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Mental Health LMFT Billing Services designed for how marriage and family therapists practice. Couples therapy sessions are coded and claims are billed within the identified patient rule. LMFTs are enrolled with Medicare, and we reverse denied couples and family therapy claims. MHBS LMFT billing service for practices treat relationships as their unit of treatment.
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Family therapy with and without the patient present, the code split you live in
The threshold to bill a conjoint session, not the full 50
The Medicare rate for MFTs against the clinical psychologist fee schedule
Billing for marriage and family therapy services is an example of behavioral health billing with a structural component. The therapeutic focus is on relationships, but the billing focus is on an individual patient. Each couple or family service charge relates back to a single identified patient and a single diagnosis for that patient. All else flows from this one concept: conjoint codes, payment limitations, and documentation requirements listed below.
It is precisely this disconnect that a non-specialized biller overlooks. In the couples therapy visit, the therapist works with two individuals in the room, but charges for only one. The treatment approach is relational, but the diagnosis is that of the identified patient alone. It is in this difference that marriage and family therapy services falter with regard to billing. Carve-out billing relies on behavioral health billing concepts, but coding guidelines are uniquely tailored to this license.
There are three codes for marriage and family therapy. 90847 is for family therapy where the patient is present. 90846 is for family therapy without the patient. 90849 is for multiple family group therapy. There is one fact that distinguishes the first two codes – the presence or absence of the identified patient.
| Code | Service | Patient Status | Time / Billing Detail | Additional Notes |
|---|---|---|---|---|
|
90847 |
Family Psychotherapy with Patient Present |
Patient present |
Codable at 26 minutes. Described as a 50-minute session. |
Used for conjoint or family therapy when the patient participates in the session. |
|
90846 |
Family Psychotherapy without Patient Present |
Patient absent |
Codable at 26 minutes. Described as a 50-minute session. |
May also apply when only the patient’s partner is seen under the patient’s claim. |
|
90849 |
Multiple-Family Group Psychotherapy |
Multiple families participate |
Billed per session, not per family. |
Used for therapy involving several families in one group session, such as a family-program group. Included permanently on the Medicare Telehealth Services List from 2026 onward. |
A visit with only one partner while the identified patient is not present is coded as a 90846 visit. The claim involves the identified patient and their diagnosis. The partner present is not considered the billable patient. Modifier codes such as 90785 do not go with the 90846 and 90847 procedure codes, as required by insurers.
Many insurers pay the 90847 at a lower rate than the 90837 individual session. A conjoint code involves more individuals and more time, but pays less for each visit. This is surprising to many therapists who feel that family therapy is worth more. Understanding this allows the practice to plan its payer mix.
Mental Health Billing Services bills behavioral health exclusively, and marriage and family therapy is core to that work. Our coders hold AAPC and AHIMA credentials. They code conjoint sessions to patient presence and keep every claim inside the identified-patient rule. This is billing expertise built on the LMFT license, not a general medical template.
An AAPC or AHIMA credentialed coder assigns each code on your claims. They select 90847 or 90846 by who was in the room. The 26-minute threshold and the add-on rules get applied correctly. A miscoded conjoint claim never leaves our desk.
Coverage attaches to one member's diagnosis on every couple's claim. Our coders anchor the claim to that patient's F-code, not a relationship Z-code. A Z63.0 primary diagnosis triggers the non-covered marital counseling denial. We keep couples and family claims on covered ground.
We check each CPT code against current AMA CPT and CMS sources. Medicare opened MFT billing in 2024, and those rules are still settling. A wrong code or a retired rule never reaches the payer. Our standard is a claim that survives a payer audit.
A pre-licensed associate’s sessions are covered by the client’s insurance hinges on three factors. The laws of the state, payer policies, and the individual contract establish the answer to this question. An inappropriate arrangement may lead to future recoupment and audit risks. We ensure that the associate billing complies with payer’s policy prior to filing a claim, not afterward.
