Coding · July 11, 2026 · 6 min read

CPT 90846 & 90847: Billing Family and Couples Therapy

Family therapy has two codes separated by one variable: whether the identified patient was in the room. Both pay well, both are telehealth-eligible with most payers — and both sit on top of the most misunderstood coverage rule in outpatient behavioral health: insurance covers treatment of a diagnosed patient, not a relationship.

The two codes

The identified-patient rule

Both codes are billed under one person: the identified patient — the family member with the covered diagnosis whose treatment plan the family work supports. The session is documented in that patient's record, tied to that patient's diagnosis and goals. Even in 90846, where the patient isn't present, the service exists to advance their treatment (e.g., parent training for a child with severe anxiety).

The couples therapy trap

"Couples counseling" as such — relationship distress without a diagnosable condition in either partner (often coded Z63.0) — is excluded by many commercial plans, because there's no medically necessary treatment of a covered diagnosis. Couples work is coverable when one partner is the identified patient with a legitimate diagnosis and conjoint sessions are clinically indicated for that diagnosis. What gets practices in trouble: billing 90847 with a diagnosis of convenience to make relationship counseling reimbursable. Verify the benefit, diagnose honestly, and have a private-pay conversation when coverage genuinely doesn't apply.

Documentation requirements

• Identified patient and diagnosis the session addresses.
• Who attended and their relationship to the patient.
• Interventions and how they tie to the patient's treatment plan.
• Session time — 26+ minutes to bill, per CPT time rules.

Billing notes and common denials

• 90846 coverage varies more than 90847 — some plans don't cover patient-absent family sessions; verify first.
• Same-day combinations — family therapy plus individual therapy on the same day for the same patient often requires modifier support and payer tolerance.
• Z-code-only claims — a Z63.0-primary claim will deny with most commercial payers.
• Group confusion — multiple-family or unrelated-member groups belong under 90853 (group psychotherapy), not 90847.

Full code list: behavioral health CPT reference; for denial recovery, see appealing behavioral health denials.

This guide is for general reference only. CPT codes, HCPCS codes, and payer rules change, always verify against current coding guidance and your specific payer policies. CPT is a registered trademark of the American Medical Association.