The 90846 CPT code is family psychotherapy delivered without the patient present. It covers a session with parents, a spouse or caregivers about the identified patient's treatment, while the patient is not in the room. It pays when the note shows three things. The session served the patient's treatment. It ran long enough. It was not folded into another psychotherapy service the same day.
Every rule below comes from a primary source and is attributed where it appears. Where a rule belongs to one Medicare contractor or to the individual payer, this page says so. The sources are:
- The CMS Medicare NCCI Policy Manual, Chapter XI, revised January 1, 2026
- First Coast Service Options LCD L33252 and billing article A57520, the Medicare contractor for Florida, Puerto Rico and the US Virgin Islands
- The CMS 2026 physician fee schedule relative value file, January release
- The CMS CY 2026 list of Medicare telehealth services
- The psychotherapy code guidance from APA Services
What does CPT code 90846 mean?
CPT code 90846 is family psychotherapy without the patient present, stated at 50 minutes. The CMS NCCI policy manual gives the descriptor as "Family psychotherapy (without the patient present), 50 minutes". The CMS 2026 relative value file abbreviates it as "Family psytx w/o pt 50 min".
| Element of the code | What it means for the claim |
|---|---|
| Service type | Family psychotherapy |
| Patient present | No. The identified patient is not in the session |
| Stated duration | 50 minutes |
| Who attends | One or more family members or others who support the patient |
| Whose treatment it is | The identified patient's, under that patient's treatment plan |
| Claim carries | One unit, under the identified patient's record and diagnosis |
| Code category | Psychotherapy, not diagnostic evaluation and not group therapy |
The point most claims turn on is in the last three rows. The people in the room are not the patient. The service is still the patient's treatment, so the claim, the diagnosis and the note all belong to the patient who was absent.
- 90846 is one unit per session, however many family members attend.
- The diagnosis on the claim is the identified patient's diagnosis.
- The note is filed in the identified patient's chart.
- The session sits inside the identified patient's active treatment plan.
- A parent or partner working on their own condition is a different service, under their own record.
How many minutes is a 90846 session?
The descriptor says 50 minutes. The reporting floor is lower. Under the CPT time rule published by APA Services, 90846 and 90847 are reportable at 26 or more minutes. The family codes have one floor and no upper band, which is a different shape from the individual codes.
| CPT code | Session time that supports the code |
|---|---|
| 90832 | 16 to 37 minutes |
| 90834 | 38 to 52 minutes |
| 90837 | 53 or more minutes |
| 90846 | 26 or more minutes |
| 90847 | 26 or more minutes |
- Under 26 minutes, 90846 is not reportable for that session.
- From 26 minutes up, the session is one unit of 90846.
- A 30 minute session and a 75 minute session are both one unit.
- There is no longer family psychotherapy code to step up to.
- Start time, end time and total minutes belong in the note, because the rule is a time floor.
Who counts as family for 90846?
Wider than the household. First Coast's LCD L33252 defines a family member, for its policy, as "any individual who spends a significant amount of the time with the patient and provides psychological support to the patient, which may include but is not limited to a caregiver or significant other." Commercial payers write their own definitions, so check the plan, but most follow the same logic: the person matters because of their role in the patient's life.
| Who attends | Fits the L33252 definition? | What the note should show |
|---|---|---|
| Parents of a child or adolescent patient | Yes | How the session addresses the child's condition and the parents' part in it |
| Spouse or partner of an adult patient | Yes, as a significant other | The link between the partner's role and the patient's symptoms |
| Adult child caring for an older patient | Yes, as a caregiver | The caregiving tasks and behaviors the session worked on |
| Foster parent or guardian | Yes, where they provide ongoing support | Their role and the patient's diagnosis the session served |
| Paid home aide who spends significant time with the patient | Can fit, as a caregiver | Why their involvement bears on the patient's treatment |
| Teacher or school counselor | Generally no | School consultation is a different service from family psychotherapy |
When is 90846 medically necessary?
L33252 sets the test for family psychotherapy in its jurisdiction. It is "medically reasonable and necessary only in clinically appropriate circumstances and when the primary purpose of such psychotherapy is the treatment/management of the patient's condition." The LCD gives two examples and one exclusion.
| L33252 says | What it means for a 90846 session |
|---|---|
| Covered when there is a need to observe and correct the patient's interaction with family members | More often a 90847 situation, since observing interaction needs the patient present |
| Covered when there is a need to assess conflicts or impediments within the family and help family members manage the patient | The core 90846 case: working with the family on how they manage the patient's condition |
| Necessary when the patient has a psychiatric illness or emotional or behavioral symptoms causing inappropriate behavior or maladaptive functioning | The patient's diagnosis and current symptoms must be in the record |
| Not reasonable or necessary for an unconscious or comatose patient | The patient must be able to benefit from the treatment the family session supports |
L33252 is one contractor's policy. It is quoted here because it states the medical necessity test in writing, and many commercial policies read the same way. It does not bind a plan outside Florida, Puerto Rico and the US Virgin Islands.
