We can relate to your level of frustration when your claims are denied despite providing vital mental health services. Couples therapy is among the least understood areas in mental health insurance, causing couples therapists to miss out on income. Therapists are often unaware of individual therapy CPT codes when both clients are present, or are unaware of the CPT 90847 time range requirements.
To safeguard your income, you must be aware of family therapy billing guidelines and couples therapy CPT codes. In this guide, we will walk you through everything you need to know about CPT codes for couples counseling.
What are the CPT Codes for Couple Therapy
As far as insurance billing, couples therapy is considered family psychotherapy. One individual needs to be designated as the identified patient, i.e., the individual who presents the diagnosis that meets the medical necessity, and for whom the claim is filed. The other individual will be the patient’s partner/spouse and will be present to assist with treatment. Here are the CPT codes for couples therapy that must be understood:
CPT Code 90847
CPT code 90847 is used for family or couple psychotherapy when the patient is present along with the partner. This code is most frequently used in couples therapy. The time duration of the session must be 50 minutes. Once 26 minutes, which is half of 50 minutes, have passed, it is possible to bill one unit according to CPT time rules.
The focus of therapy is on the interaction and relationship dynamics of the couple, not on the symptoms of the individual patient. Moreover, the identified patient (the partner with the mental health issues) must be present in the therapy session.
For example, Sarah is an identified patient with a diagnosis of Generalized Anxiety Disorder. She comes in with her partner, Michael, for a session to focus on how anxiety is affecting their relationship. The session is 50 minutes long. In this case, the bill is CPT 90847.
CPT Code 90846
This code is utilized if the individual is part of the patient’s family or the patient’s partner who is there to support the patient’s treatment, but the patient is not in the room. But the focus is on the treatment of the identified patient.
For example, the identified patient is Sara, but her husband, Michael, comes alone to the session. The focus of the session is on how to support Sarah’s exposure exercises and how to minimize her accommodation responses. In this scenario, bill CPT Code 90846.
Individual psychotherapy codes like CPT 90837 should not be used for couple therapy sessions. These codes are utilized for a one-to-one psychotherapy service where the focus is not the treatment of the relationship but the treatment of the individual.
Couples Therapy vs. Individual Therapy CPT Codes
One of the most common and most costly billing mistakes for mental health professionals is using the incorrect CPT code due to a change in the format of the session. Understanding the differences between Couples Therapy CPT Codes and individual therapy CPT codes is not only about compliance, but also about accurately reporting the work you have done.
| Feature | Couples therapy CPT codes | Individual therapy CPT codes |
| CPT code | 90847 ( 50 minutes). | 90834 (45 min) or 90837 (60 min). |
| Who Attends? | Identified patient + partner/spouse. | Identified patient only. |
| Focus | Relationship, communication, and interaction patterns. | Individual symptoms, diagnosis, and personal treatment goals. |
| Diagnosis | Yes, for the identified patient. | Yes, for the patient. |
| Time span | Approximately 45-50 min. | 38-52 min (90834) or 53+ min (90837). |
| Documentation Focus | Relational interventions. | Individual interventions. |
Family Therapy Billing Guidelines
These steps illustrate how most payers handle family psychotherapy claims, allowing you to go effortlessly from the initial consultation to payment.
Identify the Identified Patient
In medical billing for couples therapy, insurance companies require a Primary Patient model. This means that in couples therapy, one of the spouses must be designated as having a formal diagnosis, such as Major Depressive Disorder or Generalized Anxiety Disorder, to justify medical necessity.
All documentation, treatment plans, and progress notes must be written with an emphasis on this individual’s treatment needs, demonstrating how the other partner contributes to the treatment of the primary patient.
Verify Insurance Benefits
When confirming the benefits for these services, it is important to ask about “family psychotherapy coverage” rather than “couples counseling” to avoid an immediate denial due to restrictive language. It is essential to verify whether CPT 90846 and 90847 are included in the member’s specific plan, in addition to whether there are any annual session limitations or any prior authorizations that could cause a delay in service.
It is also essential to clarify the patient’s financial responsibility, including their specific copay or coinsurance. For telehealth services, it is essential to verify the current telehealth regulations, including having the appropriate place of service codes, including GT or 95 modifiers.
