CPT 90846 and 90847: Family Therapy Billing Codes

CPT 90846 is family psychotherapy without the patient present; 90847 is family psychotherapy with the patient present. Both describe 50-minute sessions, and payer policy commonly sets a 26-minute minimum. The claim goes under the identified patient, the person whose diagnosis is being treated. Ona builds that claim from the session note on the patient's chart.

Quick answer:

Patient in the room for the session: 90847. Family only, patient absent: 90846. Several families in one group: 90849.
The session has to be about treating the identified patient's condition. That is the Medicare standard, and it is why couples work without a diagnosed patient is often not covered.
Family members who join an individual session as informants do not turn it into family therapy. That time is already part of 90832 to 90838.

The Family Psychotherapy Codes at a Glance

The CMS National Correct Coding Initiative Policy Manual, Chapter XI (revision January 1, 2026), states that the descriptors for 90846 and 90847 describe 50 minutes of family psychotherapy, one without the patient present and one with. The table paraphrases the codes; time minimums come from Blue Cross and Blue Shield of Texas policy CPCP051.

Code	What it describes (paraphrased)	Patient present?	Time	Interactive complexity 90785
90846	Family psychotherapy, identified patient not present	No	50-minute descriptor; no less than 26 minutes per BCBSTX	Not reported with it, per BCBSTX
90847	Conjoint family psychotherapy, identified patient present	Yes	50-minute descriptor; no less than 26 minutes per BCBSTX	Not reported with it, per BCBSTX
90849	Multiple-family group psychotherapy	Varies	Not timed; one unit per session per NCCI	Check the payer
90832 to 90838	Individual psychotherapy, family members may join as informants	Yes	16 to 37, 38 to 52, 53 or more minutes	Allowed when documented

The 26-minute floor follows the general CPT convention that a timed unit is met once the midpoint is passed. It is published as a payer rule in the Blue Cross and Blue Shield of Texas policy, not as a CMS rule, so check each payer's own policy for the minimum it applies.

With or Without the Patient: Choosing Between 90846 and 90847

The code turns on one fact: was the identified patient in the session?

90847 is the conjoint session. The patient and family members work together, and the therapy addresses how the patient and family interact. A parent and adolescent session about conflict at home, or a session with an adult patient and their spouse about how the household handles the patient's symptoms, are typical examples.

90846 is the session without the patient. It is still treatment for the patient's condition, delivered through the people around them. Parents meeting the clinician to work on how they respond to a child's behavior, while the child is not in the room, is the classic case.

If the patient joined for part of the session, document who was present and when. Where the payer allows only one family code per date, the note should make clear which one the session as a whole supports.

The Identified Patient on the Claim

Family therapy has several people in the room and one patient on the claim. The identified patient is the person with the diagnosis the treatment is aimed at. Their name, insurance, diagnosis and treatment plan go on the claim, whether or not they were present for a 90846 session.

Medicare's language makes the logic explicit. CMS's booklet Medicare and Mental Health Coverage (March 2026) covers family psychotherapy with or without the patient present "as medically reasonable and necessary, with patient treatment as the primary purpose." First Coast LCD L33252 adds three conditions worth building into your intake and templates:

the primary purpose is treatment of the patient's condition, for example changing how the patient and family interact, or helping family members manage the patient,
a family member is someone who spends significant time with the patient and gives them psychological support,
and family therapy should be ordered as part of an active treatment plan.

That is why one claim per session is the norm, under one patient. Billing each family member separately for the same session is not what these codes describe.

Couples Therapy: The Coverage Caveat

There is no CPT code for couples therapy as such. Practices sometimes reach for 90847 when two partners attend, and whether that is payable depends on what the session is treating and on the plan.

When one partner is the identified patient with a diagnosed condition and the session is aimed at treating that condition, family psychotherapy codes may apply, the same as any 90847. When the focus is the relationship itself, with no diagnosed patient whose treatment the session serves, the Medicare test of "patient treatment as the primary purpose" is not met, and many commercial plans exclude relationship or marriage counseling in their benefit documents. Plans differ, so read the specific plan's exclusions and confirm benefits before the first session. A couple who will pay out of pocket should know that before they book, not when the claim is denied.

Same-Day Rules

The NCCI manual sets the boundaries that matter most for family work:

Informants in an individual session. 90832 to 90838 already include psychotherapy with family members present as informants. A parent who stays for ten minutes of an adolescent's individual session does not create a family therapy claim.
Individual and family on the same date. Family psychotherapy focused on the patient and family interactions may be reported on the same date as individual psychotherapy only if it is a separate and distinct service in a separate time interval. Blue Cross and Blue Shield of Texas states the same.
Evaluation on the same date. 90791 and 90792 are not reported with family or other psychotherapy codes for the same date.
Multiple-family groups. 90849 is not a timed code, and a practitioner reports one unit per date of service, per the NCCI manual.

