CPT Code 90847: Family Psychotherapy with Patient Present

CPT code 90847 is the billing code that names what family therapy actually is when the identified patient is in the room: a session where the clinician works simultaneously with the patient and the people around them, oriented to that patient’s care. It sits next to its companion code 90846, family psychotherapy without the patient, and the distinction between them is not just administrative. It describes a clinical decision that shapes how you structure the session, what you document, and what therapeutic work you are accountable for.

For therapists working with adolescents and children, 90847 is the code you reach for most often. A teenager and their parents working through a communication breakdown, a latency-age child whose anxiety is managed partly through parent coaching done with the child present, a family navigating a diagnosis together: these are 90847 sessions. The family members are in the room not as witnesses but as participants, and the patient’s engagement with them is part of what you are treating.

This guide covers when 90847 applies, how it differs from 90846, what a defensible note contains, how to pair it with individual codes, and the billing mistakes that produce denials. It links up to the broader CPT codes for therapists hub so family billing sits inside the same code map as individual and group psychotherapy.

Educational reference for licensed US therapists, psychologists, social workers, and counselors. CPT rules and coverage vary by payer and state; verify current descriptors and reimbursement rates against the AMA CPT guidance and the CMS Physician Fee Schedule lookup before billing.

What is CPT code 90847?

The CPT descriptor defines 90847 as family psychotherapy with the patient present. The patient here means the identified patient (IP): the individual whose treatment is the clinical focus. The session includes the patient and one or more family members or significant others, all in the room together, with the therapist facilitating work that is oriented to the patient’s treatment goals.

The code sits in the psychiatry section alongside the individual psychotherapy timed codes (90832, 90834, 90837), the companion family code 90846, and the group code 90853. Unlike the individual codes, 90847 is not timed. The CPT descriptor does not set a minimum or maximum session length. You document duration as a matter of clinical record; it does not determine which family code you use.

The critical phrase in the descriptor is “with patient present.” That is not a formality. It reflects that the patient’s direct participation in the family session is the therapeutic mechanism being billed. A session where the patient steps out for half the time, or is present but disengaged to the point of non-participation, warrants a clinical note that explains what therapeutic work was done and for whom. If the patient was not present, the session belongs under 90846.

90847 vs 90846: with or without the patient

The distinction between these two codes is clinical before it is administrative. 90847 and 90846 exist because family sessions with and without the identified patient serve genuinely different purposes.

90847: family psychotherapy with patient present. The patient is in the room, engaged in the session, and the family interactions are therapeutic work for them. A teenager and their parents working through differentiation struggles, a parent-child dyad practicing communication strategies, a child present while caregivers learn to reinforce behavioral skills: these are 90847 sessions.

90846: family psychotherapy without patient present. The session involves family members or caregivers, but the identified patient is not there. A parent consultation about limit-setting while the child waits outside, a caregiver psychoeducation session for a child who is too young to participate meaningfully, a collateral meeting with a young adult’s parents while the patient is seen separately: these are 90846 sessions.

In practice with child and adolescent caseloads, you will use both. A common pattern is a 90847 session with the adolescent and parents together, followed at a later date by a 90846 session with parents alone to process their own responses or coordinate a home plan. Document each session under the correct code: the presence or absence of the identified patient determines which one applies.

One complexity worth noting: some clinicians split a session, starting with the patient and family together and then meeting with caregivers briefly after the patient leaves. Document this carefully. The session as a whole is generally coded for the majority of the time, or for the clinical component with the primary payer’s beneficiary. If this structure is a regular part of your treatment model, check your payer contracts to understand how they expect split sessions to be handled.

Documentation requirements for 90847

The most important documentation principle for 90847 is the same one that applies across psychotherapy codes: the note must establish medical necessity for this specific service for this specific patient on this specific date. For family sessions, that means the note is not a transcript of the family interaction. It is a clinical record of what the identified patient experienced, contributed, and gained in the session.

A defensible 90847 note contains:

• Session date, duration, and format (for example: “50-minute family psychotherapy session, patient and both parents present”)
• Who was present: patient by relationship, not name for others (for example, “identified patient, maternal parent, paternal parent”)
• The patient’s participation: how they engaged, what they disclosed, how they responded to family members and to the clinician’s interventions
• Family interaction relevant to the patient’s treatment: the dynamics that emerged, the moments of connection or conflict, the pattern being worked on
• The clinician’s interventions: what you did, directed at whom, and why
• The patient’s clinical response: emotional, behavioral, relational
• Connection to treatment goals: link this session’s work to the patient’s documented goals
• Risk picture where relevant: any safety or crisis content that emerged
• Plan: next session, individual follow-up if applicable, any coordination with school or other providers

The note should make clear that this was not a generic family meeting. It was psychotherapy for the identified patient, delivered in a family modality.

When the patient is a child or adolescent, the note often needs to hold two levels simultaneously: the developmental context (what this stage of growth makes relevant) and the family-systems context (how the family pattern maintains or complicates the presenting problem). A teenager’s withdrawal from a parent may be both a normal individuation push and a response to a specific family dynamic. A good 90847 note names both and explains what the session did with them.

