Wiki 90847 Couples/Family Counseling

[rhedges]

90847 is a newly covered code under Medicare Part B for couples/family counseling. Z63.0 is the most appropriate dx code for this to state the
purpose of the visit. Noridian Medicare Part B, Jurisdiction F is denying this as routine. Does anyone have any written guidance from Medicare
of the rules for billing this procedure code for reimbursement? I have scoured our Medicare's websites and can't find an article or guidance
on this supposed newly covered service. I need help on this one

 

[CBLENNIE]

I have not heard that Medicare is covering 90847-Family psychotherapy (conjoint psychotherapy) (with patient present) is being covered for couples or family counseling. My understanding it represent family psychotherapy services for the treatment of mental disorders. So, the focus of the service is about one member of the family's mental health or substance abuse condition and how it affects the family. The following is the full code description per EncoderPro for Payers Professional.

The therapist provides 50 minutes of family psychotherapy in a setting where the care provider meets with the patient and the patient's family jointly. The family is part of the patient evaluation and treatment process. Family dynamics as they relate to the patient's mental status and behavior are a main focus of the sessions. Attention is also given to the impact the patient's condition has on the family, with therapy aimed at improving the interaction between the patient and family members. Reviewing records, communicating with other providers, observing and interpreting patterns of behavior and communication between the patient and family members, and decision making regarding treatment, including medication management or any physical exam related to the medication, is included.

There aren't any LCDs or Articles for Noridian Part B for any jurisdiction on this topic that I can find.

Where did you find the information that 90847 was being covered for family or couples counseling with DX Z63.0-Problems in relationship with spouse or partner? Typically, Medicare only covers medically necessary conditions and services and I'm not sure that Medicare would consider relationship problems with a spouse or partner condition which requires treatment, the counseling represented by 90847, is medically necessary.

 

[rhedges]

Thank you for responding!! My provider told me that she received notification by patients & other providers that Medicare would be covering this
in 2024. When I looked at the Medicare Fee Schedule for 2024, it shows that 90847 is payable. With the other specialities I work with, non covered
cpt codes do not show up on the Medicare Fee Schedule. Thank you for any additional information you may have on this one

 

[ckeeney]

Thank you for responding!! My provider told me that she received notification by patients & other providers that Medicare would be covering this
in 2024. When I looked at the Medicare Fee Schedule for 2024, it shows that 90847 is payable. With the other specialities I work with, non covered
cpt codes do not show up on the Medicare Fee Schedule. Thank you for any additional information you may have on this one

Although this is not specific to Noridian, I have the following from CMS: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480
It lists 90847 and the covered diagnoses.

 

[CBLENNIE]

Did your provider receive notification that 90847 is covered as a CPT code, or were they specifically told that couples/family counseling would be covered. I don't believe Medicare would cover 90847 with Z63.0 because there is not underlying medical or behavioral health condition being treated, the DX is for relationship issues.

I work in commercial insurance and our plans routinely exclude marriage/couples/family counseling in the absence of one of the participants having a behavioral health condition that is being addressed.

 

[rhedges]

I was able to find that article earlier today, I just wasn't sure if there was something newer. I almost had to laugh when the Medicare
rep this morning told me to speak to a certfied coder about the coding for this service. I told her I was a CPC and I was trying to find
the most current info on the subject. She wasn't much help. My provider has been using Z63.0 which was denied as routine. My best
understanding is to use a diagnosis code from this list that shows the issue being addressed not just that the service was performed.
I greatly appreciate your assistance with my question. Fellow coders are just the best!!