Family therapy codes fill an important niche: sessions that involve family members as part of a client's treatment. Whether you're consulting with parents about a child client, conducting couples therapy, or providing family systems work, these codes apply.
The key distinction: 90846 is for family therapy without the identified patient present; 90847 is for family therapy with the patient present.
Family Therapy Codes at a Glance
| Code | Description | Patient Present? |
|---|---|---|
| 90846 | Family psychotherapy without patient | No |
| 90847 | Family psychotherapy with patient | Yes |
Understanding "Identified Patient"
Family therapy codes require an identified patient—the individual whose treatment the family session supports.
The identified patient:
- Is an established client in your care (you've seen them before)
- Has a diagnosis warranting treatment
- Is the person whose insurance you're billing
Family members:
- Participate in treatment to support the identified patient
- Are not separately billed for the session
- Don't need their own diagnosis for you to bill these codes
Example: You treat a 14-year-old for depression. You meet with her parents to coordinate treatment. The 14-year-old is the identified patient; her parents are collateral participants. Bill under the teen's insurance using her diagnosis.
90846 — Family Therapy Without Patient Present
When to Use
The identified patient is not present in the session. You're meeting with family members only.
Common scenarios:
- Parent consultation for child/adolescent client
- Meeting with spouse/partner about adult client (with client's consent)
- Family education session about patient's condition
- Coordinating care with family caregivers
- Addressing family dynamics affecting patient's treatment
Requirements
- Identified patient must be established in your care
- Session relates to patient's treatment—you're not providing therapy to the family members independently
- Patient has consented (or consent isn't required, e.g., parent of minor)
- Documentation links session to patient's treatment goals
Time
90846 is not strictly time-based like individual therapy codes. A typical session is 50 minutes, but the code doesn't specify exact time requirements.
Documentation Example
Date: 01/15/2026
CPT: 90846
Identified Patient: [Patient name, DOB]
ICD-10: F33.1 (Major depressive disorder, recurrent, moderate)
Attendees: Patient's mother (Jane Doe) and father (John Doe). Patient (age 15) not present per treatment plan.
Purpose: Parent consultation regarding patient's depression treatment. Patient consented to family session.
Session content:
- Psychoeducation about adolescent depression
- Reviewed warning signs parents should monitor
- Discussed strategies for supporting patient's use of coping skills
- Addressed parents' questions about medication (referred to prescriber for medication-specific questions)
- Coordinated approach to limiting patient's social media at night
Outcome: Parents demonstrated understanding of depression and agreed to consistent bedtime routine. Aligned on supportive (vs. critical) responses to patient's low mood.
Plan: Follow-up parent session in 4 weeks to assess home environment changes. Continue individual therapy with patient weekly.
90847 — Family Therapy With Patient Present
When to Use
The identified patient is present along with family members.
Common scenarios:
- Family therapy sessions with identified patient participating
- Couples therapy (one partner is identified patient)
- Parent-child sessions
- Multi-generational family sessions with patient present
Requirements
- Identified patient participates in the session
- Family members participate alongside patient
- Focus is on patient's treatment (not exclusively on other family members' issues)
Time
Like 90846, not strictly time-based. Typically 50 minutes.
Documentation Example
Date: 01/15/2026
CPT: 90847
Identified Patient: [Patient name, DOB]
ICD-10: F43.23 (Adjustment disorder with mixed anxiety and depressed mood)
Attendees: Patient and spouse (partner's name). Patient present throughout session.
Session content:
- Explored communication patterns contributing to patient's anxiety
- Practiced active listening exercise with couple
- Addressed patient's tendency to avoid conflict (avoidance maintaining anxiety)
- Spouse shared impact of patient's withdrawal; patient processed this feedback
Patient response: Initially defensive, then engaged with communication exercise. Reported feeling "heard" by end of session.
Progress: Treatment Goal #2 (improve communication with spouse) showing progress. Patient demonstrating increased willingness to address conflict.
Plan: Continue couples sessions biweekly alternating with individual sessions. Assign communication homework.
90846 vs. 90847: Decision Guide
| Question | If Yes → |
|---|---|
| Is the identified patient in the session? | 90847 |
| Is the session with family only (patient not present)? | 90846 |
| Couples therapy with both partners present, one is patient? | 90847 |
| Parent consultation without child patient present? | 90846 |
Couples Therapy Billing
Couples therapy creates a specific challenge: insurance covers treatment for an individual, not for a relationship.
Approach 1: One Identified Patient
Select one partner as the identified patient. Bill under their insurance with their diagnosis. The other partner is a collateral participant.
Requirements:
- Identified patient has a billable diagnosis (F41.1, F33.1, F43.23, etc.)
