Contrary to individual patients, billing for couples has its own set of challenges. Healthcare experts often confuse between the couples therapy CPT codes and face claim rejections. Whether you are a new or established practitioner, understanding the right couple therapy codes is crucial to avoid claim denials and get faster payments.
This comprehensive guide will breakdown of Couples therapy CPT Codes and provide tips to avoid denied claims.
Commonly Used Couples Therapy CPT Codes
What are CPT Codes? This question might be messing with your head right? Current Procedural Terminology codes are used to bill the healthcare services given to patients .
Mental health experts playa key role in offering treatment to couples facing emotional challenges in life. Therefore, they strive to provide top quality treatment using their experience. However, lack the same level of expertise when it comes to code these healthcare services.
Here are the Couples Therapy CPT Codes every provider must know
90837 60 minutes Psychotherapy Session
The code reflects 60-minutes therapy sessions for the individuals. Providers use this code in marriage and family therapy if extended session requirements. The healthcare experts must document all the procedures for accurate code assignment to achieve financial growth.
90834 45 Minutes Couple Psychotherapy Session
A Couples CPT Therapy Code 90843 represents the individual counselling for 45-50 minutes. This is a shorter therapy session for married couples and families. Yet again clear documentation of this therapeutic procedure is essential for smooth claim processing.
90487 Family Psychotherapy Sessions
This couples therapy CPT code is assigned when a provider conducts a therapy session for multiple family members during the patient`s presence. The sessions aim to address the aspects that are crucial to a successful marriage.
Providers should use this Couples CPT Therapy Code when the patient is available during therapy sessions. In addition, they must document the number of family members involved in the session.
90846 Family Psychotherapy Session Without Patient
90846 Is used when the therapy session is conducted in the absence of a patient. Experts offer their advice on specific problems that negatively impact an individual`s relationship with his/her family member.
90832 30 Minutes Psychotherapy Session
This Couples therapy CPT Code is assigned when the session lasts for 30 minutes. It is used when an expert interacts with multiple individuals. Accurately documenting the members name is essential and leads to quicker payments.
90839 Psychotherapy For Crises
90839 is the code assigned in case of acute crises that require immediate solutions. Doctors assign this code when patients experience sudden emotional damage. It is important to document details like the nature of emotional crisis, patient mental state and treatment given.
90832-95 Telehealth Services
These codes are assigned against remote/online psychotherapy sessions. It has a modifier 95 that indicates services was given over the call rather than in a physical healthcare facility. Using this code ensures that healthcare experts comply with regulatory guidelines.
90834-52 Lower Services Time
This Couples Therapy CPT Code indicates shorter sessions with duration of less than 50 minutes. The 52 modifier explains that the session lasted only for 30-40 minutes.. Providers should mention the reason for such a short session to get the reimbursement.
In addition, experts must stay updated with current coding guidelines to ensure accurate code assignment every time services are rendered. You can also coordinate with Paymedics for expert medical coding services, free yourself from administrative burden and offer top quality patient care.
Couples Therapy Insurance Coverage
Insurance payers don’t offer coverage for the couple therapies considering them a relationship counselling rather than a medical necessity. They instruct providers to bill couple therapies only when it negatively impacts mental health.
According to MHPEA (Mental Health Parity and Addiction Equity Act), couple therapy sessions are a medical necessity, therefore, should be covered like other health-related conditions. However, insurance payers often consider it as a personal issue rather than a medical issue.
MHPAEA also restricts providers to impose limitations on co-pays for therapies. While these instructions are valid in case of a mental health emergency rather than personal growth counselling session.
Exceptions for Couples Therapy Insurance Coverage
As mentioned above, there are various exceptions where couples therapy comes under the insurance coverage.
- PTSD: When a patient is experiencing PTSD (Post Traumatic Stress Disorder) or a depression that can damage his relationship, the couple therapy session will come under the insurance coverage.
- ACA Compliance Plans: Here are the other reasons that ACA (Affordable Care Act) considers viable for the insurance
- Sudden Mood Swings
- Drugs
- Schizophrenia
- Employee Assistant Programs: Some companies offer a limited time coverage for the couples therapy as per their EAPs. However, the facility ends very quickly and requires the couple to visit an in-network provider for the therapy sessions.
- Added Benefits: Some insurance plans come with added benefits but clients have to pass the deductibles and submit the claims for reimbursements.
Final Thoughts
Couples Therapy CPT Codes such as 90847,90846 indicate family counselling sessions where providers address the mental health-related challenges. However, understanding these codes is crucial to avoid the claim rejection and get quick payments.
While some payers exclude couple therapy from coverage, considering it a treatment for personal growth. While there are some exceptions where the patients become eligible to receive reimbursements.
Assigning accurate code is a challenging task for healthcare experts who are often busy with patients. At Paymedics, our expert team of coders can help clients in careful code assignment ensuring first-pass claim rate and faster reimbursements.
Frequently Asked Questions
What is the CPT code for couples therapy?
90847 is the code providers assign against providing couples therapy sessions.
What does CPT Codes 99492 and 99494 reflect?
CPT Code 99492 is assigned after providing 70 minutes of session, while providers using 99494 covers only a 60 minute season.
What is the ICD-10 code for couples therapy?
Z63.0 is the ICD-10 code used for a couple therapy to address mental health issues between a couple or family members.
What are the major problems in couples counseling?
Poor communication between couples is the key issue that leads to lacking connection.
Does Medicare cover couples therapy?
Medicare does not offer any coverage for the couples therapy.