What the Family Session Note Should Show

LCD L33252 asks family session notes to summarize the themes addressed, the reactions of the patient and family, and the outcomes. Combine that with what every timed psychotherapy note needs:

Who attended, with relationship to the identified patient, and whether the patient was present.
Start and stop times or total time. First Coast's article A57520 asks for time documentation on time-based psychotherapy codes.
How the session relates to the identified patient's treatment plan goals.
Themes addressed and interventions used, named specifically.
Reactions of the patient and of family members.
Outcome of the session and the plan for the next one.

Keep family members' own sensitive details to what the patient's record needs. The note sits in the identified patient's chart.

Telehealth for Family Sessions

Both family codes are current Medicare telehealth codes in CMS's March 2026 mental health booklet, and CMS's December 2025 telehealth booklet notes that multiple-family group psychotherapy, 90849, was added to the Medicare telehealth services list for 2026. Place of service follows the patient's location: POS 10 at home and POS 02 elsewhere, per the CMS Telehealth FAQ updated October 8, 2026. Many commercial plans also want modifier 95 for audio and video sessions.

The practical limit is the technology. In Ona, a video visit is one clinician and one patient link; there is no group or shared-session format today. Ona's pages do not describe family members joining one visit from separate locations, so plan video family sessions around a single shared connection, or see the family in person. It is better to know that before you plan a 90847 schedule around video.

The same applies to the ambient scribe. For in-person recordings, Ona expects two speakers and labels them Clinician and Patient, and its own page says a third voice in the room may not be labeled correctly. On a family session, read the transcript-based draft with that in mind and correct who said what before signing.

How a Family Session Flows to the Claim in Ona

Ona is an AI-native, all-in-one practice management platform for outpatient practices, from solo family therapists to multi-location behavioral health groups. Family therapy uses the same path as any visit, under the identified patient's chart:

Separate services for 90846 and 90847. Each service carries its CPT code, place of service, modifiers and default copay, so booking "Family therapy, patient present" puts 90847 on the visit.
A family session template. Ona's note templates use bracketed placeholders, so [attendees and relationship], [patient present: yes or no], [session start time] and [session end time] become fields every family note has.
Authorizations counted. If the plan authorizes a number of family sessions, Scripts & Auths on the visit's Insurance page tracks total, used, scheduled and remaining visits, and can be limited to the visit types it covers.
Coverage checked first. Eligibility runs when the visit is booked and again in the 48 hours before it, against the identified patient's plan.
Claim or superbill. The draft claim builds from the signed note's diagnoses and services, and billing rules can require a diagnosis on every line and a note before the visit is billed. Out-of-network and self-pay families get a superbill or an invoice from the completed visit, per From visit billing to superbill and claim and Ona's billing.

Video visits default to POS 10 on the claim, and a service can carry its own code, as described on the telehealth page.

Frequently asked questions

What is the difference between 90846 and 90847?

90846 is family psychotherapy without the identified patient present, and 90847 is family psychotherapy with the patient present. Both describe 50-minute sessions per the CMS NCCI Policy Manual. The choice turns on whether the patient was in the session, so the note should record who attended.

What is the minimum time for 90847?

Payer policy commonly sets the minimum at 26 minutes, following the CPT midpoint convention for a 50-minute code. Blue Cross and Blue Shield of Texas states that service time for both 90846 and 90847 should be no less than 26 minutes. This is a payer rule rather than a CMS rule, so check each payer.

Whose name goes on a family therapy claim?

The identified patient's. That is the person whose diagnosed condition the family therapy is treating, and their insurance, diagnosis and treatment plan go on the claim, even for a 90846 session they did not attend. Medicare covers family psychotherapy when treating the patient is the primary purpose.

Is couples therapy covered by insurance?

Often not, when the focus is the relationship rather than treating one partner's diagnosed condition. Medicare covers family psychotherapy only when patient treatment is the primary purpose, and many commercial plans exclude relationship or marriage counseling. Plans differ, so check the specific plan's exclusions and confirm benefits before the first session.

Can I bill 90847 and 90837 on the same day?

Only when they are separate and distinct services in separate time intervals, per the CMS NCCI Policy Manual. Family members who join an individual session as informants are already included in 90832 to 90838, so that time does not support a separate family therapy code.

Can I run family therapy over telehealth in Ona?

Yes, with a limit. Ona's video visits are one clinician and one patient link, with no group format today, so a family on video shares a single connection rather than joining from separate locations. Family therapy codes are Medicare telehealth codes, and Ona's video visits default to POS 10 on the claim, with a service able to carry its own code.

Next step

Coding guidance in this article is general. Payer rules vary, so confirm time minimums, couples coverage and telehealth rules with each payer before you bill.

Family therapy billing comes down to three facts on every note: who attended, how long, and how the session served the identified patient's plan. Put them in the template and let the claim build from it. See insurance and claims in Ona, check seats on the pricing page, or start the 14-day free trial with no credit card.