Couples sessions are billed with the family psychotherapy codes: 90847 when the identified patient is in the room and 90846 when the patient is absent. CMS lists 90846 and 90847 as its family psychotherapy codes and has no separate couples category (CMS, Medicare & Mental Health Coverage, MLN1986542). Medicare covers family psychotherapy when it is medically reasonable and necessary, with treatment of the patient as the primary purpose (same source).
Medicare contractor policy counts a partner as family. Palmetto GBA describes a family member as someone who spends significant amounts of time with the patient and provides psychological support, and adds: "This can include, but is not limited to, a caregiver and/or significant other" (Palmetto GBA LCD L39853).
CPT is a registered trademark of the American Medical Association, which owns and maintains the code set. The code descriptions below are plain-English summaries for orientation. Bill from the current official descriptors.
CMS lists these codes in its table of commonly used mental health codes (MLN1986542, Table 2).
| Code | CMS category | Plain-English gloss |
|---|---|---|
| 90847 | Family psychotherapy | Session with the identified patient and family present |
| 90846 | Family psychotherapy | Session with family, identified patient absent |
| 90849 | Multiple-family group psychotherapy | Several families treated together in one group |
| 90832, 90834, 90837 | Psychotherapy with patient | Individual psychotherapy, by session length |
The "CMS category" column comes from the MLN booklet. The right-hand column is a plain-English gloss written for this article. For billing, use the AMA's official descriptors.
If one partner is your identified patient and the other partner joins the session, that matches the with-patient-present description of 90847.
The difference is whether the identified patient is present.
Bill a family psychotherapy session once, on the identified patient's claim, as one unit. Blue Cross and Blue Shield of Kansas tells providers to "Bill under the patient's name and identification number" for both codes and to "not report time or units greater than 001" (BCBSKS behavioral health manual). This differs from medical nutrition therapy for couples, where each person gets their own claim (insurance billing for couples and families).
APA Services lists both codes at 50 minutes, reportable once the session reaches 26 minutes (APA Services, psychotherapy codes, professional association, third-party).
A 90846 session still serves the patient. The Medicare contractor Wisconsin Physicians Service (WPS) gives two examples of covered family psychotherapy in its psychiatry coverage policy: observing and correcting the patient's interaction with family members, and assessing conflicts within the family to help family members in the management of the patient (WPS LCD L34616, Psychiatry and Psychology Services).
Coverage turns on whose condition the session treats.
CMS states that Medicare covers family psychotherapy "with or without the patient present, as medically reasonable and necessary, with patient treatment as the primary purpose" (MLN1986542). WPS puts the same condition this way: family psychotherapy services are covered only where the primary purpose is the treatment of the patient's condition (L34616).
If you are a marriage and family therapist, Medicare is newly open to you. Since January 1, 2024, MFTs and mental health counselors can bill Medicare independently for services furnished for the diagnosis and treatment of mental illnesses, paid at 75% of what a clinical psychologist is paid (CMS, MFTs and MHCs).
Commercial plans write their own policies. Before the first session, check three things with each plan:
Only when the session is individual psychotherapy for your patient.
CMS groups 90832, 90834, and 90837 as psychotherapy with patient (MLN1986542). APA Services lists 90837 for sessions of 53 minutes or more, 90834 for 38 to 52 minutes, and 90832 for 16 to 37 minutes (APA Services).
WPS states in L34616 that psychotherapy time can include face-to-face time with family members as long as the patient is present for part of the service. So a partner can join part of an individual session. WPS also states: "Individual psychotherapy CPT codes are used only when the focus of treatment involves individual psychotherapy" (L34616). Blue Cross and Blue Shield of Texas allows 90832, 90834, or 90837 on the same day as 90846 or 90847 when the services are separate and distinct (BCBSTX CPCP051).