What is the difference between 90846 and 90847?
Only whether the identified patient attends. 90847 is family psychotherapy, conjoint, with the patient present. 90846 is the same service without the patient. Both are stated at 50 minutes and both share the 26 minute floor.
| 90846 | 90847 | |
|---|---|---|
| Patient in the session | No | Yes |
| Stated duration | 50 minutes | 50 minutes |
| Reporting floor | 26 or more minutes | 26 or more minutes |
| CMS 2026 total RVU, non facility | 3.17 | 3.28 |
| Medicare telehealth list, CY 2026 | Maintain | Maintain |
If the patient joins partway through, code the service that was delivered and document who was present for which minutes. The full comparison, including mixed sessions, is on our 90847 CPT code page.
mdhub drafts the note from your session, in your template, for you to review
START FREE TRIAL →Can I bill 90837 and 90846 on the same day?
For Medicare, yes, under one condition. The CMS NCCI policy manual, Chapter XI section C, says family psychotherapy such as 90846 and 90847 "may be reported separately with psychotherapy CPT codes 90832-90838 on the same date of service if performed as a separate and distinct service during a separate time interval."
- Two sessions, two time intervals: the individual session and the family session cannot overlap.
- Each session needs its own start time, end time and content in the note.
- The same manual says 90832 to 90838 already include family members who join as informants. A parent sitting in on an individual session is not a 90846.
- A psychiatric diagnostic evaluation, 90791 or 90792, is not separately reportable with any psychotherapy on the same date under the same section.
- Commercial and Medicaid plans apply their own edits. Check whether the payer wants a modifier on the second code before the claim goes out.
| Same day pairing | Medicare rule in NCCI Chapter XI | What to document |
|---|---|---|
| 90846 with 90832, 90834 or 90837 | Separately reportable if separate and distinct, in a separate time interval | Two sets of times, two sets of content |
| 90846 with 90847 | Both are family psychotherapy; the manual gives no pairing rule | Ask the payer before billing both on one date |
| 90846 with 90791 or 90792 | Not separately reportable on the same date | Move the family session to another date |
| Individual session with a parent as informant | Included in 90832 to 90838 | No separate 90846 |
What is the difference between 90832 and 90846?
They treat different people in the room and use different time rules. 90832 is individual psychotherapy with the patient, 30 minutes, reportable at 16 to 37 minutes under the APA Services time table. 90846 is family psychotherapy without the patient, reportable from 26 minutes with no upper band.
| 90832 | 90846 | |
|---|---|---|
| Who is in the room | The patient | Family members, not the patient |
| Stated duration | 30 minutes | 50 minutes |
| Time that supports the code | 16 to 37 minutes | 26 or more minutes |
| Interactive complexity, 90785 | On the APA Services list of primary codes | Not on that list |
| CMS 2026 total RVU, non facility | 2.57 | 3.17 |
A 30 minute session spent with the parents of a child patient, without the child, is a 90846 session if it treats the child's condition. It is not 90832, which needs the patient present.
How much does 90846 pay in 2026?
The CMS 2026 relative value file, January release, sets 90846 at 3.17 total RVUs non facility and 2.97 facility. At the 2026 conversion factor of 33.4009, the national amounts are USD 105.88 and USD 99.20. Your locality adjustment applies on top.
| Code | Total RVU, non facility | National amount, non facility | Total RVU, facility | National amount, facility |
|---|---|---|---|---|
| 90846 | 3.17 | USD 105.88 | 2.97 | USD 99.20 |
| 90847 | 3.28 | USD 109.55 | 3.08 | USD 102.87 |
| 90832 | 2.57 | USD 85.84 | 2.08 | USD 69.47 |
| 90834 | 3.41 | USD 113.90 | 2.75 | USD 91.85 |
| 90837 | 5.00 | USD 167.00 | 4.05 | USD 135.27 |
- These are Medicare physician fee schedule national amounts, computed as total RVU times the conversion factor.
- The amount your Medicare contractor pays is adjusted by locality, and non physician practitioners may be paid a percentage of it.
- Commercial and Medicaid rates are set by contract and can sit well above or below these figures.
