You already do this work. You calm a parent who talks over their kid. You meet with a family while the client stays home. Some weeks a crisis keeps you far past the hour. Each of those has its own billing code. The payers' own documents say so. Prior authorization just means asking the insurer for permission before care. For these five codes at Cigna, the current provider guide says "No" authorization needed (Evernorth, March 2026). Optum and Aetna publish their own rules for the same codes. Below you'll find each code in plain words, the payer proof with links and dates, and the one pairing rule that causes the most denials.
What are the five codes, in plain words?
Two of these are true add-on codes. Three stand alone. An add-on code never gets billed by itself. It rides on top of another code on the same claim. That difference matters later, so hold onto it.
- 90785, interactive complexity. A true add-on. Use it when talking to the client takes real extra work. Maybe a caregiver keeps cutting off a child's session. Maybe a family argument takes over the treatment plan review. Maybe you needed an interpreter or play tools just to communicate. 90785 rides on top of a code like 90837. It never bills alone.
- 90839, crisis psychotherapy, first 60 minutes. Standalone. Use it for an urgent, high-distress session that needs help right away.
- 90840, crisis psychotherapy, each added 30 minutes. A true add-on to 90839. It covers crisis work that runs past the first hour.
- 90846, family psychotherapy without the patient present. Standalone. The session you run with the family while the client is not in the room.
- 90847, family psychotherapy with the patient present. Standalone. The family session with the client there.
One more thing about names. Billing blogs call all five of these "90837 add-on codes." That label is wrong. Only 90785 and 90840 are true add-ons. 90846 and 90847 stand on their own. Why care? Because add-ons follow pairing rules. And pairing rules are where denials come from. More on that below.
Will Aetna, Cigna, and Optum actually pay these codes?
Their own published documents say yes. Here's the proof, payer by payer.
Cigna. Cigna's behavioral arm is Evernorth Behavioral Health. It publishes a billing guide for providers under contract (document PCOMM-2026-168, March 2026). The guide lists 90785, 90839, 90840, 90846, and 90847 as billable individual and clinic services. You bill them on a CMS-1500 form, the standard outpatient claim form. The authorization column for each one reads "No." Five codes, zero prior authorization (Evernorth Behavioral Health Resource Guide, March 2026).
Optum, for UnitedHealthcare plans. Optum Behavioral Health keeps a national "Add-on Codes" reimbursement policy. Reimbursement just means how the insurer pays. So this is Optum's rulebook for paying add-ons like 90785 and 90840. Its latest revision is dated June 22, 2026 (Optum Provider Express). Optum keeps a separate Outpatient Family Therapy Reimbursement Policy too, reviewed December 2, 2025. Read those dates as good news. A payer does not keep updating a policy for care it quietly refuses to pay. So family therapy is a live payment category there. It is not a gray area.
Aetna. Aetna's telemedicine payment policy lists 13 psychotherapy and family codes as eligible for live two-way video. That list includes 90785, the crisis pair 90839 and 90840, the family pair 90846 and 90847, and individual psychotherapy 90832 through 90838. Bill them with modifier GT, 95, or FR (Aetna Telemedicine and Direct Patient Contact Payment Policy). One honest caveat. That document shows a last review of June 2021, with a Q&A update on January 1, 2022. It is the current posted policy on aetna.com. Still, check plan rules on Availity before you lean on it. Availity is the portal where Aetna handles provider business.
Anthem. Anthem publishes commercial documentation policies for psychotherapy services too. We could not confirm the current text while writing this, so no specifics here. Pull the policy from your provider portal and read it next to the others.
None of this fixes the rates. Commercial rates are set by each contract. That is why you will see zero dollar figures in this post. The rate problem is its own fight, and we have written about it: Why Commercial Insurers Pay Therapists So Little. But leaving covered codes off the claim turns a low rate into a lower one.
The pairing rule that gets claims denied
This is where careful people get burned. Several billing-vendor blogs claim you can attach 90785 to a crisis code or a family code. APA Services says you cannot, and APA wrote the reporting guidance.
APA's guidance took effect January 1, 2022. Under it, you can bill 90785 with diagnostic evaluations (90791 and 90792), individual psychotherapy (90832 through 90838), and group psychotherapy (90853). That is 10 eligible primary codes. You cannot bill it with the family codes (90846, 90847) or the crisis codes (90839, 90840) (APA Services, 2022).
The family rule makes sense once you see it. Handling hard family communication is already built into the family codes. Adding 90785 on top asks to be paid twice for the same work. Payers will happily deny that.
90785 has a documentation rule too. APA's guidance says you must note at least 1 of 4 interactive complexity factors (APA Services, 2022). In plain terms, a factor might be this. You had to manage people talking over each other in the room. Or a caregiver's own reactions blocked the treatment plan. Or a mandated report came up mid-session. Or you needed an interpreter or play equipment to communicate. One short, specific sentence in the note covers it. Something like: "Session required active management of repeated interruptions by client's stepfather during treatment plan review." That is the whole lift.
