Billing for couples therapy is one of the trickiest parts of running a successful practice. Insurance coverage and coding are more predictable in individual therapy. However, couples therapy billing is in a grey area, and some insurance companies might cover it, whereas others might not. It is like a jigsaw puzzle for mental health professionals!
In this blog, we will simplify things for you and provide you with all the tools you need to bill confidently and correctly. In this blog, we will cover the basics of CPT codes such as 90847 and 90846, and provide you with the best strategies to help you maximize your billings and avoid common pitfalls.
What Is Couples Therapy Billing?
Couples therapy billing involves using specific CPT codes to bill insurance for relationship or marriage counseling. It requires designating one partner as the identified patient with a qualifying mental health diagnosis. It is because the insurers usually require medical necessity for coverage.
Good couples therapy billing is all about clarity and respect. It makes sure that clients understand what they are being charged for and that documentation accurately reflects the work done. Accurate billing builds trust with clients and keeps your practice financially healthy.
Key CPT Codes for Couples and Family Therapy Sessions
The CPT codes are essential for smooth billing and insurance reimbursement. These codes help insurers understand exactly what kind of service was provided. They also make sure that your practice gets accurately compensated for the care you deliver.
- CPT Code 90847: Couples or Family Therapy with Patient Present
- CPT Code 90846: Couples or Family Therapy without Patient Present
When to Choose 90847 vs. 90846
90847 – With Primary Patient Present
Select this code when the identified patient is physically present for the session. It covers sessions where the therapy directly involves both the patient and their partner/family members.
90846 – Without Primary Patient Present
This code is appropriate when the patient is not in the room. But family members participate to support treatment goals. It is often used for sessions that aim to enhance the patient’s care plan through family or partner involvement.
Session Timing and Add-On Codes
- Standard sessions for 90846 and 90847 should last at least 26 minutes
- For longer sessions: Add-on code 99354 can be used for extended time beyond 74 minutes
- Medicare guidelines call for a minimum of 50 minutes of session time to qualify under these codes
Does Insurance Cover Couples Counseling?
One of the common questions regarding couples therapy billing is whether the sessions are going to be covered. The answer to this question is a little tricky, but it depends upon the insurance provider and the insurance policies they are offering. Pure couples counseling is rarely covered under any health insurance plan. Here is why it is not covered:
- Insurance companies typically pay for the treatment of a diagnosable mental health condition in one individual. Pure marriage counseling for improving communication and resolving conflict often gets coded as a Z-code. The insurers usually don’t reimburse Z63.0.
- Many plans do cover couples sessions if they are tied to treating one partner’s diagnosis. The therapist designates the person with the condition as an identified patient. The partner attends the session to help support their treatment plan.
Quick Reality Check: When Coverage Is More Likely
- ACA health insurance plans might cover couples therapy if it specifically helps treatment for conditions such as the following:
- Drug abuse or alcoholism
- Mood disorders
- Schizophrenia
- Laws like the Mental Health Parity Act help ensure mental health services get equal treatment to physical ones. But they do not force coverage for non-diagnostic relational work.
- Check for an Employer Assistance Program if a standard health plan denies coverage. Many employers offer a set number of free couples therapy and counseling sessions.
When It Is Usually Not Covered:
- Sessions aimed solely at relationship goals without linking to an individual’s symptoms.
- Medicare often limits it to medically necessary treatment for a diagnosed condition.
- Some plans explicitly exclude “marriage counseling” or require prior authorization.
Best Practices For Couples Therapy Billing:
Billing for couples therapy is more involved than just sending in the claims. Good billing procedures can eliminate headaches for you and your clients and make them more comfortable with the financial aspect of therapy. Here are some best practices for couples therapy billing:
Identified Patient (IP):
Most insurance companies require a designated patient with a diagnosis and treatment plan. Be sure to have documentation of how the therapy session will contribute to the patient’s care in detail.
Correct CPT Codes:
Using the right CPT codes is critical for successful reimbursement for couples therapy services. Be sure to utilize the correct family therapy codes for couples therapy.
Insurance Benefits:
It is important to check the insurance benefits prior to therapy, as different insurance plans cover different services for couples therapy.
Detailed and Ethical Documentation:
Documentation of therapy sessions is important to show the medical necessity of the therapy service, as well as to protect your practice in case of audits. Ensure that you have detailed documentation of the therapy sessions and the relationship of the therapy sessions to the treatment plan.
