Family therapy plays a crucial role in supporting mental health, but billing for it—especially in New Jersey—is far from straightforward. From misused CPT codes to payer-specific documentation requirements, even experienced providers can find themselves facing denials, delays, or audits. In this post, we break down the risks of billing CPT code 90847, explain common modifier mistakes, and shed light on how expectations vary across payers.

Welcome to the complex world of family therapy billing in New Jersey.

Understanding CPT Code 90847: More Than Just “Family Session”

CPT code 90847 is used for family or couples therapy with the patient present. It may seem simple enough—but it's one of the most misunderstood codes in mental health billing in New Jersey. This code is time-based (typically 50 minutes), but the confusion begins when:

• Providers don’t clearly document the therapeutic benefit to the identified patient.
• The session includes multiple participants without clear roles or treatment rationale.
• Payers require additional details, like relationship to patient or clinical necessity, that aren’t always captured.

In New Jersey, where managed care organizations (MCOs) and private insurers often follow their own guidelines, even small documentation gaps can flag a claim for review.

The Modifier Trap: 25, 59, or None?

Another source of confusion: modifiers. If you’re billing 90847 alongside an individual therapy session (like 90834), some payers require a modifier 59 (distinct procedural service) or modifier 25 (significant, separately identifiable E/M service on the same day).

The challenge? These modifier rules are not universal.

Some payers in New Jersey require modifier 59 when 90847 and 90834 are billed together—others won’t reimburse at all if they’re submitted for the same day. Without payer-specific billing intelligence, you risk:

• Getting one or both services denied.
• Triggering recoupment due to perceived duplication.
• Losing time resubmitting corrected claims.

That’s why working with New Jersey’s family therapy billing service provider makes a measurable difference—we decode the fine print.

Documentation Demands Are Rising

Payers in New Jersey are tightening their expectations for psychotherapy documentation. For family therapy, that means:

• A clear identified patient must be documented.
• Clinical rationale must focus on how the family interaction supports the patient’s treatment.
• Time and participants must be precisely recorded.
• Notes must differentiate family therapy (90847) from individual or group services.

Failing to meet these expectations doesn’t just delay claims—it can result in flagged audits or clawbacks.

The Telehealth Twist

Since the pandemic, many providers now deliver family therapy virtually. However, telehealth parity for 90847 is not guaranteed across all payers in New Jersey. Some allow it; others require prior authorization or different documentation standards. A few may even reclassify telehealth 90847 sessions as "non-covered" without proper modifiers or consent forms.This is yet another reason family therapy billing in New Jersey can trip up even seasoned practices.

The Instapay Way

Navigating these challenges alone is risky—and time-consuming. As New Jersey’s family therapy billing service provider, Instapay Healthcare Services:

• Knows the documentation and modifier preferences of New Jersey’s largest insurers.
• Tracks regulatory changes, especially for Medicaid, MCOs, and commercial plans.
• Ensures clean claims and compliant documentation for services like 90847.

We specialize in mental health billing in New Jersey, and our team is trained to anticipate—and prevent—billing pitfalls before they affect your bottom line.

Final Thoughts

Family therapy is essential—but billing it shouldn’t cost you time, money, or peace of mind. With the right guidance and support, you can protect your practice and your revenue while delivering the care your patients need

Let Instapay help you untangle the fine print of family therapy billing in New Jersey—and get back to what matters most: providing healing support to families in need.