How to pair 90847 with individual psychotherapy codes

CPT code 90847 can appear on the same date as an individual psychotherapy code when the encounters are genuinely separate and the payer allows both services.

The safer billing test is whether the record would still make sense if an auditor read each service on its own. Document separate services when:

• The two services are clinically distinct
• Each has its own documentation establishing separate medical necessity
• They were genuinely separate encounters, not the same session

Some commercial payers require a modifier to prevent automatic bundling. A -59 (distinct procedural service) or -XE (separate encounter) modifier appended to one of the codes may signal that these are not duplicated claims. Check your payer contracts and provider manuals for the specific requirements before billing both.

In adolescent and child outpatient work, scheduling both service types on the same day can be clinically appropriate. A session that begins individually with the adolescent, followed by a separate family session later the same afternoon, is a legitimate two-code day when the documentation reflects genuinely distinct therapeutic work in each encounter. Document each service in its own note. The individual note should not reference the family session content as if they were one encounter; the family note should not stand in for individual therapy documentation.

What is never appropriate is billing 90847 and an individual code for a single session: for example, meeting with the adolescent and their parents for 60 minutes and billing both 90837 and 90847 for the same time block. That is unbundling.

Common billing mistakes to avoid

Using 90847 when the identified patient is not present. If the patient did not attend, the session is 90846, not 90847. The presence of the identified patient is the defining element of this code.

Writing a note about the family rather than the patient. A note that describes the parents’ history, their concerns, and their communication patterns, but does not establish the identified patient’s participation and clinical response, does not support a 90847 claim. The note must make the patient’s therapy legible, not just the family dynamics.

Billing 90847 and an individual code for the same encounter. The two services must be separate clinical encounters on the same day. Billing both for one 60-minute session with the patient and their parents is not permitted.

Omitting who was present. The note should document who attended the session. For patients who are minors, this is also relevant to consent and confidentiality documentation, not just billing.

Ignoring payer-specific rules about family codes. Some payers have specific rules about which family codes they cover, under what circumstances, and whether they require a particular clinical diagnosis in the patient’s record. Medicaid programs vary by state. Check your payer contracts, especially for family sessions involving a minor patient.

Not documenting session duration. While 90847 is not a timed code, recording the session length is good practice and protects you in audit.

How Emosapien documents family sessions

Family sessions generate a specific documentation challenge: the note needs to capture individual therapeutic work in a relational context. A session involving a teenager and their parents touches multiple clinical threads: the adolescent’s own experience, the family pattern, the caregivers’ capacity, the developmental frame, and the note needs to hold all of them without becoming a narrative essay.

Emosapien’s family session workflow uses the family therapy intake form context to orient the session note, then drafts a 90847 note that keeps the identified patient’s participation and clinical response at the center. The family dynamics are documented as context for what the patient experienced, not as the primary subject of the note. The result is documentation that supports the billing code, is clinically meaningful for the patient’s record, and can be completed without a separate charting session.

For how the clinical note workflow handles family sessions, see the overview on AI clinical notes for therapists.

Frequently asked questions

What is the reimbursement rate for CPT code 90847?

Reimbursement varies by payer, locality, and credentialling status. Medicare publishes its rates in the Physician Fee Schedule; commercial rates are negotiated in your provider contract. Use the CMS Physician Fee Schedule lookup for Medicare locality estimates, then verify commercial rates in the payer contract. Do not rely on a generic national estimate for this code.

Can I bill 90847 for couples therapy?

Yes, when one partner is the identified patient and the session is structured as psychotherapy oriented to that individual’s treatment. If the therapeutic frame is more relational, with the relationship itself as the unit of treatment rather than one partner, the clinical and billing picture is more complex. Consult your payer’s coverage policies for couples therapy and document your clinical rationale clearly.

Does the patient need to participate for the full session?

The CPT descriptor does not specify a minimum participation threshold. What it requires is that the identified patient be present and that the session constitutes psychotherapy for them. If a patient is present but minimally engaged, document what happened clinically and why this constituted therapeutic work for them. For young children, presence and engagement may look different than for adolescents, so document developmental context.

Can two clinicians co-bill 90847 for the same session?

No. The session is billed by the treating clinician. If a supervisor and supervisee co-facilitate, the billing depends on credentialling and supervisory arrangement. Only one claim is filed per session.

Is a treatment plan required to bill 90847?

A treatment plan is not a billing requirement specific to this code, but it is a clinical and payer requirement for ongoing outpatient psychotherapy. Most payers expect an active, updated treatment plan in the chart. Including family session goals in the treatment plan, for example specific family communication objectives tied to the patient’s individual goals, also strengthens the medical necessity documentation for 90847 sessions.

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Dr. Elena Vasquez is a licensed psychologist (PsyD), play-therapy and child-and-family-therapy trained, US-based. She is the Child, Adolescent & Family Therapy Editor at Emosapien.