HealthCare News

Family Therapy Coding

Issue: #388 MAY2016

Topic: Coding/Billing


Family therapy is conducted with the child/adolescent, parents, and siblings in order to reduce symptomatology and integrate the child/adolescent’s treatment goals into the family unit. Family members are assisted with identifying and maximizing the strengths they bring to the treatment process and with developing problem-solving techniques. Patterns of behavior and communication are assessed and addressed, as necessary. Family treatment should be part of a child/adolescent’s treatment plan unless this modality is contraindicated for reasons of emotional or physical safety.

Family therapy codes should only be used when clinical necessity exists under the following conditions:

  • Individual’s (usually a dependent child) symptoms result from family stressors or dynamics or are worsened by the same, and therefore are expected to be reduced as a result of family therapy.
  • The family therapy level of care is necessary in order to integrate the individual’s treatment goals into the family unit.
  • Family relationships are identified as problematic.
  • Family dynamics are seen as a significant precipitant of symptoms and/or stabilization of family dynamics is instrumental to the individual patient’s return to functioning/clinical improvement.
  • The individual and the family (parent, parents, parents and siblings, etc.) are present for the session (pending unusual circumstances where child should be temporarily absent from a given session due to the child’s best interest as determined by the therapist and parents).

 

The therapist should document family strengths, family issues to be resolved, specific type of family therapy used, length of treatment, etc.

Current Procedural Terminology (CPT®) procedure codes 90846 and 90847 are used to report services for family therapy. Family sessions are conducted face-to-face with family members, with patient present (90847), or without the patient present (90846). Family psychotherapy with patient present (90847) is frequently used in situations with dependent children. These are single unit codes identifying a “session.” Reviewing records, communicating with other providers, observing and interpreting patterns of behavior and communication between the patient and family members, and decision making regarding treatment including medication management is included.

Family therapy codes are not to be used:

  • When the purpose of the visit is to explain the results of psychological testing. Such explanation is already reimbursed under the testing codes themselves.
  • For taking a family history or for Evaluation and Management (E&M) counseling services.
  • For seeing a parent alone in succession with seeing a child alone.

The CPT® codes eligible for payment by a Licensed Marriage and Family Therapist (LMFT) are:

90791 – Psychiatric diagnostic evaluation (no medical services) 90791 is a single unit service and regardless of the amount of time spent, the unit is always “one.”

90846 – Family psychotherapy, without the patient present. 90846 is a single unit service and regardless of the amount of time spent, the unit is always “one.”

90847 – Family psychotherapy (conjoint psychotherapy) (with patient present). 90847 is a single unit service and regardless of the amount of time spent, the unit is always “one.”

Any procedure codes other than 90791, 90846 or 90847 when billed by LMFTs will be non-covered as a member liable service.