Mastering the 90846 CPT Code Time Range for Family Therapy Billing

Are you losing revenue because the 90846 cpt code time range is a total mystery? It’s a headache most of us know too well. You put in the work—sitting down with a worried mother, mapping out a behavioral plan for her son, or helping a husband understand his partner’s diagnosis. You do the clinical work, but when it comes time to get paid, the claim gets kicked back. Why? Because the minutes didn’t line up with what the insurance auditor wanted to see.

It’s frustrating. Insurance audits are getting tighter every year, and the specific rules for “family therapy without the patient” are a minefield. Navigating these specific time constraints is a critical part of uncovering The Real Truth About Coding and Billing for Mental Health Services. If you bill for a full hour but your notes only show a brief update, or if you mix this code up with a standard check-in, you’re essentially donating your time. Worse, you could be flagging your practice for a clawback. You need to know exactly how many minutes count so you can protect your income.

The good news is that the rules are actually black and white once you cut through the jargon. We’re going to look at the exact 90846 cpt code time range, the minimum minutes you legally need to hit, and how to stop second-guessing your billing. By the time you finish reading, you’ll know exactly how to document these sessions so they stick.

The 26-Minute Rule (Your Safe Zone)

Let’s cut to the chase. This is the single most important detail that will save your claims.

It’s all about the midpoint.

CPT code 90846 is technically a 50-minute code. But you don’t need to stare at the clock until it hits 50:00 to get paid. According to current CMS billing guidelines, the “midpoint rule” applies. Since the target is 50 minutes, the midpoint is 25. To bill it, you have to cross that line.

• Target: 50 minutes.
• Midpoint: 25 minutes.
• The Reality: You need to log at least 26 minutes of face-to-face time.

If you wrap up at 25 minutes? You can’t bill it. If you hit 26? You’re in the clear. Burn that number into your brain: 26.

What is CPT 90846 Anyway?

To get the 90846 cpt code time range right, we have to agree on what we are actually doing in the room. This code is for “Family psychotherapy (without the patient present).”

It’s the code you use when you’re meeting with the support system—parents, spouses, siblings—but the actual client (the “identified patient”) isn’t there.

When does this happen?

• You’re teaching parents how to de-escalate a tantrum.
• You’re explaining the side effects of a new medication to a spouse.
• You’re getting a family history that the client is too young or too unwell to give you.

The catch? The conversation has to be about the client. You aren’t treating the mom’s anxiety. You’re treating the mom’s ability to help her child. That distinction is what makes the claim valid.

It’s a Time-Based Code

This isn’t like a flu shot where you just bill for the procedure. This is time-based. Your notes have to prove you spent the time. If you don’t record the start and stop times, you technically didn’t meet the 90846 coding definitions required by auditors, and they can take that money back.

The Breakdown: Minutes Matter

There’s always a disconnect between the CPT manual and what the insurance companies actually accept. Let’s look at the hard numbers.

The 90846 cpt code time range mirrors 90847 exactly. The clock doesn’t care who is in the room; it just cares that you hit that 26-minute mark.

Going Over Time?

If the session runs 55 minutes? Great. It’s still just one unit of 90846. If it runs 90 minutes? That used to be where prolonged service codes came in, but that’s become a mess with recent updates. For most commercial payers, you’re capped at one unit per day. You generally can’t bill two units of 90846 just because you talked longer.

90846 vs. 90847: Don’t Mix Them Up

This is where people get tripped up. The time requirement—that 90846 cpt code time range—is the same as 90847, but the clinical picture is totally different.

90847 is “Conjoint Psychotherapy with the Patient Present.”
This means the person with the diagnosis is sitting right there.

Here is a common scenario: You start with the kid in the room for 10 minutes, then they get bored or you ask them to leave, and you spend 40 minutes with the parents. Which code do you use?
Usually, you bill for the majority. Since the patient was gone for most of it, and you met the 90846 cpt code time range (40 mins > 26 mins), 90846 is the honest choice.

Is it Worth It? (Pros & Cons)

Should you use this code or just insist the patient comes in? Here is the trade-off.

Why Claims Get Denied (And How to Fix It)

Even seasoned pros get denials on this one. It usually boils down to sloppy timekeeping regarding the 90846 cpt code time range.

1. The “20-Minute” Trap

You get on a call with a parent. It lasts 22 minutes. You did good work. You try to bill 90846. Denied.
There is no code for 22 minutes of family therapy. It’s a gap in the system. You are either working for free, or you need to keep talking for four more minutes.

2. Vague Time Stamps

Writing “Total time: 50 mins” isn’t enough anymore. Auditors want to see “9:00 AM – 9:50 AM.” They want proof the time actually existed.

3. “Marriage Counseling” in Disguise

If you use this code for a couple where neither person has a diagnosis, you are asking for trouble. Insurance covers illness, not relationship improvement.

The Couples Therapy Confusion

Let’s be real about the cpt code for couples therapy. It doesn’t really exist in the way clients think it does.

If you are seeing a couple, you have to ask: “Who is the patient?”

• If the wife has Depression and the husband is there to learn how to support her: 90847 (if she is present).
• If the husband comes in alone to discuss her care: 90846.
• In both cases, the 90846 cpt code time range of 26 minutes applies.

If they just argue about dishes and finances with no clinical diagnosis? That’s private pay. Don’t bill insurance for that.

90846 vs. Individual Codes (90832/90834)

Don’t try to swap these out. I see therapists billing 90832 (Individual Therapy, 30 mins) for a parent session because the time matches better.

Don’t do it.
90832 requires the patient to be there. If you bill 90832 for a session with just the mom, that’s fraud. Even if the time fits better (90832 starts at 16 mins), you can’t use it if the patient is absent. As noted in the APA’s reimbursement guide, you must adhere to the specific code definitions—meaning 90846 is your only valid option here.

Your Documentation Checklist

Want to sleep better at night? Make sure every 90846 note has these five things:

1. Exact Times: Start and stop. Prove you met the 90846 cpt code time range.
2. Who Was There: “Session with spouse” or “Session with parents.”
3. Who Wasn’t: “Patient not present.”
4. Why: “Patient at school” or “Clinical decision to meet parents alone.”
5. The Link: How did this help the patient? “Discussed reducing triggers for Patient’s PTSD.”

Conclusion

Billing isn’t why you became a therapist, but it’s the only way you can keep your doors open. The takeaway here is simple: respect the 90846 cpt code time range. If you cross that 26-minute mark and your notes are solid, you are good to go. Don’t guess, don’t fudge the numbers, and don’t be afraid to bill for the time you spend helping families. You earned it.