Does Medicare cover 90847?

Editorial team Published on

Yes, Medicare Part B covers CPT code 90847 (family or couples psychotherapy with the patient present) when it is medically necessary to treat a diagnosed mental health condition.

Key Coverage Rules

  • Identified Patient: One individual must be designated as the primary patient on the claim and must hold a covered, active psychiatric diagnosis (such as major depression or anxiety, rather than just a relationship-focused Z-code).
  • Medical Necessity: The session must focus on symptom reduction or treatment for the patient's diagnosed condition, not just general relationship or marital counseling.
  • Patient Presence: The designated patient must be present and participate in the session for code 90847 to apply (use code 90846 if the family meets without the patient).
  • Telehealth: Medicare covers 90847 via telehealth when delivered through interactive audio-video systems with correct place-of-service coding.

Most users on the AAPC Medical Billing and Coding Forum agree that pure relationship counseling without an underlying behavioral health diagnosis is excluded from Medicare coverage.

What are the 5 treatments not covered by Medicare?

Original Medicare (Parts A and B) does not cover routine dental care, eye exams and glasses, hearing aids, long-term (custodial) care, and cosmetic surgery.

Common Services Excluded from Original Medicare

  • Routine dental care: Cleanings, fillings, tooth extractions, root canals, and dentures are generally not paid for by Medicare.
  • Vision care: Routine eye exams, eyeglasses, and contact lenses are excluded, though specific medical treatments like cataract surgery are covered.
  • Hearing aids: Routine hearing tests, exams for fitting, and hearing aids themselves are not included.
  • Long-term care: Custodial care—such as help with bathing, dressing, or eating over an extended period—is not covered when it is the only care needed.
  • Cosmetic surgery: Elective procedures meant to change physical appearance without improving a malfunctioning body part are excluded.

What is the pay rate for CPT code 90847?

The national 2026 Medicare reimbursement rate for CPT code 90847 (family or couples psychotherapy with the patient present) is $109.55.

Private Insurance and Commercial Payer Rates

Commercial insurance rates vary significantly by your geographic location, specific insurance contract, and provider license type.

  • National average range: $75 to $200 per session (commonly falling between $85 and $125).
  • Sample major payer averages:
    • Cigna: ~$125.32
    • Blue Cross Blue Shield (BCBS): ~$120.67
    • Aetna: ~$118.00
    • UnitedHealthcare (UHC): ~$109.68

Key Factors Impacting Pay Rate

  • Location: Fee schedules adjust based on your local cost of living and geographic adjustment indices.
  • Licensure: Master's-level clinicians or provisionally licensed providers may see scaled rates compared to psychologists or psychiatrists.
  • Network/Platform: Joining insurance networks directly or through credentialing platforms like Headway can influence contracted rates.

You can review a detailed breakdown of CPT Code 90847 Billing and Reimbursement Guidance or check out Mental Health Reimbursement Rates Comparison for additional data on current code payouts.

What are the billing guidelines for CPT code 90847?

CPT code 90847 is billed for family or couples psychotherapy lasting at least 26 minutes where the primary patient is present in the session. You can read more about these rules in the Behave Health Family Therapy Billing Guide.

Core Requirements

  • Patient Present: The identified patient must be in the room or on the telehealth call with at least one family member or partner.
  • Qualified Providers: Licensed professionals like counselors, social workers, psychologists, and psychiatrists can bill this code.
  • Interactions: The session must focus on how family or relationship dynamics affect the patient's mental health.

Time Rules

  • Minimum Time: You must spend at least 26 face-to-face minutes to bill 90847.
  • Typical Time: The standard session length is about 50 minutes.
  • Extended Time: There is no upper time band or add-on code for extra-long standard family sessions unless they cross extreme thresholds (like 74+ minutes into prolonged service territory).

Insurance and Diagnosis

  • Billed Under Patient: File the insurance claim using the primary treatment seeker’s (the identified patient's) name and policy.
  • Medical Necessity: The patient must have a clear, diagnosable mental health condition. General relationship enrichment or lifestyle coaching is not covered.
  • Reference List: You can review standard APA Services Psychotherapy Codes to ensure proper coding alignment.

Documentation

  • Session Times: Record exact start and stop times.
  • Participant Names: Note who attended the session.
  • Clinical Focus: Document specific interventions used and how family involvement supports the patient's treatment plan. More details are outlined in the TherapyNotes Family CPT Overview.

What codes are not covered by Medicare?

Original Medicare does not use a single blanket list of non-covered CPT or HCPCS codes, but instead excludes entire categories of services by statute and policy unless specific medical necessity or statutory exceptions are met.

Major Non-Covered Categories

  • Routine Dental Care: Exams, cleanings, fillings, root canals, and dentures are statutorily excluded, except for rare surgical procedures involving the jaw or reconstructions.
  • Vision and Eye Care: Routine eye exams, eyeglasses, and contact lenses are generally not covered, except for post-cataract surgery prosthetics.
  • Hearing Services: Hearing aids, exams for fitting hearing aids, and routine hearing evaluations are excluded from Original Medicare.
  • Alternative Therapies: Acupuncture (except for specific chronic lower back pain guidelines), massage therapy, naturopathy, and homeopathy are excluded.
  • Routine Physicals and Preventive Codes: Standard periodic wellness/preventive evaluation codes outside of the approved Initial Preventive Physical Examination (IPPE) or Annual Wellness Visit (AWV)—such as preventive codes 99381–99397—are not covered.
  • Custodial Care: Long-term personal care or assistance with daily activities when that is the only care needed.
  • Cosmetic Surgery: Elective procedures like chemical peels, hair transplants, or face lifts without a documented functional reconstructive necessity.

