Family practice billing doesn’t have to overwhelm you, even with hundreds of CPT codes to choose from. Getting the code wrong means delayed payments, claim denials, or worse, audit triggers that cost your practice time and money. With family practices reporting a 13.8% Medicare error rate, understanding CPT codes is essential for family practices.
This guide breaks down the key CPT codes: CPT 99417 for prolonged services, CPT 90846 for family therapy, and the updated E/M codes that drive most of your billing. You’ll learn exactly when to use each code, what documentation you need, common mistakes that trigger audits, and practical tips to maximize reimbursement.
Whether you’re a provider, biller, or coder, this straightforward guide will help you bill confidently and get paid properly.
Correct CPT codes protect your practice in three essential ways:
Family practices work with dozens of CPT codes, but there are three categories that handle most of your billing volume and, honestly, cause the biggest headaches. If you can get these right, you’ll solve most of your billing challenges and protect your revenue.
This code is for when you spend extended time with complex patients – way beyond your standard visit. It’s an add-on code, which means it only works with high-level office visits. We’re talking 99205 for new patients or 99215 for established patients, and only when your care goes well beyond normal timeframes.
You’ve got to exceed the base visit time by at least 15 minutes. So, for a 99215 (that’s established patients), you need 55 minutes total before you can bill that first 99417 unit. New patients with 99205? You need 75 minutes total. Every additional 15-minute chunk gets you another unit.
You can count face-to-face time with the patient, plus non-face-to-face stuff like reviewing records, coordinating care, and documentation. But here’s what you can’t count – any time your medical assistants or nursing staff spend. It’s only your direct provider time that qualifies.
Here’s where things get tricky. Medicare doesn’t accept CPT 99417. They have their own code (HCPCS G2212) for prolonged services. Most commercial insurers and Medicaid programs will accept 99417, so you’ve got to know which code to use depending on your patient’s insurance.
You need to document your total time spent and describe what activities justified that prolonged service. And please, avoid template language like “spent 20 minutes counseling” on every single visit. Auditors catch this pattern immediately and flag it as potential fraud.
CPT 90846 covers family therapy sessions where you work with family members while the identified patient stays out of the room. This code benefits family practices providing mental health services or coordinating care with family members for patients with behavioral health needs.
Document at least 26 minutes of face-to-face time with family members. Sessions can extend to 50 minutes, but you bill only one unit regardless of duration. The 2025 reimbursement rate averages around $103.75, though this varies by location and payer.
Licensed mental health professionals can bill 90846: psychiatrists, clinical psychologists, licensed clinical social workers, and licensed marriage and family therapists.
You cannot bill both 90846 and 90847 (family therapy with a patient present) on the same day for the same family. Use 90847 if the patient participates in any portion of the session.
List all family members present, describe family dynamics discussed, explain how the session connects to the patient’s treatment plan, and document specific mental health goals addressed. Insurance companies examine these claims carefully for medical necessity, so notes must clearly justify why family-only therapy benefits patient care.
Evaluation and Management codes generate most family practice revenue. Recent changes have simplified these codes considerably, making correct usage more straightforward.
You no longer count history and physical exam bullet points. Instead, select E/M levels based on either medical decision-making complexity or total time spent. This change eliminated much tedious documentation that previously slowed providers down.
Instead of time ranges, each code now has a minimum threshold you must meet or exceed:
When not using time thresholds, check three components: number and complexity of problems addressed, amount of data reviewed, and complication risk. You need two of three components to meet the billing level.
A key insight:
Document your actual thinking process during visits. When managing multiple chronic conditions, ordering tests, or making treatment changes, your medical decision-making often supports higher-level codes than you might realize.
Even experienced practitioners make costly coding errors. With family practices showing a 13.8% Medicare error rate, higher than the 10% average across all specialties, avoiding these common mistakes can significantly improve your revenue cycle.
Every January 1st, CPT codes get updated, and if your team continues using last year’s codes, you’re guaranteed automatic denials. It sounds straightforward, but this single mistake causes more problems than most people realize.
Set up subscriptions for CPT updates directly from the AMA, and make sure your software vendor stays current with their updates. We’ve seen practices get caught by vendors who promise automatic updates but deliver them months late. Create a January checklist; spend one morning each year verifying that your most common codes remain valid.
Auditors can identify mismatched documentation easily. Bill a level 4 visit, but only document “refilled blood pressure medication,” you’re inviting problems. What’s equally frustrating is watching providers under-code because they don’t recognize that their complex decision-making actually justifies higher billing levels.
Copy-paste documentation creates serious issues every time. When auditors see “20 minutes spent counseling” on every single level 3 encounter, warning signs appear immediately. The same applies to the template language, which clearly doesn’t match what actually happened during the visit.
