90847

Family psychotherapy (conjoined psychotherapy) (with patient present), 50 minutes

Family psychotherapy (90847) is a specialized therapeutic modality where the focus of treatment is the interactional patterns within a family system that contribute to the patient's psychiatric symptoms or hinder their recovery. This code is specifically utilized when the identified patient is present during the session alongside one or more family members. The clinical objective is to modify the family structure or communication style to support the patient's mental health goals. During the 50-minute session, which must exceed at least 25 minutes to be billable under CPT guidelines, the clinician employs evidence-based techniques such as systemic family therapy, structural family therapy, or cognitive-behavioral family therapy. The provider assesses the family's homeostasis, identifies maladaptive behaviors or 'triangulations,' and works to improve the family's collective coping mechanisms. This approach is particularly effective for pediatric populations, patients with eating disorders, or individuals whose recovery is deeply intertwined with their home environment. Documentation must reflect the medical necessity of family involvement, the specific participants involved, and the interventions used to address the family's impact on the patient's condition. Unlike individual psychotherapy, the focus is on the 'system' rather than just the 'intrapsychic' processes of the individual, even though the primary patient's diagnosis remains the central justification for the service. The clinician facilitates open communication and assists family members in understanding the patient's illness, thereby fostering a more supportive domestic environment.

Clinical Indications

  • Presence of a diagnosed mental health condition where family dynamics impact the patient's recovery
  • Marital or relationship distress that is a significant stressor for a patient with a mood or anxiety disorder
  • Pediatric behavioral or emotional disorders requiring parent-child interaction training
  • Adjustment to chronic mental or physical illness within a family unit
  • Substance use disorders where family support and boundary setting are critical
  • Eating disorders requiring family-based treatment (FBT) or Maudsley approach
  • Complex trauma history where family communication is fractured

Procedure Steps

  1. Conduct a brief check-in with the patient and family to assess immediate safety and current symptoms.
  2. Review therapeutic progress since the last session and any homework assignments given to the family.
  3. Facilitate dialogue between family members to identify conflict points or communication breakdowns.
  4. Implement specific interventions, such as role-playing, reframing, or circular questioning, to disrupt maladaptive patterns.
  5. Provide psychoeducation to family members regarding the identified patient's diagnosis and treatment plan.
  6. Develop shared coping strategies and assign tasks to be practiced within the home environment.
  7. Document the duration of the session, specific participants, and the relationship of the intervention to the patient's psychiatric goals.

Coding Guidelines

  • The session must last at least 26 minutes; sessions shorter than this are not billable as 90847.
  • The identified patient must be present for the majority of the session.
  • Do not report 90847 on the same day as individual psychotherapy (90832-90838) or group therapy (90853) for the same patient by the same provider.
  • If family therapy is performed without the patient present, use CPT code 90846.
  • 90847 may be billed with an Evaluation and Management (E/M) service if the E/M service is separate and distinct, appended with modifier 25.
  • Only one unit of 90847 can be billed per day, regardless of the number of family members present.
  • Documentation must justify why family involvement is medically necessary for the treatment of the patient's psychiatric condition.

Associated ICD-10 Codes