Outpatient family psychotherapy reimbursement (CPT 90846-90849)
Governs claim submission and reimbursement rules for outpatient family psychotherapy services (CPT 90846, 90847, 90849) billed on CMS-1500 or electronic equivalents for Optum-administered Commercial and Medicare products and associated behavioral health plans.
No material clinical or coverage changes in this revision.
Family Psychotherapy Coverage Criteria
Family psychotherapy coverage criteria
Reimbursement is available when the following conditions are met:
ALL of the following must be true
- Service is reported using the CMS-1500 (1500 Health Insurance Claim Form) or its electronic equivalent, or submitted online through provider portals.
- Service is performed by a licensed physician or other qualified health care professional.
- Service is an outpatient family psychotherapy service (CPT 90846, 90847, or 90849).
- Only one family psychotherapy session is reimbursable per family per date of service regardless of the number of eligible family members present or their diagnoses.
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