90846 vs 90847: Family Therapy Codes and Medicare Rules
90846 is family psychotherapy without the patient present; 90847 is with the patient. Medicare coverage limits, couples therapy, 90837 vs 90847 and live rates.
On this page 8 sections
90846 is family psychotherapy without the patient present, and 90847 is family psychotherapy with the patient present. Both treat the patient's condition by working with the family, and both are written around a session of about 50 minutes. Under Medicare the patient is the beneficiary whose diagnosis is being treated, and that's the main source of denials: family therapy is covered only when its purpose is treating that patient.
Key takeaways
- Patient in the room for the session: 90847. Family members only: 90846.
- Medicare covers family psychotherapy only when the primary purpose is treating the Medicare patient's condition.
- Neither code is for taking a family history, routine updates with staff, or E/M counseling.
- 90846 carries a restricted-coverage status in the CMS fee schedule file. Check your contractor's policy before relying on it.
- Couples therapy is billable to Medicare only as family psychotherapy for a diagnosed patient, not as relationship counseling.
90846 vs 90847 at a glance
| 90846 | 90847 | |
|---|---|---|
| Who's in the session | Family members, without the patient | The patient and family members |
| Built around | A session of about 50 minutes | A session of about 50 minutes |
| CMS status | R (restricted coverage) | A (active, paid under the fee schedule) |
| Typical use | Working with parents or caregivers on the patient's care | Sessions where the family and patient work together |
| Telehealth | On the Medicare telehealth list | On the Medicare telehealth list |
Both codes are billable by the clinicians Medicare pays for psychotherapy, including psychologists, clinical social workers, marriage and family therapists and mental health counselors.
Medicare coverage rules for family psychotherapy
CMS covers "family psychotherapy with or without the patient present, as medically reasonable and necessary, with patient treatment as the primary purpose" (MLN1986542). Contractors spell out what that rules out:
- The family member's own problems. Novitas: family therapy is reasonable and necessary only for treating the Medicare beneficiary's mental illness, not the family members' problems (L35101).
- History-taking and counseling. WPS: the codes "should not be used when the service performed is taking a family history or E/M counseling services" (A57480).
- Staff consultations. Novitas: family psychotherapy without the patient present "does not represent routine consultation with staff" (L35101).
- Patients who wouldn't benefit. Novitas excludes sessions with a patient whose condition would be unaffected by changes in the family.
The note should name the patient's diagnosis, who attended, how the session served the patient's treatment plan, and the time.
90846 vs 90847 reimbursement
Compare codes · National
90847 vs 90846: Medicare rates
As with every behavioral health code, provider type sets the share: 100% for psychologists and psychiatrists, 85% for NPs and PAs, and 75% for LCSWs, LMFTs and LPCs (rates by provider type). Family therapists who don't bill Medicare still use these numbers: commercial plans and EAPs often set family session rates by reference to Medicare's 90847, so it's the benchmark when you review a contract or set a self-pay fee.
90837 vs 90847
Both are hour-scale psychotherapy sessions with the patient present, but they describe different work:
- 90837 is individual psychotherapy with the patient for 53 minutes or more.
- 90847 is family psychotherapy: the family is part of the treatment, with the patient present.
Pick the code from who the session was with and what it did, not from which pays more. A family member who sits in for a few minutes of an individual session doesn't make it 90847, and a family session doesn't become 90837 because it ran an hour.
Compare codes · National
90837 vs 90847: Medicare rates
Couples therapy and Medicare
Medicare has no benefit for relationship counseling on its own. Couples work can be billed as family psychotherapy only when one partner is the patient, has a diagnosed mental health condition, and the session's purpose is treating that condition. Bill it under the patient, with 90847 if the patient attended. Commercial plans set their own rules for couples therapy; check each plan's policy.
90846 and 90847 by telehealth
Both family codes are on the Medicare Telehealth Services List (MLN1986542). Behavioral health telehealth has no geographic or location restrictions, family members can join from home, and audio-only is allowed for a patient at home (modifier 93). Use POS 10 when the patient is at home. See telehealth rules for therapy.
FAQ
What is the difference between 90846 and 90847?
Whether the patient is there. 90847 is family psychotherapy with the patient present; 90846 is the same service with only family members.
Does Medicare pay for 90846?
Sometimes. 90846 has a restricted-coverage status in the CMS file, so payment depends on your Medicare contractor's policy and on the session treating the patient's condition.
Can 90847 be used for couples therapy?
Under Medicare, only when one partner is the patient with a diagnosed condition and the session treats that condition. Relationship counseling alone isn't covered.
Can an LMFT bill 90847 to Medicare?
Yes. Since January 1, 2024, marriage and family therapists can enroll and bill Medicare for mental health services, including family psychotherapy, at 75% of the fee schedule amount.
Can I bill 90847 and 90837 on the same day?
They're separate services. If an individual session and a separate family session both happened, each needs its own documentation and time. Check your contractor's policy and NCCI edits before billing both for one patient on one day.
Keep reading
- Mental health billing: the full behavioral health code set, payment and telehealth rules.
- Psychotherapy CPT codes: individual, crisis and group codes, including 90853.
- 90834 vs 90837: the time line for individual sessions.
- Behavioral health fee schedule: family, individual and group rates for your ZIP.
Sources: CMS MLN1986542, Medicare & Mental Health Coverage (March 2026); Novitas LCD L35101, Psychiatric Codes (revision effective Jan 1, 2024); WPS Billing and Coding Article A57480 (revision effective Jan 1, 2026); CMS Medicare Physician Fee Schedule relative value file (release shown in the widgets), status indicators for 90846 and 90847; 42 CFR 414.53. Verified October 7, 2026.
Related tools and guides
Behavioral healthCPT Codes for Therapy: Psychotherapy Time Ranges (2026)
The CPT codes for therapy sessions, 90832, 90834 and 90837, with their Medicare time ranges, add-on codes, crisis and family codes, and live 2026 rates.
Behavioral healthMental Health Billing Codes and Medicare Rates (2026 Guide)
Mental health billing codes in one place: which code fits each session, what Medicare pays LCSWs, LPCs and psychologists, 2026 telehealth rules and incident-to.
Behavioral health90834 vs 90837: Time Ranges, Rates and Audit Risk (2026)
90834 vs 90837 comes down to documented minutes, 38–52 for 90834 and 53 or more for 90837. See the live Medicare rate gap, telehealth rules and audit traps.
