — multiple family members may be involved for extended time in the therapeutic process for the same patient. As a healthcare professional, you know that billing for these sessions can be complex, especially when different family members require varying levels of care. Understanding how to navigate these situations is crucial for accurate billing and effective treatment planning.

Let’s consider a typical scenario involving three clients: Client A (the mother), Client B (the child who is the primary focus of treatment), and Client C (another child). Each session might involve different combinations of these clients, depending on the patient's interaction and therapeutic needs.

• Session 1: All three clients (A, B, and C) attend therapy together. This session would likely be billed under CPT code 90847, as it involves family therapy with the patient (Client B) present.
• Session 2: The following week, you see Client A alone to discuss Client B’s treatment concerns. This session might be billed under CPT code 90846, which covers family therapy without the patient present.
• Session 3: The next day, you see Client B individually to focus on their specific treatment needs. Depending on the session length, this could be billed under CPT code 90834 (45 minutes) or 90837 (60 minutes).
• Session 4: A week later, Client A decides that she needs therapy for her own distress and sees you for individual treatment. Depending on the duration, this session would also be billed under 90834 or 90837.

Family and couples therapy often has more extended session sessions and involves varying combinations of individuals in therapy sessions. Mental health practitioners play a critical role in navigating these billing complexities, ensuring that each session is appropriately documented and billed together.

Final thoughts

Family therapy is a complex and dynamic field that requires specialized training, knowledge, and skills. It involves a deep understanding of family history and the relationships among family members. Additionally, navigating the intricacies of billing is essential.

Understanding family therapy billing codes can be challenging, yet they are extremely crucial for securing accurate reimbursement and preventing claim denials. By properly applying CPT codes, staying updated on reimbursement rates, and accurately billing for sessions that include each family member, you can safeguard your practice's financial health while prioritizing what truly matters: delivering quality care to your clients.