How to Navigate Billing for Couples and Family Therapy

One of the most common topics of my consultations is how to bill for couples and family therapy. Here are some frequently asked questions:

Do insurance plans cover couples and family therapy?

My experience is that most do, but don’t make assumptions (ex. one client with ABC insurance may have this benefit and another might not). I recommend that you call the payer directly to verify that this type of service is covered. If it is covered, it will only be covered when the plan feels the treatment is medically necessary to treat a diagnosis of one member, not aimed solely at relationship growth or communication skills. Therefore, you’ll need to have someone in the room who is your identified patient (IP) who has a diagnosis (something more than a Z-code – an Adjustment Disorder is usually covered, if present). So, when you call to check coverage, don’t ask if they cover couples or family counseling, which to them may sound oriented to personal-growth ) – ask if the plan covers CPT codes 90847 (family/couples therapy with client present) and 90846 (family/couples therapy without client present) for a client with a diagnosis.

How is a couples or family session listed on a claim?

Choose one client as your identified patient – if two or more clients have diagnoses, you might choose the one with the more severe symptoms. If one client is the primary holder of their insurance you might choose him/her. Put the name of your IP on your superbill/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). The CPT code 90847 on the claim reflects a couples or family session therapy session. The names of other session attendees are not listed on the claim. Put only your IP’s diagnosis on the claim. For those of you that use SimplePractice, this can be done automatically. SimplePractice creates the claim with just a single click!

Can I use CPT codes 90832, 90834, and 90837 for family sessions?  

Not for ongoing family or couples sessions.  For a period of time it got confusing when the title of these CPT codes was “psychotherapy with patient and/or family member.”  However, it was clarified by the AMA in 2016 that these codes were to be used for individual sessions (30 minutes, 45 minutes, and 60 minutes respectively), or when you bring a family member intermittently or briefly into your ongoing sessions with the identified patient. For example, if your client is a child and you bring his 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 a family therapy code (90847). The IP has to be present for part of the session. However, I repeat: use code 90847 instead for ongoing couples or family therapy.

When I see a couple, can I bill each of their insurance plans for a couples session, or bill each for an individual session?

Not unless you want to risk losing your license. This is insurance fraud, as you are charging twice for the same session.

Will an insurance plan cover a client for couples counseling if s/he is in individual counseling, also?  

I have never found this to be a problem, as long as couples counseling is a covered benefit. Of course, if the plan calls to review your treatment, you may need to defend why both types of treatment are medically necessary.

What if the IP is covered by two insurance plans (ex. a child is covered by both parents’ plans, or a wife is covered by her own plan and her husband’s)?

This can be complicated. You’ll need to contact the insurance plans involved and figure out which plan is primary, bill that plan first, then bill the secondary plan, enclosing a copy of the Explanation of Benefits (EOB) from the primary plan which outlines how much they paid (to learn more about double coverage, get my book). SimplePractice customers get the benefit of a system that manages secondary claims automatically – there’s no additional information you have to pass on to the secondary payer.

How would I code it if I saw one member of the couple or family alone one time?

If you see the IP alone, use a psychotherapy CPT code as you would for an individual session (e.g. 90832, 90834, or 90837). If you see a non-IP family member alone, you continue to list your IP as the patient on the claim form, but use CPT code 90846, which as was mentioned, is for “family/couples therapy w/o patient present.”

What is the time length on the 90847 or 90846 Couples/Family Therapy CPT Codes?

These codes historically had no time length, but in 2016 the AMA clarified that these sessions were 50 minutes long. And there is no way to indicate on a claim a longer session. If couples/family therapy is a covered benefit, the plan will typically pay the same amount for a couples/family session that lasts 50 minutes or 2 hours. However, this does not preclude you from contracting directly with the client to pay for the extra time, but you need to do so in writing, in advance, and only charge the plan’s rate for the time. (For ideas and details on how to  get reimbursed for extended sessions, click here to read my post on Billing for Extended Sessions.)

A final thought: Many insurance plans reimburse at a higher rate for couples/family therapy and for intake sessions than for individual therapy. You might want to charge more for these services.  

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