And if a clean claim still comes back denied, do not eat it. Appeal with the payer's own policy attached. Here is what actually wins those fights: Mental Health Parity Denials: What to Document to Win.
How the crisis codes work: 60 minutes, then 30s
Crisis psychotherapy runs on a clock. 90839 covers the first 60 minutes. Add-on 90840 covers each extra 30 minutes after that. Two payers print the same setup in their own documents. Aetna's eligible-code list spells out "first 60 minutes; or each additional 30 minutes." Evernorth's March 2026 guide lists 90839 the same way (Aetna payment policy; Evernorth, March 2026).
The math is simple. A 90-minute crisis session is 90839 plus one unit of 90840. A two-hour session is 90839 plus two units. Write down your start and stop times. Time-based codes live or die on documented time. A note without times hands the payer an easy denial.
Most of us have run a crisis session long past the hour, then billed it as a plain 90837. The system trained us to keep claims boring so they move fast. These codes exist so the extra time counts. Check your plan's rules on when crisis codes apply. Then use them when the work was truly a crisis.
Why does this matter more every year?
Because psychotherapy is carrying the commercial telehealth system. FAIR Health tracked commercial telehealth claims from July through September 2025. In September, 62.1% of commercially insured patients with a telehealth claim had a mental health diagnosis. Across those three months the range ran 62.0% to 63.1% (FAIR Health, published February 19, 2026). Psychotherapy ranked as a top-two telehealth procedure category nationwide in all three months.
Read that plainly. Our field drives the volume in commercial telehealth. That is a huge pile of psychotherapy claims moving every month. Every claim that leaves a covered code off is a quiet gift to a payer.
What you will not find in this post, on purpose
Three things did not make the cut, and the reasons matter.
No dollar amounts. Vendor blogs love to quote per-unit dollar figures for 90785. Those numbers trace back to other vendor blogs, not to payer documents. Commercial rates are set by your contract. Your contract is the only rate sheet that counts, so we printed none.
No Anthem specifics. Anthem's commercial psychotherapy documentation policy exists. We could not confirm its current text for this post. Guessing is worse than a gap. Check your portal.
No "therapists underbill by X%" stat. We looked for a real study on how often clinicians skip these codes. We did not find one worth citing. What we do see is a pattern every consultation group knows. Solo clinicians default to 90834 and 90837 because those codes never get questioned. And nobody taught us the other codes in grad school. That is an observation, not a stat. The payer documents above are the part you can check.
How to start this week
Five steps, in order:
1. Pull last month's claims. Count family sessions billed as individual sessions. Count crisis sessions billed as a plain 90837. That number is your baseline. 2. Save the payer documents. The Evernorth guide, the Optum reimbursement policy page, and the Aetna payment policy. All three are linked in the Sources below. Pull Anthem's from your portal. 3. Add one line to your note template. A prompt for interactive complexity factors. When a factor shows up, one specific sentence captures it. 4. Write start and stop times on every crisis session. Past 60 minutes, add a unit of 90840. 5. Check before you scale. Rules vary by contract and plan. Confirm on each payer portal once, then bill without flinching.
The honest summary is that this win is boring. It is paperwork keeping up with work you already did, at the exact point in the day when the tank is empty. Documentation load is already pushing people out of the field. We wrote about that in Therapist Documentation Burnout. It is also the itch behind VibeCheck.luxury, built by a clinician who does this same paperwork. The goal: make the note match the session without eating your evening. If you want a look, book a call. If you would rather just grab the payer links and run, that is a win too.
FAQ
Is 90847 an add-on code?
No. 90846 and 90847 are standalone family psychotherapy codes. In this group, only 90785 (interactive complexity) and 90840 (added crisis time) are true add-on codes. An add-on must ride on another code on the same claim. A standalone bills by itself.
Can I bill 90785 with 90847 or with the crisis codes?
No. APA Services' reporting guidance, effective January 1, 2022, allows 90785 with diagnostic evaluations (90791, 90792), individual psychotherapy (90832 through 90838), and group therapy (90853). It excludes the family codes and the crisis codes. Some vendor blogs say otherwise. Follow the APA rule.
Does Cigna require prior authorization for these five codes?
Cigna's Evernorth resource guide (March 2026) lists all five with an authorization requirement of "No" for contracted individual and clinic providers billing on a CMS-1500. Your contract and the client's specific plan still control, so confirm both before you bill.
Can these codes be billed for telehealth?
Aetna's payment policy lists all five, plus 90832 through 90838, as eligible for live two-way video with modifier GT, 95, or FR. That policy shows a last review of June 2021, with a Q&A update dated January 1, 2022, so verify current rules on Availity. Other payers publish their own telehealth lists.