The test is what the session worked on. If it treated your patient's condition and the partner joined for part of it, the individual codes describe it. If the work was the couple's interaction, which is WPS's first example of family psychotherapy, the family codes describe it.
The claim carries the identified patient's diagnosis.
CMS states that the law defines MFT services as services for the diagnosis and treatment of mental illnesses (CMS MFT and MHC enrollment FAQ), and covers family psychotherapy when treatment of the patient is the primary purpose. The claim needs a patient and a condition the session addressed.
If the only thing your record supports is relationship distress, with no diagnosed condition for either partner, the claim has no patient condition to point to under that standard. Check that before the first session and talk with the couple about self-pay if the answer is no.
ICD-10-CM lists Z63.0 as Problems in relationship with spouse or partner (CMS ICD-10 codes). WPS states that "claims must be submitted with a covered diagnosis" (L34616), and the covered diagnosis list in its billing article for these codes includes no Z codes (WPS A57480).
WPS states that the medical record must indicate the time spent in the psychotherapy encounter and the therapeutic maneuvers that were applied to produce a therapeutic change (L34616).
For a couples session, write each note so a reviewer can see the primary purpose:
The first three items decide the code. The last three show the session treated the patient.
A couples claim rests on the two conditions above: a plan that covers family psychotherapy, and a note that names the patient.
Practice Better lets you build note templates in SOAP, DAP, BIRP, or a custom format (charting), so you can build a couples template that prompts for the identified patient, who attended, and the time. Through the Claim.MD integration, US customers can check eligibility, submit claims, and track their status, and without Claim.MD you can still create and export CMS-1500 claims and create and send superbills to clients (billing and insurance).
Start a free trial of Practice Better to keep your notes, claims, and superbills in one place.
For the wider code set, see a wellness pro's guide to CPT codes. If a couples claim comes back denied, the clinician's guide to insurance claim appeals walks through the next step. For couples who pay out of pocket, see your super guide to superbills. Dietitians billing nutrition sessions for couples use a different code set, covered in insurance billing for couples and families.
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Couples sessions are billed with the family psychotherapy codes: 90847 when the identified patient is in the room and 90846 when the patient is absent. CMS lists 90846 and 90847 as its family psychotherapy codes and has no separate couples category (CMS, Medicare & Mental Health Coverage, MLN1986542). Medicare covers family psychotherapy when it is medically reasonable and necessary, with treatment of the patient as the primary purpose (same source).
Medicare contractor policy counts a partner as family. Palmetto GBA describes a family member as someone who spends significant amounts of time with the patient and provides psychological support, and adds: "This can include, but is not limited to, a caregiver and/or significant other" (Palmetto GBA LCD L39853).
CPT is a registered trademark of the American Medical Association, which owns and maintains the code set. The code descriptions below are plain-English summaries for orientation. Bill from the current official descriptors.
CMS lists these codes in its table of commonly used mental health codes (MLN1986542, Table 2).
| Code | CMS category | Plain-English gloss |
|---|---|---|
| 90847 | Family psychotherapy | Session with the identified patient and family present |
| 90846 | Family psychotherapy | Session with family, identified patient absent |
| 90849 | Multiple-family group psychotherapy | Several families treated together in one group |
| 90832, 90834, 90837 | Psychotherapy with patient | Individual psychotherapy, by session length |
The "CMS category" column comes from the MLN booklet. The right-hand column is a plain-English gloss written for this article. For billing, use the AMA's official descriptors.
If one partner is your identified patient and the other partner joins the session, that matches the with-patient-present description of 90847.
The difference is whether the identified patient is present.
Bill a family psychotherapy session once, on the identified patient's claim, as one unit. Blue Cross and Blue Shield of Kansas tells providers to "Bill under the patient's name and identification number" for both codes and to "not report time or units greater than 001" (BCBSKS behavioral health manual). This differs from medical nutrition therapy for couples, where each person gets their own claim (insurance billing for couples and families).
