When the treatment of a patient's psychiatric condition requires the involvement of their family members (or spouse), you bill the family psychotherapy codes: 90846 and 90847.
With vs Without Patient
The distinction is entirely based on whether the primary identified patient is in the room:
- 90846 (Without Patient): You are meeting with the parents, spouse, or caregivers to discuss the patient's treatment plan, but the patient is NOT present.
- 90847 (With Patient): The patient AND the family members are present in the room together for the session.
The "Couples Counseling" Denial Trap
Medicare and most health plans do not cover general marriage counseling (Z68.x). To get 90847 paid for a couple, one of the spouses MUST have a diagnosed mental illness (e.g., Major Depressive Disorder), and the therapy must be focused on treating that illness.
NCCI Edits
These codes are generally 50 minutes long. If you perform individual therapy (90834) and family therapy (90847) on the same day, you must append Modifier 59, and they must be distinct, separate time blocks.