Have you ever wondered why some family therapy sessions get reimbursed smoothly while others face constant denials and administrative headaches? The answer lies in minute details. Many billers treat psychotherapy claims in a generalized way. What they don’t realize is that even a minor difference in the services or circumstances requires an entirely different billing code. This eventually leads to denials.
Family psychotherapy billing codes are particularly prone to these mistakes. CPT code 90846 is one of the most frequently used codes in mental health practices. That’s why we have included it in our CPT code guide series.
By the end of this guide, you will know how and when to use this code. So, let’s start.
CPT Code 90846 – Description
CPT code 90846 is defined as:
“Family psychotherapy (without the patient present), 50 minutes.”
As the definition shows, code 90846 is a psychotherapy billing code for family psychotherapy sessions where the patient is not present. You might wonder what the point of a counseling session is if the patient is not there. Sometimes, the physician needs to prepare family members on how to approach the patient and resolve communication challenges. The therapist may also educate the family on family dynamics that could either positively or negatively affect the patient.
According to the definition, these counseling sessions last about 50 minutes. However, this is not an absolute requirement. You can use CPT code 90846 to bill sessions that last anywhere between 26 and 50 minutes.
An important detail that many billers miss is that code 90846 must be used only to treat mental disorders. It should not be used to bill evaluation and management sessions or when the therapists assess family history. The psychotherapy session under this code is only for the treatment of the patient and not family members.
Additionally, like other psychotherapy codes, code 90846 is payable in all settings. The place of service is irrelevant for billing.
Scenarios Where CPT Code 90846 is Applicable
To better understand how to use CPT code 90846 practically, let’s look at some real-world scenarios:
Vascular Dementia
A 65-year-old woman has mild dementia. Lately, she has been experiencing increasing agitation and confusion in the evenings. Her husband and adult son accompany her to the psychiatrist’s office. The family reports that she becomes easily frustrated, sometimes throwing objects when confused. This has created a lot of tension in the house. The family members don’t know how to deal with her and the situation.
The psychiatrist determines that the family needs a comprehensive counseling session to educate them on how to support the patient. The psychotherapy session is conducted, but the patient herself is not included in it. This session can be billed via CPT code 90846.
Postconcussional Syndrome
Let’s consider another scenario. Suppose a man had a road accident three months ago in which he had a concussion. Ever since, he has been experiencing persistent headaches, irritability, and emotional lability. All these symptoms are persistent with postconcussional syndrome. The family feels helpless watching his personality change.
The psychiatrist believes family therapy would benefit everyone involved in supporting the patient’s recovery. Recognizing the family’s distress and their critical role in the patient’s recovery environment, the psychiatrist schedules a family therapy session without the patient present. This session can be billed via CPT code 90846.
Applicable Modifiers for CPT Code 90846
Let’s now look at some modifiers that you can append to CPT code 90846 to provide additional information about the procedure:
| Modifier | Description | When to Use |
|---|---|---|
| 59 | Distinct Procedural Service | Applied when 90846 is billed with another therapy service on the same day to indicate separate, distinct sessions. |
| GT/95 | Telehealth Services | Modifier GT or 95 is used when therapy services are delivered via synchronoustelecommunications technology. |
CPT Code 90846 – Billing & Reimbursement Guidelines
The following billing tips and guidelines will help you submit error-free claims and secure fast and accurate reimbursements for your services.
Provide Comprehensive Documentation
Comprehensive documentation is probably the most vital part of filing insurance claims. Without proper documentation, your claims are sure to be denied. Always make sure to provide the following details with CPT 90846 claims:
- Precise beginning and conclusion times of the appointment.
- The particular kind of care or treatment delivered.
- Topics and issues addressed throughout the meeting.
- Treatment modalities and strategies utilized, encompassing any pharmaceutical options reviewed or recommended.
- The credentials and name of the healthcare professional who administered the service.
Append Valid ICD-10 Diagnosis Code
For successful reimbursement, justifying medical necessity is vital. It is essential to report the appropriate ICD-10 codes in the claim. Some suitable procedure codes for CPT code 90846 are:
- F01.A11: Vascular dementia, mild, with agitation
- F01.A18: Vascular dementia, mild, with other behavioral disturbance
- F01.A2: Vascular dementia, mild, with psychotic disturbance
- F03.C4: Unspecified dementia, severe, with anxiety
- F04: Amnestic disorder due to a known physiological condition
- F05: Delirium due to a known physiological condition
- F06.0: Psychotic disorder with hallucinations due to a known physiological condition
- F06.1: Catatonic disorder due to a known physiological condition
You can check the complete list of valid ICD-10 codes on CMS’s guide on Psychiatric Diagnostic Evaluation and Psychotherapy Services.
Confirm Reimbursement Rate Before Submission
The reimbursement amount for CPT codes varies based on location and facility. The national average Medicare reimbursement for 90846 is $98.66 for non-facility settings and $98.33 for facility settings.
You can use Medicare’s PFS Lookup Tool to check the exact amount for your MAC locality.
Wrapping Up
We have reached the end of this guide. We understand that this is a lot of information to absorb. So, let’s do a quick recap of the most essential points.
- CPT code 90846 represents a family psychotherapy session in which the patient is not present.
- The session duration should be between 26 and 50 minutes.
- For proper reimbursement, append the appropriate modifiers (when necessary) and supporting documentation.
- Justify medical necessity via a valid ICD-10 diagnosis code.
If you are new to medical billing or frequently face claim denials, it is advisable to let professionals handle everything. For expert mental health billing services, you can consult with our billing experts at MediBillMD.
