Setting boundaries with insurance companies: A guide to panel management
Summary
Most insurance plans cover couples and family therapy only when treatment is deemed medically necessary for an identified patient with a DSM-5 diagnosis, so therapists should verify benefits directly with the payer before billing.
When submitting claims, use family therapy CPT codes such as 90847 for 50-minute sessions with the identified patient present and 90846 for sessions where the patient is absent.
The CPT code for couples psychotherapy, 90847, should be used for ongoing couples sessions rather than individual therapy codes like 90832, 90834, or 90837, which are reserved for individual or brief family-inclusive sessions.
Therapists should never bill both partners' insurance plans for the same couples session, as this constitutes insurance fraud and risks license revocation.
Questions about how to bill for couples therapy and family therapy using CPT codes are common in therapist coaching consultations.
To help, this couples and family therapy billing FAQ covers the most common scenarios, including family therapy CPT codes and the CPT code for couples psychotherapy.
Do insurance plans cover couples and family therapy?
Most health insurance plans include coverage for couples and family therapy. Your mileage may vary, so it’s important to avoid making assumptions.
For example, a client with Blue Cross Blue Shield insurance coverage may have couples and family therapy benefits included in their plan, while another with the same carrier might not. Call the payer directly to verify that coverage.
If couples and family therapy are covered by insurance, it will only be covered when the plan deems the treatment medically necessary to treat a diagnosis of one member.
These services are typically not covered by insurance when the purpose of therapy is solely relationship growth or communication skills.
That means you’ll need to have someone in the room who is your identified patient (IP) who has a Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnosis, typically something more than a V or Z code. For example, an adjustment disorder is usually covered, if present.
One practical tip when calling the insurance payer: rather than asking if they cover couples or family counseling, which may sound personal-growth-oriented to the insurance representative, ask if the plan covers couples and family therapy CPT codes. Specifically, find out if they cover the CPT code for couples psychotherapy, like CPT code 90847 (couples therapy or family therapy with the patient present) and the 90846 CPT code (50-minute family/couples therapy without the patient present) for a client with a diagnosis.
How is a couples or family session listed on an insurance claim?
Choose one client as your identified patient (IP). If two or more clients have diagnoses, you might select the client with the more severe symptoms as the IP. Or, you might choose 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.
The CPT code 90847 description on the claim reflects a 50-minute couples or family therapy 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), the software creates the insurance claim with just a single click.
Can I use CPT codes 90832, 90834, and 90837 for family sessions?
No, when trying to determine which CPT code for couples psychotherapy or family therapy CPT codes to use, you should not use CPT codes 90832, 90834, and CPT code 90837 for ongoing family or couples sessions.
Before 2016, the official title of these CPT codes was “psychotherapy with patient and/or family member,” which often caused widespread industry confusion.
However, in 2016, the American Medical Association (AMA) clarified that these codes were to be used for individual therapy sessions (30 minutes, 45 minutes, and 60 minutes, respectively), or 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 a family therapy CPT code (90847). The IP has to be present for at least part of the session.
All that said, in most ongoing couples or family therapy situations, CPT code 90847 is the right choice when the identified patient is present.
Can I bill each partner’s insurance plans for the same couples session, or bill each for an individual session?
No, therapists should not bill each partner’s insurance for a couples therapy session or individual therapy session.
This is insurance fraud, regardless of how you use the CPT for couples therapy, as you are charging twice for the same session. Any therapist who does this would risk losing their license.
Will an insurance plan cover a client for couples counseling if he or she is in individual counseling as well?
This is generally not a problem, as long as couples counseling is a covered benefit under the client’s specific insurance plan.
If the insurance plan calls to review your treatment plan, you may need to defend why both types of treatment are medically necessary.
What if the IP is covered by two insurance plans?
Billing insurance for clients covered by multiple plans, for example, a child covered by both parents’ plans, or a spouse covered by their own plan and their partner’s, can be complicated. Contact both insurance plans involved and to determine which plan 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.
Therapists who use SimplePractice as their EHR benefit from 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 a session when I see only one member of the couple or family?
If you see the identified patient (IP) alone for an individual therapy session, use a psychotherapy CPT code as you would for an individual therapy session, for example, CPT codes 90832, 90834, or 90837.
If you see one of the IP’s family members alone for an individual session, you continue listing your IP as the patient on the claim form, but use the 90846 CPT code, which covers family/couples therapy without the patient present.
What is the session length for the 90847 and 90846 CPT codes?
The CPT code for couples psychotherapy and family therapy CPT codes historically carried no time length, but in 2016, the AMA clarified that these sessions were 50 minutes long.
There is no way to indicate on a claim form that a session was longer than 50 minutes. If couples and family therapy is a covered benefit under a particular insurance plan, the plan will typically reimburse the same amount regardless of whether the session lasted 50 minutes or two hours.
That said, nothing prevents therapists from contracting directly with the client to pay for the additional time. Simply make sure this agreement is in writing, established in advance, and only charged the plan’s rate for the time.
For ideas and details on how to get reimbursed for extended sessions, read Billing Best Practices for Extended Therapy Sessions.
Additional frequently asked questions about family therapy CPT codes
What is the most commonly used family therapy CPT code?
CPT code 90847 is the most widely used family therapy CPT code. It covers a 50-minute couples or family therapy session with the identified patient present. Use this code for ongoing couples and family sessions rather than individual therapy codes like 90832, 90834, or 90837.
What is the CPT code for family therapy when the patient is not present?
The CPT code 90846 description identifies it as the correct family therapy CPT code when the identified patient is not in the session. This comes up, for example, when you meet individually with a family member to discuss treatment progress. The IP is still listed as the patient on the claim form.
How do I know whether a client's insurance covers family therapy CPT codes?
Call the payer directly and ask whether the plan covers family therapy CPT codes—specifically 90847 and 90846—for a client with a DSM-5 diagnosis. Avoid asking broadly whether they cover "couples counseling," which insurers may interpret as personal growth rather than medically necessary treatment.
Are family therapy CPT codes different from individual psychotherapy codes?
Yes. Family therapy CPT codes 90847 and 90846 are distinct from individual psychotherapy codes 90832, 90834, and 90837. The individual codes apply to one-on-one sessions or to sessions where a family member participates briefly. When a couple or family is the primary focus of ongoing treatment, the appropriate codes are 90847 (patient present) or 90846 (patient absent).
Sources
American Psychological Association (APA) Office of Health Care Financing, PracticeUpdate, November 17, 2016, Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual: The American Medical Association revises coding manual for 2017.
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