- Treatment addresses that patient's condition
- Documentation focuses on identified patient's treatment
Example: Husband has GAD (F41.1) exacerbated by marital conflict. Wife participates in therapy to address communication patterns affecting husband's anxiety. Bill 90847 under husband's insurance with F41.1.
Approach 2: Private Pay
Many couples pay out-of-pocket to avoid the identified patient complexity. This allows treatment to focus on the relationship without navigating insurance requirements.
Approach 3: Alternating Identified Patients
Some therapists alternate which partner is the identified patient session to session.
Caution: This approach is ethically and legally murky. Some consider it appropriate if both partners have legitimate diagnoses and treatment alternates focus. Others consider it problematic. Consult your licensing board and ethics code before using this approach.
Z-Code Consideration
Z63.0 (Problems in relationship with spouse or partner) is an ICD-10 code for relationship problems. However:
- Many insurers don't reimburse Z-codes as primary diagnosis
- Coverage varies significantly by payer
- Check your specific contracts before relying on Z63.0
Billing Nuances
Who Gets Billed?
Bill the identified patient's insurance only. You're not separately billing the family members who participate.
Multiple Services Same Day
If you provide individual therapy AND family therapy on the same day:
- Document each service separately with distinct start/stop times
- Ensure services are clinically distinct (not just one long session)
- Example: 90834 in the morning (individual), 90847 in the afternoon (family session)
Group Family Therapy?
If you're seeing multiple families together, that's closer to group therapy dynamics. Standard family codes assume one identified patient's family per session.
Medical Necessity
Family therapy is medically necessary when family involvement supports the identified patient's treatment. Document the connection:
Strong medical necessity:
- "Parent involvement necessary to coordinate behavioral interventions for child's ADHD"
- "Couples work addresses interpersonal patterns maintaining patient's depression"
- "Family education essential for patient's PTSD recovery—family is primary support system"
Weak medical necessity:
- "Family wanted to be involved" (not clinically justified)
- "Patient asked me to see their family" (need clinical rationale)
Consent and Confidentiality
When Patient Can Consent
For adult patients, you typically need patient consent before meeting with family members about their treatment.
Document consent: "Patient provided written consent for family session with spouse."
When Patient Cannot/Need Not Consent
- Minors: Parents generally have right to participate in child's treatment (though older adolescents may have some privacy rights depending on state law)
- Guardianship: Legal guardian can consent for incapacitated adult
- Emergency: Imminent safety concerns may override usual consent requirements
Confidentiality Limits
What the patient shares in individual sessions isn't automatically shared with family. Clarify:
- What will be shared in family sessions
- What remains confidential
- Document these discussions
Common Mistakes
Mistake 1: No Identified Patient
Wrong: Meeting with a family to address "family conflict" without any family member established as your patient.
Right: Establish one family member as the identified patient with their own diagnosis and treatment plan.
Mistake 2: Billing Family Members' Insurance
Wrong: Billing each family member's insurance for the same session.
Right: Bill only the identified patient's insurance.
Mistake 3: 90847 When Patient Not Present
Wrong: Using 90847 for a parent session when the child patient isn't there.
Right: Use 90846 when patient is not present.
Mistake 4: No Clinical Connection
Wrong: Documentation doesn't explain how family session relates to patient's treatment.
Right: Clearly link session content to identified patient's diagnosis and treatment goals.
Telehealth Family Therapy
When providing family therapy via telehealth:
Billing: 90846-95 or 90847-95 (modifier 95)
Place of Service: 10 (telehealth, patient at home)
Considerations:
- All participants may be in different locations
- Verify patient location (impacts licensure requirements)
- Document platform used and participants' locations
Frequently Asked Questions
- Can I bill 90846 if I've never seen the identified patient?
- Generally no. The patient should be established in your care. The family session is part of that patient's treatment. If you've never met the patient, what treatment are you supporting?
- How often can I bill family therapy codes?
- No hard limit, but the frequency should be clinically justified. Weekly family sessions for months may attract questions. Document why ongoing family involvement is necessary.
- Can I bill 90847 for couples therapy when neither partner has a mental health diagnosis?
- This is challenging. Insurance generally requires a diagnosis. Z63.0 (relationship problems) may not be covered. Many couples therapists use private pay for this reason.
- What if one partner has a diagnosis and the other doesn't?
- The partner with the diagnosis is the identified patient. Bill under their insurance with their diagnosis. The other partner participates to support treatment.
- Can I do 90846 if the patient doesn't want me talking to their family?
- No. For adult patients, you need consent to involve family in treatment. If the patient declines, respect that boundary.
Family therapy codes extend your billing options beyond individual work. Keep the identified patient clear, document the clinical connection, and use 90846 vs. 90847 based on whether the patient is in the room.