How to Bill Insurance for Couples Therapy with CPT Codes?

If you're a behavioral health professional, it's common for clients to ask about bringing their partner into therapy. Relationship problems often affect a person's mental health, and in some cases, joint sessions can be helpful as part of the treatment process.

However, couples or marriage therapy is not always covered by insurance. Many clients assume that if they're already in individual therapy, adding their partner won't change anything about billing. Later, they may be surprised to learn that they're responsible for a co-pay or even the full cost of those sessions.

For therapists, this can put you in a difficult position. You want to support your client's progress, but you must also adhere to legal and ethical guidelines when it comes to billing. Submitting a claim incorrectly, even with good intentions, can lead to problems with your insurance or license.

This guide will help you understand how to bill insurance correctly when working with couples. It explains what constitutes a covered service, how to use the correct billing codes, and what type of documentation is required. The goal is to provide you with a clear approach that enables you to offer support while adhering to the rules.

Can You Bill Insurance for Couples Therapy?

The short answer is yes, it is possible to bill insurance for couples therapy. However, it’s essential to note that not all insurance plans will cover it. Some policies have specific rules about what kinds of therapy are considered medically necessary.

You can use CPT codes to bill for couples or marriage therapy. As a clinician, you’re already familiar with CPT codes. They’re used to describe the services you provide so insurance companies can pay you. The key is to use the correct code and ensure the session meets the coverage requirements, which we’ll explain further below.

Does Insurance Pay for Couples Therapy?

Insurance doesn’t always cover the cost of couples or marriage counseling. Many insurance plans clearly state that these sessions are not covered under their policies.

Mental Health Laws Don’t Always Apply

Laws such as the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) were enacted to protect access to mental health care. These laws ensure that insurance companies treat mental health in a manner similar to physical health. But they usually apply only when there’s a precise mental health diagnosis. Since couples therapy often doesn’t involve a specific diagnosis, it’s not always covered.

Individual Therapy May Be Covered

If a client is dealing with anxiety, depression, or another mental health condition, and the partner joins to support that treatment, insurance might still help pay for the session. But if the session focuses on the relationship itself and one person’s mental health, then coverage is much less likely.

Be Careful with Billing

Some therapists attempt to classify couples therapy as individual therapy to secure insurance coverage. For example, they might use one partner’s diagnosis to submit the claim, even though both are attending and the session is about their relationship. This is considered insurance fraud, a serious offense that can result in severe consequences.

Always Check the Plan First

Before scheduling a session involving both partners, it’s essential to verify what the client’s insurance covers. Even if the plan includes some couples therapy, they may ask for proof that it’s necessary to treat a mental health condition. It’s better to know the rules up front than deal with denied claims later.

Are There Any Exceptions to Insurance Coverage for Couples Counseling?

In general, most health insurance plans do not cover couples or marriage counseling. Still, there are a few exceptions where coverage might be possible. Therapists should always check state rules and individual insurance policies to avoid any confusion.

When Mental Health Conditions Are Involved

If a couple's issues are directly related to a mental health condition, for example, if one partner is dealing with sex addiction that affects the relationship, there may be a chance for insurance to cover the therapy. However, coverage usually depends on the insurer and requires strong documentation to show that the treatment is connected to a diagnosed mental health issue.

Additional Benefits on Certain Plans

Some insurance plans include couples counseling as an extra benefit. In these cases, clients may need to choose a therapist from an approved provider list. Others may offer reimbursement only after the couple pays out of pocket and submits a claim for reimbursement. Often, the couple must also meet a deductible before the coverage kicks in.

Employee Assistance Programs (EAPs)

Some employers provide limited coverage for couples counseling through Employee Assistance Programs. These programs are meant to support employees' well-being, and therapy that improves personal relationships can sometimes be included, especially if relationship problems are linked to individual issues like depression or addiction. However, EAP coverage is usually short-term and limited to a few sessions.

What About the ACA and Medicare?

The Affordable Care Act (ACA) does not require health insurance plans to cover marriage or couples therapy because it is rarely considered medically necessary. In most cases, "medically necessary" means treating a diagnosed illness or condition.

However, if a person is struggling with mental health disorders such as substance use, mood disorders, or schizophrenia, and their treatment plan includes family or couples sessions, some coverage may be allowed. Medicare Part B may also cover family therapy when it's part of a treatment plan to improve a person's condition. However, restrictions apply, including the type of provider and services covered.

How to Use a CPT Code for Couples Therapy the Right Way?

If you've worked with CPT codes before, you may already be familiar with the specific ones used for couples or family therapy. The main code for couples counseling is 90847, which is used when your identified patient is present during the session. This code enables you to bill insurance for sessions that involve more than one person, such as when a partner joins therapy to support the treatment process.

When 90847 Can Be Used

You can use 90847 for sessions where both your patient and their partner are involved—this is often called conjoint psychotherapy. However, insurance may not always fully cover it. In some cases, it might be covered partly, especially when the therapy is helping to treat a diagnosed mental health condition that one partner has.

