CPT Code 90846 Description & Reimbursement Guidelines

Family involvement is often key to mental health treatment success. Addressing family dynamics, even without the patient, is valuable to therapy. CPT code 90846 covers these family-focused sessions. Understanding its use and reimbursement is vital for comprehensive care and accurate billing.

This guide will explain the CPT 90846 descriptor, applicable modifiers, clinical scenarios, and reimbursement guidelines. Mental health professionals need to understand the nuances of this code. It will not only help them deliver comprehensive care but also receive accurate payment against their service.

CPT Code 90846 Description

CPT code 90846 is from the ‘Other Psychotherapy Procedures’ code range and is maintained by the American Medical Association (AMA). It covers a 50-minute-long family psychotherapy session without the patient. Simply put, it involves counseling the family on the psychological issues affecting the patient and the family.

Appropriate Use Cases for CPT Code 90846

Below are some clinical scenarios where the CPT 90846 applies:

Supporting a Schizophrenia Patient’s Family

Assume a 65-year-old woman recently diagnosed with schizophrenia. Her adult son is having trouble understanding her condition and how to support her. Therefore, the therapist meets with the son (without the mother) for a 50-minute session (CPT code 90846).

The session educates the son about schizophrenia. It covers common symptoms, medication management, and effective communication.

Additionally, the therapist addresses the son’s emotions regarding his mother’s diagnosis. The therapist also helps him develop coping skills and realistic expectations.

Parental Conflict & Child Anxiety

Picture a 9-year-old child diagnosed with generalized anxiety disorder. The parents are often in conflict, and the therapist believes this is worsening the child’s anxiety. Therefore, the therapist schedules a 50-minute session (CPT code 90846) with the parents (without the child). 

This session discusses conflict dynamics and their impact on the child’s mental health. It also explores collaborative parenting strategies and aims to improve communication. The goal is to understand how to create a supportive home environment for their child.

Supporting Siblings After a Suicide Attempt

Imagine a 21-year-old who recently tried to end his life but failed. His two teenage siblings, 15 and 16, are experiencing significant distress and confusion following his recent suicide attempt. The therapist meets with both siblings (without the older brother) for a 50-minute session (CPT code 90846).

This session provides a safe space for teenagers to express feelings and process traumatic events. It also normalizes emotional reactions and provides information about coping mechanisms and support resources.

Modifiers to Append with CPT Code 90846

The following are the applicable modifiers for family psychotherapy without the patient:

Modifier 52

What happens when a therapist discontinues the family psychotherapy session (without the patient) before completing the time limit? You report CPT code 90846 with modifier 52 to ensure fair reimbursements.

Modifier 59 & XE

Append modifier 59 to CPT code 90846 when a family psychotherapy session (without the patient) is distinct and separately identifiable from other sessions rendered on the same day. 

For instance, you performed a family psychotherapy session with the patient (CPT code 90837) followed by a family psychotherapy session without the patient (CPT 90846). 

Now, what happens? If billing Medicare, you should ensure specificity and append modifier XE (separate encounter) to CPT code 90846. Contrarily, modifier 59 applies when billing commercial payers.

Modifier 59 helps you avoid unnecessary bundling of services typically billed together. Modifier XE is part of modifier X{EPSU} – a subset of modifier 59 introduced by CMS to offer greater coding specificity. Many private payers do not recognize and accept the X{EPSU} modifiers.

Reimbursement Guidelines for CPT Code 90846

Here are the billing and reimbursement guidelines for a family psychotherapy session in which the patient is not present:

Only Licensed Behavioral Health Providers Can Bill It

A licensed mental or behavioral health professional can bill the CPT code 90846, qualified to provide family therapy. It primarily includes the following:

• Clinical Psychologists (PhDs or PsyDs)
• Licensed Professional Counselors (LPCs)
• Licensed Clinical Social Workers (LCSWs)
• Licensed Marriage and Family Therapists (LMFTs)
• Psychiatrists (MDs)

Detailed Documentation Is Required

Comprehensive documentation is essential to support the medical necessity of CPT code 90846. A lack of detail in documentation may lead to delayed payment or claim denial.

Therefore, your documentation must fulfill the following requirements:

• Date of the family psychotherapy session.
• Precise record and documentation of the start and end times of the session.
• Identifying one person in the family as the patient. 
• Mentioning only the patient’s name and diagnosis on the medical claim.
• Clinical indications that justify the medical necessity of the session.
• Mentioning the goal of the therapy session and details of the activities.
• Clinical notes that include details of the therapeutic process, including observations, progress, challenges, and plan updates.

Precisely Monitor and Document Time

Time documentation is another critical billing requirement of the CPT code 90846. While a standard family therapy psychotherapy session is 50 minutes, coding guidelines require a minimum of 26 minutes of documented face-to-face time (in-person or telehealth).

Remember that if the documented session time is less than 26 minutes, you cannot report this CPT code.

Final Thoughts on CPT Code 90846

Yes, following through with everything we discussed in this guide is challenging. Since the nuances involved in each billing code can easily overwhelm even seasoned coders and billers. Therefore, before we conclude this guide, let’s summarize the key takeaways:

First, we explained the descriptor of CPT code 90846. It covers the 50-minute family psychotherapy session that involves the patient’s family without the patient.

Next, we looked into a few clinical scenarios where this CPT code may apply. These include supporting a schizophrenia patient’s family, providing support to siblings after a suicide attempt, and addressing parental conflict and child anxiety.

We also shared a list of all modifiers that apply to the CPT 90846, including 52, 59, and XE.

Finally, we discussed the family psychotherapy billing guidelines.

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