Not sure how to bill for psychotherapy and E&M? View the AACAP guide below.
E/M + Psychotherapy Documentation
If billing both (say, 99214 + 90833), documentation should clearly separate the medical management and the psychotherapy:
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Section 1: E/M
Symptoms, med review, MSE, med changes, labs. -
Section 2: Psychotherapy
20+ minutes focused on therapy content, with start/end time, modality, patient engagement, and plan. -
Total Time statement if coding by time.
Example language:
“Total encounter time 50 minutes: 20 minutes medication management (history, exam, med adjustments, documentation) and 30 minutes psychotherapy (CBT for negative cognitions).”
Pro-tip You might consider making a quick text for easy access to a standardized template.
Compliance Reminders
- Document safety assessments (suicidality, substance use, risk factors).
- State who was present (patient, family, interpreter).
- Always link documentation back to diagnosis (ICD-10 codes in assessment).
- Avoid cloning notes—must reflect that day’s unique session.
Family Psychotherapy, Parent-Only Encounters, and Related Codes
Article Update 11/2025Most confusion in coding comes not from individual psychotherapy with E/M, but from parent-only sessions, family sessions, or interpretation-only visits.
Here’s how to select the correct family-related psychotherapy codes.
Family Psychotherapy Codes (90846 & 90847)
Family psychotherapy codes are used when the therapeutic focus involves the family system, parenting strategies, interaction patterns, or behavioral/emotional regulation within the family context.
They are distinct from individual psychotherapy codes and may NOT be paired with E/M codes.
90846 — Family Psychotherapy (Patient Not Present)
Use 90846 when you meet with parents/caregivers without the child present and the work is psychotherapy, not simply education.
This includes:
- Parent coaching
- ADHD behavior strategies
- School accommodation planning
- Emotion regulation guidance
- Integration of OT/therapy recommendations
- Improving parent–child dynamics
- CBT-based parent interventions
Time: 38–52 minutes.
Important billing note:
90846 is treated by most payers as a stand-alone psychotherapy service when the patient is not present. It cannot be reliably paired with any E/M code on the same date of service, even if medical decision-making occurs. Payers routinely deny E/M + 90846 combinations.
If medication management or other medical evaluation is needed during a parent-only encounter, the options are:
• Bill E/M only (as a medical consultation with the parent/guardian), or
• Bring the patient into the visit and instead use 90847 (family psychotherapy with patient present), which can pair with E/M, or
• Split psychotherapy and med-management onto separate dates.
Document 90846 sessions strictly as psychotherapy to avoid denials, audit issues, or downcoding.
90847 — Family Psychotherapy (With Patient Present)
Use 90847 when:
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The patient is physically present, and
-
The work focuses on relational dynamics, communication patterns, behavioral/emotional regulation, parent–child interaction, or family-system concerns rather than medication management alone.
Examples include:
- Joint sessions focusing on communication or co-regulation
- Addressing parent–child conflict
- Coaching parents with the child present
- Triadic work (clinician + patient + caregivers)
- Attachment-focused or systemic therapies
- Sessions where the child and parent both participate in the therapeutic content
Time: 38–52 minutes of family psychotherapy.
E/M Pairing:
You may pair 90847 with an E/M code (99213/99214/99215) when a distinct and separately identifiable E/M service is performed and documented.
90785 — Interactive Complexity (Add-On Code)
This is never a standalone code.
Add 90785 to ANY psychotherapy code (individual or family) when the session involves CPT-defined communication complications such as:
- High emotional/behavioral dysregulation requiring de-escalation
- Safety concerns (SI/HI, mandated reporting)
- Interpreter use
- Conflict or chaotic communication
- Barriers requiring structured mediation or specialized techniques
Do not use for routine parenting sessions, mild dysregulation, or basic ADHD behaviors.
90887 — Interpretation/Explanation to Family or Others
This code is not psychotherapy.
Use only when the visit is strictly:
- Explaining test results
- Reviewing psychological evaluations
- Reporting findings
- Providing a non-therapeutic summary or interpretation
- Feedback-only encounters
Payment reality (2025):
Only Oklahoma Complete Health and Humana Healthy Horizons reimburse this code!
Commercial plans (BCBS, UHC, Aetna, HealthChoice, CCOK) either deny it or require full write-off.
Use sparingly and only when it truly matches the service.
Which Code Do I Use? Quick Grid
| Scenario | Correct Code(s) | Time Range |
|---|---|---|
| Parent-only psychotherapy | 90846 | 38–52 minutes |
| Parent-only psychotherapy | 90846 | 90846 = 38–52 min |
| Family psychotherapy with patient present | 90847 | 38–52 minutes |
| Individual psychotherapy + E/M (patient present) | 90833 + 99213/99214, 90836 + 99213/99214, or 90838 + 99213/99214 | 90833 = 16–37 min; 90836 = 38–52 min; 90838 = 53+ min |
| Individual psychotherapy only (patient present) | 90832, 90834, or 90837 | 90832 = 16–37 min; 90834 = 38–52 min; 90837 = 53+ min |
| Interpretation/reporting only (non-therapy) | 90887 | No time requirement (non-psychotherapy) |
| Any psychotherapy session with CPT-defined communication complications | +90785 (add-on to therapy code) | Add-on; no time threshold |
Psychotherapy FAQ
I am a solo practitioner and generally see my patients for both E/M and psychotherapy on a weekly basis. Does the E/M code I bill limit the psychotherapy code I can bill?
No. The two services are separate. You code and document for whatever level of E/M is warranted by the patient’s presenting problem that day and select the add-on psychotherapy code based on the length of time of the psychotherapy provided. (The add-on psychotherapy codes are 90833 for 30 minutes, 90836 for 45 minutes, and 90838 for 60 minutes.) Since the current psychotherapy codes are not for a range of time, like the old ones, but for a specific time, the CPT “time rule” applies. If the time is more than half the time of the code (i.e., for 90832 this would be 16 minutes) then that code can be used. For up to 37 minutes you would use the 30-minute code; for 38 to 52 minutes, you would use the 45-minute code, 90834; and for 53 minutes and beyond, you would use 90837, the 60-minute code.
Are the times listed for the add-on psychotherapy codes in addition to the time spent doing the E/M or is the time spent doing the E/M included in the time listed for the psychotherapy?
The time listed for the psychotherapy add-on code accounts ONLY for the time spent providing psychotherapy. Any time spent providing E/M services should not be included in the psychotherapy add-on time.