Couples and family therapy CPT codes for billing

Most questions about family therapy CPT codes come down to two things: whether the identified patient is in the session and whether the plan will treat the sessions as medically necessary.

Do insurers cover couples and family therapy?

Many health insurance plans cover couples and family therapy, but coverage varies, so avoid making assumptions. For example, one client with a given carrier may have couples and family therapy benefits in their plan, while another with the same carrier might not. Call the payer directly to verify coverage.

If couples and family therapy are covered, the plan will cover it only when it deems the treatment medically necessary to treat a diagnosis of one member. These services are typically not covered when the purpose of therapy is solely relationship growth or communication skills.

That means you'll need someone in the room who is your identified patient (IP) with a diagnosis from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), typically something more than a Z code. In my experience, an adjustment disorder is usually covered, if present.

One practical tip on how to bill for couples therapy: when calling the payer, rather than asking if they cover couples or family counseling, which may sound personal-growth-oriented to the representative, ask if the plan covers couples and family therapy CPT codes. Specifically, find out if they cover the CPT code for couples psychotherapy, 90847 (with the patient present), and 90846 CPT code (without the patient present) for a client with a diagnosis.

How do couples sessions appear on claims?

Here’s how to bill for couples therapy when two people attend: choose one client as your IP.  If two or more clients have diagnoses, you might select the client with the more severe symptoms, or the client who is the primary holder of their insurance.

List the IP's name on your superbill or invoice, or in Box 2 of the CMS-1500 under "Patient's Name." The name of the primary holder of the insurance goes in Box 4, "Insured's Name."

On the claim, report 90847, the CPT code for couples psychotherapy, for a couples or family session with the patient present. The names of other session attendees are not listed on the claim, and only the IP's diagnosis should appear.

For therapists using SimplePractice as their electronic health record (EHR), SimplePractice creates the insurance claim from your session details once the client's insurance information and a diagnosis code are on file.

Can individual psychotherapy codes bill couples sessions?

No. For ongoing couples or family sessions, use 90847 instead of 90832, 90834, or 90837. Through 2016, the official title of those individual psychotherapy codes was "psychotherapy with patient and/or family member," which caused widespread confusion.

Starting January 1, 2017, the American Medical Association (AMA) revised the descriptors to read "with patient" and clarified that these codes are for individual therapy sessions: 16–37 minutes for 90832, 38–52 minutes for 90834, and 53 minutes or longer for 90837. They can also be used when the therapist brings a family member intermittently or briefly into ongoing sessions with the IP.

For example, if your client is a child and you bring a parent in for the final portion of the session, or once a month to update the parent on the child's progress, these codes could be used instead of family therapy CPT codes such as 90847. The IP has to be present for all or most of the session.

In most ongoing couples or family therapy situations, 90847, the CPT code for couples psychotherapy, is the right choice when the identified patient is present.

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Can I bill both partners' insurance?

No. Billing each partner's insurance for the same couples session, or billing each partner for an individual session, is double billing because you are charging twice for the same session. This can be treated as insurance fraud, whichever family therapy CPT codes you use, and therapists who do it risk losing their license.

Is couples therapy covered alongside individual therapy?

In my experience, this is generally not a problem, as long as family therapy CPT codes are a covered benefit under the client's specific insurance plan. If the plan calls to review your treatment plan, you may need to defend why both types of treatment are medically necessary.

What if the patient has two plans?

Billing family therapy CPT codes for clients covered by multiple plans can be complicated. Examples include a child covered by both parents' plans or a spouse covered by their own plan and their partner's. Contact both plans to determine which is primary, bill that plan first, and then bill the secondary plan along with a copy of the Explanation of Benefits (EOB) outlining how much the primary plan paid.

In SimplePractice, you can create and submit secondary claims electronically. If you're enrolled to receive Payment Reports from the primary payer, the primary payment details populate the secondary claim automatically. Otherwise, you enter them manually from the EOB.

How do I code a one-person session?

If you see the identified patient alone, use an individual psychotherapy code rather than 90847, the CPT code for couples psychotherapy, for example 90832, 90834, or 90837.

If you see one of the IP's family members without the IP, you continue listing the IP as the patient on the claim form but use the 90846 CPT code, the family therapy CPT code for sessions without the patient present. The session has to serve the IP's treatment. If a family member wants their own therapy, they become a separate client with their own diagnosis.

How long are 90847 and 90846 sessions?

Family therapy CPT codes 90847 and 90846 list 50 minutes in their descriptors as of the AMA's 2017 CPT revisions. Sessions of at least 26 minutes can be reported, but shorter sessions cannot.

There is no way to indicate on a claim form that a session was longer than 50 minutes. In my experience, if couples and family therapy is a covered benefit under a particular plan, the plan will typically reimburse the same amount whether the session lasted 50 minutes or two hours. The prolonged-service add-on codes 99354 and 99355 were deleted on January 1, 2023, so they are no longer an option.

You may be able to contract directly with the client to pay for the additional time, but check your health plan contract first for anything that forbids it. Make sure any agreement is in writing and established in advance.

For ideas and details on how to get reimbursed for extended sessions, read How to bill insurance for extended therapy sessions.

More couples and family billing questions

Are same-day family and individual sessions billable?

Yes, when the services are separate and distinct. According to the American Psychological Association (APA), family therapy CPT codes 90846 and 90847 can be reported on the same day as individual psychotherapy codes such as 90832, 90834, and 90837 under that condition. Check each payer's policy, and document the two sessions separately.

What if neither partner has a diagnosis?

Insurers pay for family therapy CPT codes when the sessions treat an identified patient's diagnosis, so sessions focused only on the relationship generally aren't billable to insurance. Clients can pay privately, and out-of-network clients can request a superbill, though a superbill doesn't guarantee reimbursement. For more on coverage, see our guide on couples therapy and insurance..

Does Medicare cover family therapy?

Medicare covers family therapy CPT codes 90846 and 90847, with or without the patient present, when the service is medically reasonable and necessary and treating the patient is the primary purpose.

Sources

• American Psychological Association Office of Health Care Financing. (2016). Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual. PracticeUpdate.

• National Uniform Claim Committee. (2012). 1500 health insurance claim form reference instruction manual for form version 02/12.

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