Imagine you filed a claim for a psychotherapy session. However, after a few days, your claim gets rejected by the insurance payer. Reason? Using the wrong CPT code.
If this has happened to you, then you are not alone. The same scenario plays out in medical practices across the country every day. Mental and behavioral health billing can be confusing if you are not aware of the latest guidelines.
That’s why our experts at MediBillMD have created this detailed guide on CPT code 90847’s billing. So, let’s start.
CPT Code 90847 – Description
CPT code 90847 is defined as:
“Family psychotherapy, with patient present, 50 minutes”
90847 is a psychotherapy billing code. It is used for family counseling sessions in which both the patient and family members are present. The therapy sessions under this code usually last 50 minutes. However, the duration must be at least 26 minutes for 90847 to be valid.
However, a vital point that many billers miss is that CPT code 90847 should only be used for treating mental disorders. Don’t use it for therapy sessions in which the therapist assesses family history or performs evaluation and management services. The purpose of this type of therapy is to address relational patterns, communication challenges, and family dynamics that directly impact the patient’s mental health condition.
However, please note that according to the Centers for Medicare and Medicaid Services (CMS) guidelines, the therapy is to treat only the patient and not family members. Additionally, like other psychotherapy codes, code 90847 is payable in all settings. The place of service is irrelevant for billing.
Scenarios Where CPT Code 90847 is Applicable
When should healthcare providers utilize CPT code 90847 versus other psychotherapy codes? The answer lies in understanding the therapeutic intent and session structure. The following are some scenarios in which 90847 can be used:
Vascular Dementia
Suppose a 60-year-old man is brought to the psychiatrist’s office by his daughter and son-in-law. The patient has mild vascular dementia following a series of small strokes last year. The daughter reports to the physician that her father is exhibiting increased agitation and pacing around the house at night. He becomes verbally abusive when the family members try to redirect him. The daughter reports feeling overwhelmed and stressed by these behavioral changes.
The psychiatrist recognizes that the patient’s agitation is affecting the entire family dynamic and decides that family intervention is crucial. Rather than treating the patient in isolation, the psychiatrist conducts a comprehensive family therapy session. This session can be billed via CPT code 90847.
Alcohol Abuse
A 28-year-old patient with Alcohol Use Disorder participates in family therapy sessions with his spouse to address relationship dynamics that may trigger substance use, develop healthy coping mechanisms, and establish family-based recovery support systems.
The identified patient’s presence and active participation in addressing substance use disorder through family intervention justifies the use of CPT code 90847.
Applicable Modifiers for CPT Code 90847
The following are some modifiers that can be used when billing for CPT code 90847:
| Modifier | Description | When to Use |
|---|---|---|
| 25 | Significant, Separately Identifiable E/M Service | Used when evaluation and management (E/M) services are provided on the same day as family therapy. |
| 59 | Distinct Procedural Service | Applied when 90847 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 synchronous telecommunications technology. |
Remember, you can not just use modifiers without context and need. Many billing audits stem from inappropriate use of modifiers. So, always provide supporting documentation with your claims to justify the use of modifiers.
CPT Code 90847 – Billing & Reimbursement Guidelines
Below are some billing and reimbursement guidelines that you must follow to improve your claim acceptance rate.
Provide Comprehensive Documentation
Comprehensive documentation is crucial for avoiding claim denials. You must append the following details to your CPT code 90847 claims:
- Duration of the encounter with exact start and end time
- The specific type of service provided
- The content covered during the session
- The therapeutic techniques and approaches employed, including any medications discussed or prescribed
- The identity of the professional who performed the service
Use a Valid ICD-10 Diagnosis Code
To justify the medical necessity of the family psychotherapy, you must use a valid ICD-10 diagnosis code. The following are some ICD-10 codes that support the use of 90847:
- F01.A11: Vascular dementia, mild, with agitation
- F01.A18: Vascular dementia, mild, with other behavioral disturbance
- F01.A2: Vascular dementia, mild, with psychotic disturbance
- F04: Amnestic disorder due to a known physiological condition
- F05: Delirium due to a known physiological condition
- F07.0: Personality change due to known physiological condition
- F07.81: Postconcussional syndrome
To get the complete list of valid ICD-10 codes, you can check the CMS’s Psychiatric Diagnostic Evaluation and Psychotherapy Services guide.
Confirm the Medicare Reimbursement Rate
The reimbursement amount for CPT code 90847 varies for each MAC locality. However, Medicare has set its national average reimbursement amount at $102.54 for facility settings and $102.86 for non-facility settings.
You can check the reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
Let’s wrap up this guide! CPT code 90847 is used to bill a 50-minute family psychotherapy session. The code can also be used to bill sessions performed virtually. For proper reimbursement, you must append the appropriate modifiers, documentation, and ICD-10 diagnosis codes.
We have covered this CPT code in detail, but you can always seek professional help if you lack a competent billing team. Many third-party companies like MediBillMD offer specialized mental health billing services at affordable rates.
