CPT Code 90846: Complete Description (+Reimbursement Details 2024)

Description

Current Procedural Terminology (CPT) Code 90846 is used within mental and behavioral health services to denote a specific type of therapeutic interaction. This code is important in the coding and billing process as it helps categorize mental health professionals' services. CPT code 90846 is used for 50-minute face-to-face or telehealth family psychotherapy sessions when the patient is absent.

CPT codes are special codes used for mental health services. They help in setting a common way to name these services and in getting paid for them. There are many codes available for family therapy. The code you choose depends on what kind of help is being offered and how long the session lasts. It's very important to pick the right code based on these details.

Code 90846 is used for appointments when the patient is absent. These appointments often involve family participation in the treatment process of a family member. If a married couple identifies as a family, they may also qualify for the family code. When we help a child, we often believe that making changes in how the family behaves and interacts with each other will make the child's feelings or behavior better.

Family therapy helps families and individuals manage their mental health challenges. When billing for mental health family therapy services, it's vital to use the correct CPT codes – ensuring that mental health professionals are reimbursed accurately for their services.

The use of the code 90846 is getting more important because mental health experts understand how crucial family and relationships are for a person's overall health. By focusing on these areas, therapists can help people build stronger, better relationships and improve their mental health outcomes.

The use of CPT code 90846 acknowledges the important behind-the-scenes work for effective mental health treatment. It recognizes that the therapeutic process extends beyond the face-to-face time spent with the patient, encompassing a range of activities that contribute to overall treatment effectiveness. This code helps ensure that mental health professionals are adequately compensated for the comprehensive care they provide, including the time spent on activities that are essential to the patient's treatment plan but do not involve direct interaction.

Time Issues

Specifying a 50-minute duration for activities under CPT code 90846 provides a standardized benchmark for billing and documentation purposes. It offers clarity and consistency in the billing process, enabling therapists and other mental health providers to accurately represent the time and effort invested in each patient's care. This facilitates a smoother reimbursement process with insurance companies and ensures that mental health services are accessible and sustainable for both providers and patients. Code 90846 represents a 50-minute duration of time spent on activities without direct patient interaction.

Reimbursement

To bill 90846, therapists must identify one family member as the patient (often the primary insurance holder or the family member with the more severe symptoms). Only that person's name and diagnosis are included in the claim. The focus of the session in the documentation must be clearly described.

You can't use code 90846 if the service is just about recording family history or quickly checking on how the patient is doing before or after their one-on-one session. It also doesn't cover when family counseling is given to professional caregivers or staff.

When it comes to billing on the same day, you can bill for family therapy and individual psychotherapy together if they are for different services. This means you can have one session just with the patient and another session with their family (without the patient) on the same day, and bill for both.

However, usually, you can't bill for both 90846 and 90847 for the same patient on the same day, even if you have two separate sessions.

Reimbursement for CPT code 90846 varies based on several factors. These variations are due to insurance company standards, geographical location, and specific details of the activities that influence payment rates.

• Different insurance providers have reimbursement schedules and policies, affecting the amount reimbursed for services. Companies may negotiate different rates with providers or have specific guidelines on what conditions or activities they cover.

• Geographical location impacts reimbursement rates because the cost of living and the cost of providing mental health services vary widely across different regions. Companies often adjust reimbursement rates to reflect geographical differences. For example, providers in urban areas with a higher cost of living may receive higher reimbursement rates than those in rural areas.

• Service details influence reimbursement rates, including the complexity of the issues being addressed and whether the session is part of a broader treatment plan. Some insurance plans might offer higher reimbursement for sessions identified as more complex or requiring a higher level of expertise.

Given the above factors, mental health providers and patients must verify the exact reimbursement rate for CPT code 90846 with the insurance provider or the billing department handling the insurance claims. This verification process should occur before treatment to clarify coverage and avoid unexpected expenses. Therapists may need to provide detailed documentation to justify the necessity and complexity of treatment to secure appropriate reimbursement.

Patients and providers should be aware that insurance coverage can change, and what’s covered under one plan or in one year may not necessarily be covered in the same way in the future. Keeping abreast of changes and regularly verifying coverage can help manage expectations and financial planning.

Modifiers

CPT code 90846 has no age limit and can be used by families with children of any age. Modifiers may be required or recommended depending on the specific circumstances and the policies of the payer or insurance company. Common modifiers used with code 90846 include -52 (Reduced Services), -59 (Distinct Procedural Service), or other modifiers that reflect specific situations.

Documentation Requirements

The CPT code 90846 is used for a therapy session that helps families, but the person getting help doesn't need to be there. This therapy is done by someone with a special license, like a psychiatrist, psychologist, or social worker. They can use this code to charge for their work only if they talk with the family for 50 minutes. They must also write down why the therapy is needed, what they hope to achieve, any improvements, and what they plan to do next.

Proper documentation is critical to the billing process, especially for mental health services billed under CPT code 90846, which applies to activities without the patient present. Ensuring detailed and accurate records for each session impacts the reimbursement process and insurance and regulatory standards. Here’s what a mental health professional’s documentation should include:

Date, Start, and End Times:

Every session must be accurately logged with its specific date, start time, and end time. This information is crucial for verifying that the billed services correspond to the therapy sessions provided. Precise timing helps establish each session's duration, which can be important for insurance claims as some reimbursement rates may vary based on session length.

Nature of the Activities:

Document the nature of the activities during a session and the time they took place.

Relevant Clinical Notes:

Clinical notes should include comprehensive details about the therapeutic process, including any observations, patient progress, challenges encountered, and any changes in the treatment plan. Notes are vital for justifying the necessity and effectiveness of treatment and offering a continuum of care – showing how each session builds upon the previous one toward achieving therapeutic goals.

Confidentiality and Consent:

While maintaining thorough documentation, adhering to confidentiality laws and ethical guidelines is essential. This includes obtaining and documenting appropriate consent for treatment, especially when dealing with family therapy sessions where multiple individuals are involved. Documentation should be stored securely and shared only with authorized parties to protect patient privacy.

Compliance with Insurance Requirements:

Different insurance providers may have specific documentation requirements to process and approve reimbursement claims. Mental health providers must be familiar with these requirements and ensure their documentation meets or exceeds these standards. This might include using specific forms, providing detailed session notes in a specific format, or including diagnostic codes.

Meticulous documentation for CPT code 90846 supports the billing and reimbursement process and enhances the quality of care by ensuring continuity and coherence in treatment planning and delivery. It serves as a tool for communication among healthcare providers and aids in legally protecting both the therapist and the patient. It facilitates audit processes by insurance companies or regulatory bodies. Investing time and effort into accurate and comprehensive record-keeping is indispensable for mental health professionals.

Frequency

The frequency of using CPT code 90846 will depend on the treatment plan and the therapist’s clinical judgment. It’s important to follow ethical and clinical guidelines when determining the frequency of non-face-to-face psychotherapy services.

CPT codes and their descriptions can change over time, so it's essential to refer to the most recent version of the Current Procedural Terminology (CPT) code book or consult with a qualified medical coder or billing specialist for current information and guidance on billing and coding practices.

The Bottom Line:

CPT code 90846 plays a vital role in the mental and behavioral health field because it serves as a mechanism for recognizing and billing for the essential, indirect, therapeutic activities carried out by mental health professionals. By standardizing the documentation and reimbursement for these activities, CPT code 90846 supports delivering comprehensive mental health care, ultimately contributing to the well-being of individuals seeking psychological support.

Reference:

• Psychotherapy Codes for Psychologists. (2023). Retrieved from https://www.apaservices.org/practice/reimbursement/health-codes/psychotherapy