APA Services lists both codes at 50 minutes, reportable once the session reaches 26 minutes (APA Services, psychotherapy codes, professional association, third-party).
A 90846 session still serves the patient. The Medicare contractor Wisconsin Physicians Service (WPS) gives two examples of covered family psychotherapy in its psychiatry coverage policy: observing and correcting the patient's interaction with family members, and assessing conflicts within the family to help family members in the management of the patient (WPS LCD L34616, Psychiatry and Psychology Services).
Coverage turns on whose condition the session treats.
CMS states that Medicare covers family psychotherapy "with or without the patient present, as medically reasonable and necessary, with patient treatment as the primary purpose" (MLN1986542). WPS puts the same condition this way: family psychotherapy services are covered only where the primary purpose is the treatment of the patient's condition (L34616).
If you are a marriage and family therapist, Medicare is newly open to you. Since January 1, 2024, MFTs and mental health counselors can bill Medicare independently for services furnished for the diagnosis and treatment of mental illnesses, paid at 75% of what a clinical psychologist is paid (CMS, MFTs and MHCs).
Commercial plans write their own policies. Before the first session, check three things with each plan:
Only when the session is individual psychotherapy for your patient.
CMS groups 90832, 90834, and 90837 as psychotherapy with patient (MLN1986542). APA Services lists 90837 for sessions of 53 minutes or more, 90834 for 38 to 52 minutes, and 90832 for 16 to 37 minutes (APA Services).
WPS states in L34616 that psychotherapy time can include face-to-face time with family members as long as the patient is present for part of the service. So a partner can join part of an individual session. WPS also states: "Individual psychotherapy CPT codes are used only when the focus of treatment involves individual psychotherapy" (L34616). Blue Cross and Blue Shield of Texas allows 90832, 90834, or 90837 on the same day as 90846 or 90847 when the services are separate and distinct (BCBSTX CPCP051).
The test is what the session worked on. If it treated your patient's condition and the partner joined for part of it, the individual codes describe it. If the work was the couple's interaction, which is WPS's first example of family psychotherapy, the family codes describe it.
The claim carries the identified patient's diagnosis.
CMS states that the law defines MFT services as services for the diagnosis and treatment of mental illnesses (CMS MFT and MHC enrollment FAQ), and covers family psychotherapy when treatment of the patient is the primary purpose. The claim needs a patient and a condition the session addressed.
If the only thing your record supports is relationship distress, with no diagnosed condition for either partner, the claim has no patient condition to point to under that standard. Check that before the first session and talk with the couple about self-pay if the answer is no.
ICD-10-CM lists Z63.0 as Problems in relationship with spouse or partner (CMS ICD-10 codes). WPS states that "claims must be submitted with a covered diagnosis" (L34616), and the covered diagnosis list in its billing article for these codes includes no Z codes (WPS A57480).
WPS states that the medical record must indicate the time spent in the psychotherapy encounter and the therapeutic maneuvers that were applied to produce a therapeutic change (L34616).
For a couples session, write each note so a reviewer can see the primary purpose:
The first three items decide the code. The last three show the session treated the patient.
A couples claim rests on the two conditions above: a plan that covers family psychotherapy, and a note that names the patient.
Practice Better lets you build note templates in SOAP, DAP, BIRP, or a custom format (charting), so you can build a couples template that prompts for the identified patient, who attended, and the time. Through the Claim.MD integration, US customers can check eligibility, submit claims, and track their status, and without Claim.MD you can still create and export CMS-1500 claims and create and send superbills to clients (billing and insurance).
Start a free trial of Practice Better to keep your notes, claims, and superbills in one place.
For the wider code set, see a wellness pro's guide to CPT codes. If a couples claim comes back denied, the clinician's guide to insurance claim appeals walks through the next step. For couples who pay out of pocket, see your super guide to superbills. Dietitians billing nutrition sessions for couples use a different code set, covered in insurance billing for couples and families.
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