Appropriate Code Selection
Is the identified patient physically present in the session?
- If yes, use CPT code 90847.
- If no, use CPT code 90846.
Assign the Diagnosis Correctly
When making the claim for reimbursement, only the Identified Patient’s diagnosis must be reported, which is typically located in the ICD-10 F Chapter (Mental and Behavioral Disorders). It is necessary to note that there is no such code as “F-code” that equates to “Couples Therapy”; rather, the code is based on the mental or behavioral disorder of the individual.
Although some payers allow Z-codes to be listed as secondary and provide context for relationship and family problems, using only the Z-code will deny the claim. To establish medical necessity to ensure reimbursement, a billable mental health diagnosis is required as the primary code.
Document for Medical Necessity
To make sure your claim is of the highest standard for medical necessity, your documentation should clearly show how each session helps in meeting the clinical goals of the identified patient. Each note should include an explicit mention of all the people who attended, their roles, and the start and stop times to verify the service provided.
It should also include the specific therapeutic interventions used, showing their direct connection to the patient’s treatment, in addition to showing the patient’s response to the intervention and the therapist’s strategy for future sessions.
Submit the Claim Correctly
To ensure that payment is sent on the first submission, you must always enter the identified patient’s demographic information in the patient fields. Also, you must include the correct family psychotherapy code (90847 or 90846) along with a billable clinical diagnosis.
For virtual sessions, it is also important that you verify that you have identified the correct Place of Service (POS), as well as attaching any necessary telemedicine modifiers (such as 95). For dual coverage, it is also crucial that you include the secondary claim along with the primary plan’s EOB.
Monitor the Claim Status
Maintain vigilance by tracking claim statuses and responding to any denials promptly. When a refusal occurs, closely compare the reason code to your documentation to ensure medical necessity and coding compliance.
Reimbursing Couples Therapy via Telehealth
How to Verify Coverage
As requirements are not uniform, it’s always a good idea to check the specific telehealth policies for a payer through these sources:
- Policies or Telehealth sections of websites such as Aetna, Cigna, UHC, BCBS, etc.
- Payer-specific official medical library or resource manuals.
- Utilize resources like Availity if the payer maintains this information on the clearinghouse websites.
Billing Codes & Modifiers
The use of Place of Service (POS) with modifiers identifies to the payer the exact place of the patient and the type of session conducted.
| Payer Type | Place of service(POS) | Required Modifier |
| Commercial Plans | 10 ( patient at home) 2 (patient not at home) | 95 (Real-time audio/video) |
| Medicare | Use the POS code for an in-person visit | 95 (To indicate telehealth) |
| Medicare Advantage | Some follow Commercial; others follow Medicare | 95 |
It is always important to double-check the Medicare Advantage plans, which most often differ from standard Medicare requirements in favor of commercial requirements.
Common Denial Reasons
- Service not covered: marriage counseling.
- Missing/incorrect telehealth modifier.
- Z-code used as primary diagnosis.
- Billing both partners’ insurance for one session.
- Same-day billing of 90837 + 90847 without justification.
Frequently Asked Questions (FAQs)
Q1: What should be included in the documentation to bill couples therapy?
Ans. Documentation should include:
- The CPT code.
- The Patient’s diagnosis.
- A short medical necessity covering every minor detail.
- List all participants and the clinical value of their presence.
- Time started and finished.
- A paragraph briefly stating why this was family therapy, not family enrichment.
Q2: Does health insurance cover couples therapy?
Ans. Only if billed as family psychotherapy to treat the diagnosed mental health issue of one of the partners.
Q3: Is it okay to bill both partners’ insurance plans for one session?
Ans. No, billing both insurance plans for the same service constitutes insurance fraud and will be denied by both insurance companies.
Q4: Can the relationship Z-code be the primary diagnosis?
Ans. No, the clinical F-code diagnosis of the patient’s mental health issue must be the primary diagnosis.
Final Thoughts
The process of successfully billing for couples therapy services entails changing the paradigm of practice from relationship enhancement to the medical treatment of the diagnosed patient’s mental health condition. The process can be made possible by adhering to the CPT code guidelines of 90846 and 90847 and documenting the medical necessity of the services.