Family Therapy Billing — 2026 Rules for 90846 vs 90847 vs 90849

Family therapy has 3 CPT codes that get confused constantly, causing systematic denials for BH practices. Here’s the 2026 clarity.

90846 — Family Psychotherapy Without Patient Present

• Provider works with family members only, without client
• Client-focused work still (progress toward client’s treatment goals)
• 50-minute typical unit

90847 — Family Psychotherapy With Patient Present

• Client attends session with family
• Most common family therapy code
• 50-minute typical unit

90849 — Multiple-Family Group Psychotherapy

• Two or more families in group format
• Rare code, specialty use case

Common Denials 2026

1. 90847 billed when patient wasn’t present (should be 90846)
2. 90847 concurrent same-day with 90837 individual therapy (payer-varying rules)
3. Progress note doesn’t tie family session to client treatment goals

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– KD, Revenant Care