- Source: CMS PPRRVU2026_Jan_nonQPP, conversion factor 33.4009.
Is 90846 covered by Medicare?
Yes, with conditions set by each Medicare contractor. First Coast's billing article A57520 lists 90846 among the psychiatric codes it covers when the claim carries an ICD-10-CM diagnosis from its covered list. The LCD then adds the medical necessity test and documentation rules quoted on this page.
- The diagnosis on the claim must be the patient's and must appear on the contractor's covered list.
- The family session must be part of an active treatment plan for that diagnosis.
- L33252 requires family psychotherapy to be ordered as part of an active treatment plan.
- It must be delivered face to face by a physician, psychologist or other mental health professional licensed under state law.
- Other Medicare contractors publish their own LCDs. Read the one that covers your state.
Can 90846 be billed for telehealth?
90846 is on the CMS CY 2026 Final List of Medicare Telehealth Services with a status of Maintain, as are 90847, 90832, 90834 and 90837. Commercial and Medicaid telehealth coverage is set by each plan and by state law, so confirm it for the specific payer.
| Code | Short descriptor in the CMS list | CY 2026 status |
|---|---|---|
| 90846 | Family psytx w/o pt 50 min | Maintain |
| 90847 | Family psytx w/pt 50 min | Maintain |
| 90832 | Psytx w pt 30 minutes | Maintain |
| 90785 | Psytx complex interactive | Maintain |
Can 90785 be added to 90846?
Not according to the primary code list published by APA Services. The interactive complexity add on 90785 is listed as reportable with 90791, 90792, 90832, 90834, 90837 and 90853. 90846 and 90847 are not on that list. Family sessions often involve the factors 90785 describes, such as high conflict among participants, and the list still excludes them.
What must a 90846 progress note document?
L33252 documentation item 14 applies to family psychotherapy "with or without the patient present". It requires the record to show the medical necessity of each family session and to include specific elements. The list below follows the LCD, with what each element looks like in a session the patient did not attend.
| L33252 requires | In a 90846 note |
|---|---|
| The medical necessity of each family session | Why this session, today, serves the patient's treatment |
| A psychiatric illness or emotional or behavioral symptoms sufficient to alter baseline functioning | The patient's diagnosis and current symptoms, not the family members' |
| A summary of themes addressed | The topics covered with the family and how they relate to the patient's goals |
| Descriptive documentation of interventions | What the clinician did: coaching, behavior plans, communication work, psychoeducation |
| The patient's participation and response, and changes or lack of change in symptoms | Without the patient present, record what the family reports about the patient's symptoms and behavior since the last session |
| Ordered as part of an active treatment plan | The treatment plan goal this session addresses |
| Conducted face to face by a licensed professional | Clinician, credentials and session modality |
Item 11 of the same LCD asks for periodic documentation, across family and other psychotherapy, of the patient's capacity to participate and benefit, the estimated duration of treatment in sessions, the target symptoms and measurable goals. Item 13 says statements such as "supportive psychotherapy given" are not adequate.
- Who attended, by role: mother, father, partner, caregiver.
- Why the patient was not present, in one line.
- Start time, end time and total minutes.
- The patient's diagnosis and the treatment plan goal the session served.
- What was worked on and what the clinician did.
- What the family reports about the patient's symptoms since the last session.
- The plan for the next family or individual session.
What does a 90846 note look like?
A short example for a fictional patient, written to the elements above. Names and details are invented.
| Field | Entry |
|---|---|
| Identified patient | J., age 14, generalized anxiety disorder, school avoidance |
| Attended | Mother and father. Patient not present; session planned with parents only to set a home plan |
| Time | 4:00 pm to 4:48 pm, 48 minutes |
| Treatment plan goal | Return to full school attendance over the next 8 weeks |
| Patient status reported by family | Missed 3 of 5 school days this week; morning stomach complaints on each missed day |
| Themes | Morning routine, parental accommodation of avoidance, consistency between parents |
| Interventions | Psychoeducation on avoidance cycles; built a graded morning plan; role play of supportive non accommodating responses |
| Parents' response | Agreed on one script and one plan; father to lead mornings this week |
| Plan | Individual session with J. Thursday; family session with J. present in 2 weeks |
The note gives a reviewer what the LCD asks for: the diagnosis, why the patient was absent, time above the floor, the plan goal and specific interventions.
