Family and Couples Therapy Billing: 90846 vs 90847, and When Insurance Pays

Use 90847 when the identified patient attends the family or couples session, and 90846 when the session is with family members without the patient present. Both are 50-minute codes billed under the identified patient’s insurance and diagnosis, and both need the session to focus on treating that patient’s condition. That is also why couples therapy is often denied: insurance pays to treat a diagnosed condition, not relationship problems on their own.

Family and couples sessions are some of the most denied therapy claims, usually for one of three reasons: the wrong code for who attended, a diagnosis the payer will not accept, or notes that do not connect the session to the patient’s treatment.

90846 vs 90847 at a glance

	90846	90847
Who attends	Family members, without the identified patient	Family members with the identified patient (conjoint)
Typical use	Parent sessions about a child’s treatment; family guidance when the patient cannot attend	Couples sessions; family sessions with the patient present
Time in the code	50 minutes	50 minutes
Billed under	The identified patient’s insurance and diagnosis	The identified patient’s insurance and diagnosis

Time. Under current CPT time rules, a session generally needs at least 26 minutes to be reported with these codes. Record start and stop times in every note. Some payers set their own minimums, so check before you schedule shorter family sessions.

Couples therapy and insurance

Insurance pays for treatment of a diagnosed mental health condition. A couples session can be covered when:

• One partner is the identified patient with a diagnosis such as depression, anxiety, PTSD or a substance use disorder, and
• The session treats that condition, for example how the relationship affects the patient’s symptoms, or how the partner can support the treatment plan.

Couples counseling for communication or relationship problems alone is usually not covered. Relationship-problem codes, such as Z63.0, describe a circumstance rather than a mental health disorder, and payers generally will not accept them as the main diagnosis. Tell couples clients this up front, and offer private pay or a superbill when the work is not medically necessary treatment. Never change a diagnosis to make a session billable.

Documentation that gets family sessions paid

Every family or couples note should show:

1. Who attended, by name and relationship, and whether the identified patient was present.
2. Start and stop times.
3. The identified patient’s diagnosis and how this session addressed it.
4. What was done, such as the interventions used and how family members were involved.
5. How it fits the treatment plan, including goals and progress.

A note that only describes the family’s conflict, without linking it to the patient’s condition, is the most common reason these claims are taken back on review.

Common denials

Denial	Usual cause	Fix
Wrong code	90847 billed when the patient was not there, or the reverse	Match the code to who attended
Diagnosis not covered	Relationship-problem code as the primary diagnosis	Bill only when treating the identified patient’s diagnosed condition
Same-day conflict	90847 and an individual therapy code on the same day	Check payer edits; document separate sessions separately
Session too short	Less than the minimum time	Record times; do not bill short sessions with these codes
Not a covered provider	Some plans limit which licenses can bill family therapy	Verify benefits and your network status first

Telehealth family sessions

Many payers cover 90846 and 90847 by telehealth, using their own rules for place of service and modifiers. See our guide to telehealth billing. Medicare also covers family psychotherapy, and since 2024 marriage and family therapists and mental health counselors can enroll in Medicare; see Medicare for LPCs and LMFTs.

For individual therapy codes, see 90837 vs 90834 vs 90832. For the denial codes you may see on a remittance, see denial codes explained.

This guide is general information, not legal or coding advice. Codes and payer rules change, so check current CPT guidance and each payer’s policy before billing.

How RevenueCTRL can help

We bill family, couples and individual therapy for therapists and group practices, and we check the code, diagnosis and payer rules before each claim goes out. If family sessions are being denied, a free 90-day claims audit shows why.

Frequently asked questions