Some payers cover an associate’s services billed under their supervisor’s NPI. Other payers do not recognize associates altogether. State laws regarding scope of practice are another element to consider. The same associate can be covered by one plan and uncovered by another.
Filing associate’s sessions to plans that prohibit such action makes one liable to recoupment in case of an audit. Using NPI of the supervisor in a payer that forbids this will pose the same risk. Preparing an appropriate arrangement at the very beginning of the process is the key to securing revenue.
We study every payer’s policy in regards to associates prior to billing under a supervisor. We know which panels accept associates and enroll there when applicable. The supervisor NPI arrangement follows each plan’s rules, not one blanket approach. That payer-by-payer discipline keeps associate claims clean.
The billing process in MFT includes five related steps. Eligibility checks if there is any coverage for family-therapy. Credentialing registers the LMFT. Coding and billing convert the visit into the bill. Submittal and posting submit the bill. Denial management gets back anything denied by the payer. Every step is informed by a marriage-and-family perspective that general billers lack.
We make sure the insurance plan covers family therapy before the first visit. Couples’ benefits may be different from individual mental health benefits under many plans. This process ensures that there is any coverage, limits on visits, and if an authorization is needed. What we verify in particular is the family-therapy benefit.
We register the LMFT with every insurer using the proper MFT taxonomy. In 2024, the Medicare panel was open for MFTs, while the procedures are different for commercial ones. All CAQH and NPI data should match in all applications. More information can be found on our credentialing and enrollment page.
Each session is coded for whether a patient was present and for the Identified Patient Rule. Depending on who was in the room, either a 90847 or a 90846 is coded. The F-code diagnosis of the identified patient is used for anchoring the claim and not a relationship Z-code. The charge entry captures the time spent for the session relative to the 26-minute threshold.
Clean claims are submitted, and we track each claim until the claims have a decision. We post payments from the remittance report and reconcile to the allowable amount. Conjoint claims that are paid lower than an individual session are tracked for underpayments since this is common. Remittance reports show what allowable amounts are paid by each payer.
Appeals are filed based on the reason codes for denying MFT claims. Non-covered marital counseling claims are amended to covered diagnoses supported by the documentation. Limitations set only for therapy can be challenged based on parity laws. The appeal engine is available in our denial management page.
Want a read on how your couples and family claims are coded today? Send 90 days of claims for a free review.
Testing billing splits into two separate code layers. Evaluation codes cover the psychologist’s interpretation, integration, and report time. Administration codes cover the face-to-face testing time. Administration then splits by who performed it, the psychologist or a technician. Mixing these layers is the top psychology-specific denial, and the codes below show why.
An individual LMFT handles all billing chores between appointments on his own. The burden of conjoint coding, eligibility verification, and denials all falls on him. We help the practitioner relieve this burden and allow the practice to concentrate on the clinical side while the billing side is running behind the scenes.
The identified patient requirement is part of every day routine of the couples-therapy-focused practice. Almost all claims are 90847 code billed against one of the partners’ diagnoses. The traps of the Z-codes and of reimbursement gaps affect these practices most adversely. We build the coding discipline required to keep these claims covered.
Group practice bills several therapists operating out of one office. Every therapist requires proper enrollment and up-to-date roster with the payers. A credentialing gap for one therapist stalls that person’s claims. We manage the roster so every clinician bills in the network.
A training program invoices for pre-licensed associates on a supervised basis. Billing guidelines for associate billing have some variability among payers with potential for audits. The NPIs of the supervisor need to conform to each plan’s policies. We go with the associate billing guidelines by program.
Community organizations usually invoice Medicaid and managed care plans quite extensively. Each plan has its guidelines and authorization limits for family therapy. Multiple MCO enrollments make up another task in themselves. We operate the payer mix these organizations need.