How to Check Specific Codes

Because coverage rules shift based on Medicare Administrative Contractor (MAC) local coverage determinations (LCDs), you should verify exact billing guidelines directly via the CMS Medicare Coverage Database or check official rules outlined in the Medicare Learning Network Non-Covered Guidance.

If Family Therapy Works, Why Do Insurers Pay Less for It?

9 related questions found

What is the big mistake people make with Medicare?

The single biggest and most costly mistake people make with Medicare is missing enrollment deadlines, leading to permanent late-enrollment penalties and gaps in coverage.

Missing Enrollment Deadlines

  • Initial Enrollment Period (IEP): This window lasts for seven months. It starts three months before the month you turn 65, includes your birthday month, and ends three months after.
  • Late Penalties: Failing to sign up for Part B or Part D on time can trigger permanent monthly or yearly financial penalties added to your premiums.
  • Delayed Enrollment Confusion: Many people wrongly assume they can delay Medicare past age 65 just because they have health coverage like COBRA, a marketplace plan, or small-employer insurance.

Other Costly Medicare Mistakes

  • Ignoring Annual Changes: Sticking with automatic renewal without reading the Annual Notice of Change (ANOC) can result in unexpected costs, as drug lists and doctor networks shift every year.
  • Choosing Solely by Low Premiums: Picking a plan based only on a low monthly cost while ignoring total out-of-pocket expenses like deductibles, copays, and coinsurance.
  • Missing the Medigap Window: Forgetting to apply for a Medigap (Medicare Supplement) policy during your open enrollment window. After this six-month period, insurers can use medical underwriting to charge more or deny coverage.
  • Skipping Financial Assistance: Overlooking programs like Medicare Savings Programs or Part D Extra Help that assist with out-of-pocket medical and prescription expenses.

What are the 5 treatments that Medicare won't cover in 2026?

Original Medicare (Parts A and B) does not cover routine dental care, routine vision care, hearing aids, most alternative medicine, and elective cosmetic surgery in 2026.

🦷 Routine Dental Care

  • What's excluded: Cleanings, fillings, root canals, and dentures.
  • The cost: 100% out-of-pocket unless you have a Medicare Advantage plan.
  • Exception: Rare emergency dental services tied to specific procedures like organ transplants.

👓 Routine Vision Care

  • What's excluded: Routine eye exams, eyeglasses, and contact lenses.
  • The cost: Entirely paid by the patient.
  • Exception: Diagnostic exams and treatments for medical conditions like cataracts or glaucoma.

🦻 Hearing Aids and Exams

  • What's excluded: Routine hearing tests and hearing aid fittings.
  • The cost: Average costs can exceed thousands per pair out-of-pocket.
  • Exception: Balance and hearing exams ordered specifically by a physician for medical illness.

🌿 Alternative Medicine

  • What's excluded: Acupuncture (non-back pain), massage therapy, and chiropractic maintenance.
  • The cost: Full private expense.
  • Exception: Limited acupuncture sessions specifically approved for chronic lower-back pain.

💄 Elective Cosmetic Surgery

  • What's excluded: Facelifts, elective procedures, and cosmetic enhancements.
  • The cost: Fully self-funded.
  • Exception: Reconstructive surgery required following traumatic injury or disease treatment (like mastectomies).

Does Medicare pay for 90847?

Yes, Medicare Part B pays for CPT code 90847 (family and couples psychotherapy with the patient present) when the service is medically necessary to treat an identified beneficiary's diagnosed mental health condition.

Key Medicare Rules for 90847

  • Identified Patient: One person must be designated as the main patient who has a covered behavioral health diagnosis.
  • Not Standalone Relationship Counseling: Medicare does not cover couples or family therapy if it is only for general relationship issues or marital conflict without an underlying medical or mental health diagnosis.
  • Patient Presence: The Medicare beneficiary (the patient) must be present for part of the session to bill 90847.
  • Cost Sharing: Standard Part B coinsurance (typically 20% after meeting the annual deductible) applies.
  • Reimbursement: The 2026 national non-facility amount for 90847 is $109.55.

Most users on AAPC Medical Billing and Coding Forum agree that the documentation must clearly show how the family session directly supports the patient's treatment and symptom reduction.

How many minutes is a 90847 session?

A CPT code 90847 session typically lasts 50 minutes, but it only requires a minimum of 26 minutes of face-to-face time to be billed legally.

Session Length Guidelines

  • Standard Length: 50 minutes is the clinical standard.
  • Minimum Time: 26 minutes (any session under 26 minutes cannot use this code).
  • Maximum Time: There is no strict upper limit code for 90847, though standard billing rules often apply extended or add-on codes if sessions run significantly past 74–90 minutes.

What is Code 90847?

  • It stands for family or couples psychotherapy with the primary patient present.
  • The identified patient must be present for at least part (16+ minutes) of the session.
  • You can read more about insurance and time guidelines through the American Psychological Association or TherapyNotes.

Does a person only bill one person in a family for a 90847?

Yes, a therapist bills only one person (the designated "identified patient") in a family or couple for CPT code 90847.

How 90847 Billing Works

  • One Unit of Service: Code 90847 covers the entire family or couples therapy session as a single service, meaning you cannot bill multiple family members or both partners separately for the same meeting. Doing so is considered insurance fraud.
  • The Identified Patient (IP): You must designate one person in the session as the primary client or identified patient. This individual usually has the qualifying mental health diagnosis that makes the session medically necessary, or they are the primary insurance policyholder.
  • The Claim: Only the name and diagnosis of that single identified patient go on the insurance claim form, and the insurance is billed under their policy.