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TRICARE Policy Manual 6010.63-M, April 2021
Medicine
Chapter 7
Section 3.11
Family Therapy
Issue Date:  August 31, 1987
Copyright:  CPT only © 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved.
Revision:  
1.0  CPT CODES
90846, 90847, 90849
2.0  DESCRIPTION
Family Therapy Defined. Family therapy is a form of psychotherapy directed toward the family as a unit, instead of toward a single individual. Family therapy is based on the assumption that the mental or emotional illness and the functional impairment of the identified-patient is related to family interactions and, therefore, the family is the unit that should be treated. Problems and dysfunctional behaviors are dealt with as responsibilities of all family members and are not necessarily focused on any one individual. Family therapy may involve the complete or partially available family unit and normally would involve the same therapist or treatment team. When geographical distance necessitates therapy be given to partial family units at separate locations, collaboration between treating therapists is acceptable. For the purposes of coverage, the family generally would include the husband or wife of the patient, his or her children or, in the case of child patients, the parents, stepparents and siblings. When determined appropriate, other family members residing in the same household could also be included.
3.0  POLICY
Family therapy can be cost-shared when rendered in conjunction with otherwise covered treatment of a beneficiary suffering a diagnosed mental health or Substance Use Disorder (SUD).
4.0  POLICY CONSIDERATIONS
4.1  Telephone calls, therapeutic leaves and visits among family members are not a substitute for family therapy, although they can be important adjuncts to a child’s treatment. Multi-family group therapy does not meet the family therapy requirement. A collateral visit, a session between an authorized provider and a significant person in the identified-patient’s life, is primarily for the purpose of information gathering and does not constitute a family therapy session.
4.2  Special Considerations Involving Partial Hospitalization and Residential Treatment Center (RTC) Care.
4.2.1  Family Therapy involving Partial Hospitalization and RTC Admissions. In accordance with the appropriate medical care standard, discharge planning should start with the day of admission. The goal should be to restore the patient’s ability to function in one or more major life activities. In the case of a child under age 21, the environment to which the patient is to be discharged is a major consideration. To be authorized, RTCs and partial hospitalization programs are required to address the feasibility of family therapy as part of the treatment plan.
4.2.1.1  Standards. A compliance requirement of the RTC standards (see 32 CFR 199.4(b)(4)(vii)) and the partial hospitalization standards is that the admission process must include the family’s (or responsible relative’s or legal guardian’s) understanding of residential or partial hospitalization treatment and of their involvement in treatment as well as the probable Length-of-Stay (LOS) of the patient. The RTC standards dictate that if the patient is not returning to the family, appropriate documentation in the clinical record should indicate the type of preparation made with other persons who will be involved with the patient upon discharge. The RTC and partial hospitalization standards require that all specific therapeutic modalities be spelled out in the treatment plan, including family therapy.
4.2.1.2  Under the accrediting body’s standards by an accrediting organization approved by the Defense Health Agency (DHA), a specific plan for involving the family in the treatment plan, when indicated. There is also a requirement that the patient’s record shall contain documentation of family member’s involvement in the patient’s treatment program. If appropriate, a separate record may need to be maintained on each family member involved in the patient’s treatment program.
4.2.2  Detailed Description of Family Therapy in Treatment Plan. Family therapy is an integral part of the treatment of children and adolescents and should be included in all mental health treatment plans unless circumstances exist which make such treatment contraindicated. Treatment plans must provide rationale for why such therapy is not being provided. In all cases, this is an issue subject to medical review, dependent on the needs of the individual patient.
4.2.3  Family is Geographically Distant from the Child. If the family is not in the area, the patient may not be a candidate for partial care as individuals in this program return to their home setting daily, and effective family interaction is essential. If an RTC accepts a child for admission whose parents are geographically distant, the facility must document its plans for including the family in therapy, in accord with RTC standards and the appropriate medical care standard. If one or both parents reside a minimum of 250 miles from the RTC, the RTC has the flexibility of setting up therapy with the parents at the distant locality, while the child is in treatment in the RTC. Additionally, the RTC may elect to provide family therapy via Telemedicine in accordance with existing Telemedicine requirements (see Section 22.1). The parent’s therapist and child’s therapist must collaborate in all cases. Collaboration between therapists is the responsibility of the RTC and must be documented in the medical records.
4.2.4  Geographical distance of the patient’s family is not considered an appropriate reason to exclude the family from the treatment plan. By accepting a child for admission, the RTC or Partial Hospitalization Program (PHP) is acknowledging that it can provide the specific treatment appropriate to the individual child’s needs and is responsible for taking only those children whom it feels it can help through the development of an appropriate treatment program designed to maximize the patient’s ability to function in one or more major life activities.
4.2.5  Circumstances Where Family Therapy is Inappropriate. If family therapy is inappropriate due to the particular circumstances of the case, supporting documentation and rationale must be provided in the treatment plan. An example of such circumstances might include not returning to the family unit following treatment. Authorization shall be denied for RTC care if the patient’s treatment plan does not address the provision of family therapy.
4.2.6  The contractor shall notify the Government Designated Authority (GDA) if it finds that a facility’s treatment planning demonstrates a pattern of failure to provide for family therapy, as this constitutes a violation of the standards and may reflect domiciliary care.
5.0  EFFECTIVE DATE
Removal of quantitative limits on mental health care, October 3, 2016.
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