Document your thinking, not just your actions. When you’re reviewing Mrs. Johnson’s latest A1C results, considering drug interactions with her new heart medication, and coordinating with her cardiologist, write that down. Those mental processes you perform every day often support much higher billing levels than most providers realize.
Modifier mistakes create serious billing problems because payer systems detect them automatically. Use the wrong modifier, and you might receive payment initially, but when the payer discovers the error later, they’ll want their money back.
Everyone knows you need modifier 25 when providing both an E/M service and a procedure the same day, but don’t apply it universally. The services must be truly separate and significant. We’ve seen auditors scrutinize practices that use modifier 25 on every claim “just to be safe.”
Some practices think they’re being strategic by only billing middle-level codes, assuming it keeps them under scrutiny. This approach backfires because you end up with unnatural billing patterns that appear artificial to auditors.
Your coding should reflect your actual patient mix. Sick patients need higher-level codes, healthy patients getting checkups need lower ones. Trying to manipulate the system by staying in the middle just makes you appear suspicious.
Medicaid rules change dramatically from state to state, especially around preventive care, vaccines, and mental health services like 90846. California’s rules have nothing to do with what Texas requires, but practices keep making assumptions.
Check your specific state’s Medicaid manual for your common codes. Better yet, join your state medical association’s practice management group; they’ll alert you when local policies change.
Commercial insurers keep expanding their prior authorization requirements, often for services that never needed approval before. Miss one of these requirements, and your perfectly coded, perfectly documented claim gets denied automatically.
Train your front desk team to check prior authorization requirements during scheduling, not after the patient leaves. Create a simple reference sheet showing which procedures need approval from which payers.
Even perfect coding won’t eliminate all denials and audit risks. The key is handling these situations professionally so they actually strengthen your billing process instead of damaging it.
Payers flag practices whose billing looks different from their regional peers. Are Bill’s consistently higher E/M levels than those of similar practices? Use certain codes more frequently than average? You might receive unwanted attention. Doesn’t mean you’re doing anything wrong, but you’d better have documentation to back up your patterns.
Specific Red Flags:
Auditors also search for documentation that doesn’t match billed complexity levels, template language that clearly doesn’t fit the patient’s actual situation, and missing elements that should support your code selection.
Set up systems that let you retrieve complete documentation quickly. Medical records, test results, provider correspondence, time records, everything needs to be accessible immediately.
Pick specific staff members to handle audit communications and train them properly. They need to understand your documentation style, coding logic, and practice patterns well enough to explain them clearly to outsiders.
Write down your coding policies and decision processes. When auditors question your patterns, you want written policies based on your patient population and practice style to reference.
Address denials within 48 hours. Let them sit in your system, and they become exponentially harder to collect. Set up daily workflows where designated team members review and categorize new denials immediately.
Most family practice denials fall into predictable categories: insufficient documentation, missing prior authorization, wrong patient information, or coding errors. Track these patterns; they’ll show you exactly where your system needs improvement.
Different payers have completely different appeal rules and deadlines. Create template letters for your common denial reasons, but customize every single one. Include relevant medical literature when it supports your coding decisions.
Monitor these numbers monthly: overall denial rate, denial rate by payer, days in accounts receivable, and first-pass claim acceptance. Aim for denial rates under 5% and collect 95% of expected revenue within 120 days.
Don’t let perfectionism slow down your billing department. Better to submit clean, well-documented claims quickly than delay everything while triple-checking minor details. Focus your quality control energy on high-volume and high-dollar codes.
Verify benefits properly, not just coverage, but actual benefits for your specific services. Know which patients need prior authorization, which payers have special requirements for codes like 90846, and which plans restrict prolonged service codes.
Run quarterly training for everyone who handles billing. Cover code changes, payer updates, and lessons from recent denials or audits. Keep these sessions practical, focus on situations your practice actually encounters.
Network with other family practice administrators and billing managers in your area. They’re dealing with the same challenges and often have solutions for difficult situations you haven’t faced yet.
Build relationships with healthcare attorneys and compliance consultants before you need them. When audit letters arrive or complex billing situations develop, having expert advice ready saves significant money and stress.
View denials and audits as system improvement opportunities, not personal attacks. Each challenge shows you weak spots in your process that you can strengthen.
Every claim you submit correctly the first time saves your staff hours of rework and gets cash flowing faster. Getting these basics right will get you exactly that.
Start by auditing your current approach against these guidelines. Pick your five highest-volume CPT codes and verify you’re handling them correctly. Then gradually work through more complex scenarios.
Your investment in proper coding education and systems pays off daily through faster payments, fewer denials, and the confidence that comes with compliant, profitable billing.
Need help implementing these changes? Book a consultation with our medical billing specialists who understand family practice workflows and can optimize your revenue cycle while you focus on patient care.
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