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Billing individual and/or family therapy sessions?

Best practices to help ensure your claims reflect the important work you do

Magellan’s Special Investigations Unit (SIU) has identified billing and documentation patterns for Family Psychotherapy and Individual Psychotherapy that do not fully align with established guidelines.

Learn about common billing errors to avoid and check out some tips to ensure your claims accurately reflect the services you deliver.

About service overlap

We’ve seen instances where providers billed multiple 90847 sessions (family psychotherapy with patient present) for sibling pairs on the same day. While this may be appropriate in certain cases, records showed both siblings received therapy simultaneously from the same clinician—a practice known as service overlap. Each session must be a distinct encounter with individualized goals and documentation tailored to each patient.

Individual Psychotherapy

Codes 90832, 90834 and 90837 represent psychotherapy with the patient and/or a family member. Although CPT titles no longer include the word “individual,” the focus remains on the identified patient. Providers may involve family members occasionally, but the treatment must center on the individual’s needs.

Family Psychotherapy

Codes 90846 (without patient present) and 90847 (with patient present) focus on family dynamics or interactions, such as those between parents and children. While the treatment benefits the identified patient, the session’s primary goal is to address family-related issues.

If a session includes time with the patient alone and time with family members, you must determine whether the session qualifies as individual or family therapy. Documentation must clearly support this decision.

Best practices for accurate billing

To ensure accurate billing and documentation:

• Use the correct code: Bill family therapy sessions using family therapy codes, not individual therapy codes.
• Avoid duplicate billing: Bill one family session per identified patient, not multiple individual sessions.
• Document clearly: Include who attended, session start and end times, and how the service supports the patient’s treatment plan.

Following these practices helps maintain program integrity and ensures members receive high-quality care.

Learn more

• Review Magellan’s policy on fraud, waste, and abuse, and HIPAA standard code sets in Section 4 of Magellan's National Provider Network Handbook (PDF).
• For questions about our process for audits or investigations, contact the SIU via email at SIU@MagellanHealth.com or via our hotline 1-800-755-0850 (you can remain anonymous).