Billing Policies and Client Education:
Educate your clients regarding your billing policies in detail, ensuring they are comfortable with the process and costs involved in couples therapy services.
Offer Flexible Payment Options When Needed:
Many couples therapy sessions are not fully covered by insurance, so offering a discounted fee for self-pay clients can make therapy more accessible.
Stay Updated on Insurance and Compliance Guidelines:
Billing regulations are subject to change, so staying current on insurance requirements helps ensure your billing process remains accurate and compliant.
Couples Therapy Billing: Examples and Practical Scenarios
The following are some practical scenarios that will help you with couples therapy billing:
Scenario 1: The Collaborative Session (IP Present)
Sarah is diagnosed with a major depressive disorder. Her husband accompanies her to the session, which lasts 50 minutes. The goal is to help the husband understand the triggers and the ways to work with his wife.
- Coding: You would bill 90847.
- Reason: Sarah is the Identified Patient. And she is physically present for this conjoint session. CPT 90847 is the most accurate way to describe the service to the insurance provider.
Scenario 2: The Support System Strategy (Partner Attends Alone)
Sarah’s husband schedules a session to meet with you privately. He needs specific guidance on how to help Sarah navigate a particularly difficult week of symptoms. But Sarah is not up for attending that day.
- You would bill 90846.
- Explanation: Even though the session is for Sarah’s benefit and supports her treatment plan but the IP is not present. This code allows you to bill for the time spent with her support system without misrepresenting who was in the room.
Scenario 3: Shifting Back to Individual Work
You see Sarah for a standard 45-minute individual check-in later that month. Her husband is not involved in this visit. The focus is solely on her personal coping skills and medication management.
- You would bill 90834.
- Justification: This is a classic individual psychotherapy session. You use Sarah’s primary diagnosis of depression and the time-based code that corresponds to a 45-minute encounter.
Couples Therapy Billing CPT Codes Table
Here is a table of CPT codes commonly used in couples therapy billing. These are the codes therapists typically use when billing insurance or documenting services.
| CPT Code | Description | Typical Usage |
| 90847 | Family/Couples Psychotherapy with the patient | Used for standard and 50-minute joint sessions |
| 90846 | Family/Couples Psychotherapy without the patient | Used when meeting with a partner/family member alone |
| 90840 | Add-on Code (Crisis) | Used with 90839 for extended and intense sessions |
| 99354 | Add-on Code (Extended Time) | Used for sessions lasting 80-124 minutes |
Final Thoughts!
The key to easier couples therapy billing is having a system in place that works. This means using the correct CPT codes and making sure the patient is identified when billing insurance and documentation is accurate. This means that couples therapists can focus on their patients instead of getting bogged down with the details.
This is where Paymedics can help make a real difference in your life. Our team is dedicated to providing medical billing services that are tailored to the unique needs of healthcare providers such as yourself.
Frequently Asked Questions
Is there a specific CPT code for a 90-minute couple session?
There is no standalone code for longer sessions. You would bill 90847 and then use the add-on code 99354 if the session exceeds 74 minutes. These also depend on the payer’s rules.
Can I bill for telehealth couples therapy?
For telehealth couples therapy billing you can utilize the CPT codes 90847 and 90846. However, it is essential to ensure that you utilize the -95 modifier and the Place of Service code.
What do i do if my claim is denied due to medical necessity?
It is essential to review your notes. Ensure you have clearly documented how the partner’s involvement is directly helping the IP manage their symptoms.
Why do some plans require Prior Authorization for 90847?
Some payers view couples’ work as “higher level” care or elective. Always verify if an authorization is needed before the second session to avoid unpaid claims.
Can I bill 90837 and 90847 on the same day?
Only if they are separate and distinct sessions. For example, if you see Sarah for individual work in the morning and Sarah and her husband in the evening. You would likely need a -59 modifier.
Can I bill 90837 for couples?
90837 is not for couples therapy billing. This is an individual code and using it for conjoint sessions can be flagged as insurance fraud during an audit
Why do physiotherapy clinics outsource billing services?
Many clinics bring in someone to handle the billing, including couples therapy billing. This minimizes the workload and aids in faster payment as the therapists focus on the patients.
Do both people get charged in couples therapy?
Insurance typically only allows you to charge one “Identified Patient” per session. Only one person who benefits is billed.
