The intake: 90791
Every new child starts with a psychiatric diagnostic evaluation, 90791. It has no time threshold and no medical component; prescribers use 90792. With children the evaluation is usually two conversations, one with the parent and one with the child, and often some paper: rating scales, school reports. Document every source. Some payers let the two conversations fall on different dates as one evaluation; most want it on one claim.
The three individual codes: 90832, 90834, 90837
Individual psychotherapy is billed by face-to-face time with the client, with family members allowed to be present:
The bands are strict. A 36-minute session is 90832; a 38-minute session is 90834; 53 minutes and up is 90837. Documentation time, waiting for a family to join, and messaging afterward do not count. Under 16 minutes is not billable psychotherapy.
Family codes: 90846 and 90847
These are the codes child therapists under-use.
- 90846 is family psychotherapy without the patient present: a parent session that advances the child's treatment. Parent management training for a five-year-old's behavior is the classic case. Minimum 26 minutes.
- 90847 is family psychotherapy with the patient present: conjoint work with the teen and the parents in the room. Minimum 26 minutes.
The frame decides the code. If the goal is the child's own therapy and a parent sits in for support, bill the individual code. If the goal is the relationship or the family pattern, bill 90847. If the child is not there and the parent is the whole session, 90846.
Who is the identified patient
The child. Always, in this work. The parent session under 90846 is billed to the child's record and serves the child's treatment plan. If a parent needs their own therapy, that is a separate client with their own intake, not a longer 90846.
Interactive complexity: 90785
90785 is an add-on for sessions where communication was harder for a listed reason: play equipment needed to communicate with a young child, an interpreter, maladaptive communication among participants that you had to manage, or a mandated report that had to be discussed. It rides on 90791, the timed individual codes, and 90847. It never goes on 90846, and "the client is seven" is not by itself a reason.
Crisis: 90839 and 90840
An unscheduled crisis contact of 30 to 74 minutes is 90839; each additional 30 minutes is 90840. Crisis codes replace the psychotherapy code for that visit. Document the risk, the safety plan made with the parent, and any consultation.
Telehealth: modifier 95 and place of service
Video sessions carry modifier 95 for most payers and a place-of-service code that says where the child was: 10 for home, 02 for anywhere else. Note the child's location in every session; a teen in a parked car outside school is 02, and a few payers restrict some locations. Emora applies the modifier and place of service the payer wants; you record modality and location.
What the note has to show
Payers pay the code the note supports. For every timed session: start and stop time or total minutes; who attended and from where; the interventions and the child's response; progress against the plan; the plan for next time; your signature on the day. See progress notes and treatment plans for child sessions.
What you never do
Do not round time up. Do not bill a no-show to insurance. Do not bill 90837 by default. Do not turn a parent's own therapy into a long 90846. Do not leave the child's location out of a telehealth note.
Every code has its own page with time band, who bills it, child and family notes, and what the note must include: CPT codes for child and family therapy.
How this works on Emora
On Emora you write and sign the note. Emora reads it, selects the code the note supports, adds the payer's telehealth modifier and place of service, files the claim, and pays you per completed session, twice a month, whether or not the payer has paid. Family sessions under 90846 and 90847 are paid the same way. If a payer needs authorization for 90837 or limits same-day services, we tell you before the session, not after.
Questions clinicians ask
- Can I bill 90847 if only the parent attends?
- No. Without the child present the code is 90846.
- Is 90837 allowed for a 12-year-old?
- Yes, when the therapeutic time is 53 minutes or more and the plan supports it.
- Which code for a session that runs 50 minutes?
- 90834 (38 to 52 minutes).
- Do I add modifier 95 myself?
- No. You document modality and the child's location; Emora applies the modifier and place of service the payer requires.
- What is 90785?
- The interactive complexity add-on, for sessions where a listed factor made communication harder. It attaches to 90791, the timed individual codes, and 90847.
Sources
This is general information for licensed clinicians, not legal or billing advice. Your board and your payer contracts control.