Q&A: Determining when to report individual, family psychotherapy in CPT
Q: Would it be appropriate to use family psychotherapy CPT codes 90846-90849 to report therapy for the benefit one person that involves input from family members?
A: If the treatment is focused on the benefit of one person, it should be reported as individual psychotherapy regardless of how many people are in the room. Children often attend therapy sessions with one or both parents in the room. The following CPT codes are used to report individual psychotherapy sessions (performed without an E/M service):
- 90832, psychotherapy, 30 minutes with patient
- 90834, …; 45 minutes with patient
- 90837, …; 60 minutes with patient
If medical E/M services are performed with the psychotherapy, the coder would instead report one of the following add-on codes in addition to the E/M code(s):
- 90833, psychotherapy, performed with an E/M service, 30 minutes with patient
- 90836, …; 45 minutes with patient
- 90838, …; 60 minutes with patient
If the treatment is focused on the family unit, then family psychotherapy should be reported. The term "family" may apply to traditional family members, live-in companions, or significant others involved in the care of the patient.
Family psychotherapy CPT codes are:
- 90846, family psychotherapy (without the patient present), 50 minutes
- 90847, family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes
- 90849, multiple-family group psychotherapy
Family psychotherapy sessions must be at least 26 minutes in duration to be reported. Codes 90846 and 90847 are not time based but are typically 45 to 60 minutes in duration.
Code 90849 describes group therapy sessions to support multiple families and is not typically covered by Medicare.
Editor’s note: Stephanie Moore, CPC, CPMA, physician services educator at Wentworth-Douglass Hospital in Dover, New Hampshire, answered this question during the HCPro webinar, “Master Outpatient Behavioral Health Coding and Documentation.”
This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.