CPT code 90846: Family psychotherapy without the client present

When to use 90846

• Family/collateral sessions held without the identified client present
• Sessions that still serve the client's treatment plan and diagnosis

What to document

• Who attended and why the client was not present
• How the session relates to the client's diagnosis and treatment goals
• Interventions used and outcomes
• Time spent (generally 26 minutes or more)

Common reasons 90846 gets denied

• The identified client has no covered, billable diagnosis
• Relationship counseling only, for example coded Z63, with no billable diagnosis. Plans often don't cover it
• Plan does not cover family psychotherapy

Billing 90846 by telehealth

The CPT code stays the same when you see a client by video or phone. For Medicare, the place of service changes. Use 10 when the client is at home and 02 when they are somewhere else, such as a clinic. Add modifier 93 when the session was audio-only. Commercial plans and Medicaid set their own rules, and many of them also want modifier 95 on video sessions, so check each payer's telehealth policy.

Medicare covers mental health telehealth in the client's home permanently, wherever the client lives. Through 2027 it pays for audio-only sessions with no extra conditions. From January 1, 2028, audio-only needs a client who can't use video or doesn't agree to it. In 2028 Medicare also starts requiring an in-person visit within 6 months before a client's first mental health telehealth session, then one every 12 months. Clients who start telehealth before 2028 only need the yearly visit. The CMS telehealth page has the current Medicare rules.

How much does 90846 pay in 2026?

Restricted Medicare coverage. 90846 has status indicator R. When Medicare covers it, your Medicare Administrative Contractor sets the price, so the figure below is an estimate from the code's RVUs, not a published national rate.

Medicare, national non-QP

$105.88

Typical commercial range

$116 to $159

• The commercial range is 110 to 150% of Medicare. Real contracts run from below 80% to above 200%.
• Medicare pays master's-level clinicians (LCSW, LMFT, LPC) about 75% of the listed amount.
• Your locality's geographic adjustment (GPCI) moves the rate a little.
• Qualifying APM Participants are paid under a slightly higher conversion factor than the non-QP $33.4009 used here.

Medicare figures checked against the official CMS 2026 Physician Fee Schedule Relative Value Files (RVU26D) on Oct 17, 2026.

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