Reasons for denial of MFT claims can be listed in just a few items. Almost all of them are associated with the identified-patient provision, the diagnosis, or lack of authorization. Every one of these denials is sent to the MHBS service responsible for its resolution. The following table presents the typical denial causes alongside their solutions.
| Denial driver | How it gets resolved |
|---|---|
|
Non-covered marital counseling classification |
Rework to the identified patient’s F-code where the record supports it, via denial management. |
|
Diagnosis-to-service mismatch |
Align the claim’s diagnosis to the conjoint service documented in the note. |
|
Missing authorization |
Capture the family-therapy authorization before the session, confirmed at eligibility. |
|
Telehealth POS or modifier error |
Correct the place-of-service code and modifier 95 to match the visit. |
|
Carve-out misrouting |
Route the claim to the behavioral plan, a carve-out issue the pillar covers. |
|
Timely filing after a payer recoupment |
Refile inside the window with the recoupment documented, via denial management. |
We bill marriage and family therapy claims to all three payer types. That includes national commercial payers, Medicare, and state Medicaid, along with its managed care payers. Routing of employee assistance programs and TRICARE adds their own particularities. Each payer group has its own conjoint billing rules and associate billing rules.
Aetna, BCBS, Cigna, UnitedHealthcare, Humana, and Anthem are the commercial payers we bill for conjoint family therapy claims. Starting from 2024, Medicare was added to the list of MFT payers. Every commercial payer has its own conjoint coverage. Behavioral benefit usually goes through a carved-out company.
Family therapy is covered by state Medicaid programs on their own terms. Most Medicaid programs route through managed care organizations (MCOs), each MCO having its own limits on the number of sessions allowed. We monitor each program for its own states for which practices bill Medicaid.
The billing of employee assistance program sessions is governed by different rules from the ordinary claim billing rules. EAP authorization and the number of sessions allowed under it come first, often with the HJ modifier class rules. There are some other rules for TRICARE.
Telehealth family therapy bill will have a place of service code along with modifier 95. The place of service code 10 will indicate the patient is at home, and 02 will indicate other places. The audio-only payment depends on the insurance carrier. The virtual conjoint visit too will need the note to indicate whom the patient attended, as presence of patient determines the code.
The patient presence guideline does not become lenient when it comes to video. A 90847 requires an identified patient in the virtual office for 26 minutes. In case the partner only is present, it will be a 90846. Again the documentation in the note will be needed to indicate whom the patient attended. Mismatch in the place of service codes is a typical telehealth denial that we can avoid while coding.
Insurance covers couples and family therapy for treating a member's diagnosis. This individual is known as the identified patient, and their diagnosis makes up the claim. Relationship objectives by themselves do not satisfy the criteria. A relationship Z-code is the trigger for the non-covered marital counseling category. An established F-code must be the foundation of the claim.
Family therapy involves three CPT codes. 90847 is family therapy that includes the patient. 90846 is family therapy without the patient. 90849 is multiple-family group therapy. The presence of the identified patient makes the distinction between 90847 and 90846. Every procedure is billed with a minimum of 26 minutes.
The only difference is one factor, whether the identified patient was present or not. 90847 is family therapy with the patient present. 90846 is family therapy without the patient present. 90846 also includes sessions of a partner when seen separately under the patient's claim.
Yes. Marriage and family therapists may begin billing Medicare on their own as of January 1, 2024. Medicare Part B will reimburse MFTs at 75% of the clinical psychologist fee schedule. Qualifications include licensure by the state, qualification in degrees, and 3,000 hours of supervised experience. Billing is done using NPI and PECOS.
Not always. There are plans which cover the cost of services of the associate MFT under the NPI of the supervisor. On the other hand, there are some which refuse to credential associate MFTs. Each state has its own requirements. It is always risky to bill your associate MFT under a plan which does not cover him/her.
We charge 1% of collections. You have to pay once you collect from the plan. You are not bound to us in the long run. Our commission will always depend on the number of collections in a cycle. No lock-in period and free review of your billing needs.
A free read on your couples and family claims
Send us 90 days of your couples and family therapy claims. We show you what was miscoded, underpaid, or never appealed. Call (860) 500-1471 or send the form
Where are family-therapy claims costing you?
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