Why do 90846 claims get denied?
| Denial cause | How it happens | Fix |
|---|---|---|
| Session under 26 minutes | Short check in with a parent billed as 90846 | Bill only at 26 minutes or more; record times |
| Wrong patient on the claim | Session billed under a parent's own coverage | Bill under the identified patient, with the patient's diagnosis |
| Focus on the family member's own condition | Note reads as the parent's therapy | Tie each theme to the patient's goals, or treat the parent under their own record |
| No active treatment plan | Family sessions added without a plan goal | Add the family work to the plan before billing |
| Same day conflict | 90846 and 90837 billed with overlapping or missing times | Separate time intervals, separate content, payer modifier if required |
| Same day diagnostic evaluation | 90846 billed with 90791 or 90792 | Schedule the family session on another date |
| 90785 attached | Interactive complexity added to the family code | Remove; 90785 is not listed with 90846 |
| Vague note | "Met with parents, discussed progress" | Document interventions and the patient's reported symptoms |
| Plan excludes family therapy | Benefit not covered or needs authorization | Verify benefits and authorization before the first session |
Can 90846 be used for parent sessions in child therapy?
Yes, when the session is about the child's treatment. That is the L33252 example of helping "family members in the management of the patient". Parent training, a home behavior plan for the child's diagnosis, or setting up school return steps all fit. A session where the parent works on their own anxiety or marriage does not, even if the child is the reason they came in.
- Bill under the child's record and the child's diagnosis.
- Name the child's treatment plan goal the session served.
- Keep consent and release requirements for the child's information in view.
- If the child joins for part of the session, document the minutes and see the 90847 page.
Can couples therapy be billed as 90846?
Only when one partner is the identified patient with a diagnosis, and the session is part of that patient's treatment. A session with the partner alone, about the patient's condition, can be 90846. Relationship counseling with no identified patient and no diagnosis sits outside the family psychotherapy codes, and many plans exclude it.
What should you check before a 90846 claim goes out?
- The identified patient is named on the claim, with the patient's diagnosis.
- The patient was not present. If they were, the code is 90847.
- The session ran 26 minutes or more, and the times are in the note.
- The treatment plan includes family work and names the goal.
- The note lists who attended, why the patient was absent, the themes and the interventions.
- No 90791 or 90792 on the same date.
- Any same day individual session has its own time interval and content.
- No 90785 on the claim line.
- Telehealth sessions carry the place of service and modifier the payer requires.
- Benefits and authorization for family psychotherapy are confirmed for the patient's plan.
90846 CPT code FAQ
What does CPT code 90846 mean?
Family psychotherapy without the patient present, stated at 50 minutes. The family members attend; the identified patient does not; the claim goes under the patient.
How many minutes is 90846?
The descriptor states 50 minutes. Under the CPT time rule published by APA Services, 90846 is reportable at 26 or more minutes, as one unit.
What is the difference between 90846 and 90847?
90847 is family psychotherapy with the patient present. 90846 is the same service without the patient. Both are 50 minutes with a 26 minute floor.
Can I bill 90837 and 90846 on the same day?
For Medicare, yes, if the two are separate and distinct services in separate time intervals. That is the rule in CMS NCCI Chapter XI. Commercial plans apply their own edits.
What is the difference between 90832 and 90846?
90832 is individual psychotherapy with the patient, reportable at 16 to 37 minutes. 90846 is family psychotherapy without the patient, reportable from 26 minutes.
Is 90846 covered for telehealth?
90846 is on the CMS CY 2026 Final List of Medicare Telehealth Services with a status of Maintain. Other payers set their own telehealth rules.
Can 90785 be billed with 90846?
APA Services lists 90785 as reportable with 90791, 90792, 90832, 90834, 90837 and 90853. 90846 is not on that list.
Whose diagnosis goes on a 90846 claim?
The identified patient's. The session is part of that patient's treatment, even though the patient is not present.
How much does 90846 pay under Medicare in 2026?
The 2026 national amount is USD 105.88 non facility and USD 99.20 facility. That is from the CMS relative value file at a conversion factor of 33.4009, before locality adjustment.
Can 90846 be billed with 90791?
Not on the same date for Medicare. NCCI Chapter XI says 90791 and 90792 are not separately reportable with family or other psychotherapy codes on the same date.
Who counts as family for 90846?
First Coast LCD L33252 counts anyone who spends significant time with the patient and gives psychological support. That includes a caregiver or significant other. Payers may define it differently.
How often can 90846 be billed?
CPT sets no frequency limit. Visit limits and authorization rules come from the payer, and each session needs its own medical necessity in the note.
For the other psychotherapy codes, see our pages on 90847, 90832, 90834, 90837 and 90791, and our treatment plan template.
Streamline Your Practice
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