Please note that 90847 should only be used when the identified patient (IP) is present during the session. If you're seeing only the spouse or partner without the IP, then use 90846 instead.

Same-Day Sessions

You're allowed to bill 90847 on the same day as an individual session with the same patient, as long as the sessions are separated in time and purpose. For example, a 45-minute individual session in the morning and a couples session later in the day would qualify.

However, please note that you cannot use 90847 for a regular one-on-one session with the patient alone. For that, you'd use a different code, such as 90834 or 90837, depending on the length of the session.

Session Length and Add-On Time

To bill 90847, the session must be at least 26 minutes long. Medicare, for example, requires a minimum of 50 minutes if the patient is covered under their plans.

If the session lasts longer than 74 minutes, you can add extra time using code 99354, which covers an additional 30 minutes. This add-on code works with both 90846 and 90847.

Choosing the Identified Patient (IP)

Before starting couples counseling, it's important to decide who the identified patient will be. This is the person whose mental health diagnosis you'll be treating and whose information will go on the insurance claim.

For example, if your client Becky has been coming in with depression and now wants her spouse to join for support, Becky stays as the identified patient. The diagnosis and documentation will focus on her condition, and you'll use her insurance for billing.

If both partners have mental health concerns, you should select the person whose condition is more severe or who holds the insurance policy, especially if they're married.

Correct Codes for Individual Sessions

If you're seeing the IP alone, use an individual therapy code based on session length:

• 90834 for a 45-minute session
• 90837 for a 60-minute session

If you're meeting with the spouse or partner alone, without the identified patient (IP), use 90846, as this is still considered part of family therapy, just without the IP present.

Final Tip

Using the correct CPT codes is crucial for receiving proper payment and avoiding billing errors. Always double-check the code, document the session clearly, and ensure your billing aligns with the insurance requirements for optimal results.

 

BillingFreedom Offers Expert Billing Services for Couples Therapy and Mental Health Providers

When it comes to couples therapy, knowing when to use CPT code 90847 (with the identified patient present) or 90846 (without the IP) is crucial. Even minor billing errors can result in rejected claims or compliance issues.

At BillingFreedom, we help ensure every session is coded and billed correctly, including sessions that overlap with individual therapy. You provide the care. We handle the codes.

Mental Health Billing Is All We Do - And We Do It Right

• 100% focus on behavioral and mental health providers
• Experts in CPT code compliance and documentation
• Faster claims. Fewer rejections. Better cash flow.
• Personalized support for private practices and group clinics

BillingFreedom stays updated on the latest regulations, including how to handle sessions tied to specific mental health diagnoses that may affect a relationship. We’ll guide you on what’s billable, what’s not, and how to protect your practice.

BillingFreedom Knows the Exceptions and How to Bill for Them

Sometimes, couples therapy may be covered if it’s part of treating a mental health condition like addiction or depression. Our team helps you:

• Determine the right identified patient
• Meet documentation requirements
• Submit claims under the correct codes and provider
• Stay compliant with Medicare, private insurance, and EAP guidelines

Let BillingFreedom Handle the Rest

You became a therapist to help people, not to chase down insurance payments. With BillingFreedom, you can stop worrying about:

• Coverage questions
• Time-based billing codes
• Denied claims
• Audit risks

We take the billing burden off your shoulders so you can focus on your clients.

Partner With BillingFreedom, The Mental Health Billing Experts

Whether you’re offering couples therapy, individual counseling, or family sessions, BillingFreedom helps you get paid faster, stay compliant, and avoid common billing mistakes.

Schedule your free consultation with BillingFreedom today and experience stress-free billing support tailored for mental health providers.

 

FAQs

Why Can't I Bill Both Partners' Insurance for the Same Session?

Submitting claims to each partner's insurance for a joint session is considered double billing, which is classified as insurance fraud. You are only permitted to bill one insurance policy for the service. BillingFreedom helps mental health providers stay compliant by accurately managing claims and protecting their practices from legal and financial risks.

What If a Patient Has Dual Coverage?

When a client is covered under two insurance policies, such as their own and their spouse's, you cannot bill both for the same session. BillingFreedom determines the primary insurance and files claims properly, reducing confusion and avoiding errors that can lead to denied reimbursements.

Can a Client Be Covered for Both Individual and Couples Therapy?

A patient who qualifies for individual therapy does not automatically receive coverage for couples counseling. BillingFreedom assists you in providing the necessary documentation, including treatment plans and clinical justification, to help support medical necessity and improve the chances of insurance approval for both services.

How Do I Avoid Coding Errors in My Claims?

With a full client load, it is easy to make mistakes in CPT code selection or documentation. BillingFreedom utilizes advanced billing tools and a trained team to ensure that the correct codes are submitted accurately and consistently. Whether the session involves code 90847 or 90846, we make sure your billing is precise and compliant.

Let BillingFreedom Streamline Your Practice

BillingFreedom specializes in billing services for mental health professionals. Our team understands the complexities of couples therapy billing. It ensures that every claim is handled correctly, allowing you to focus more on your clients and spend less time on administrative work.

For more details about our exceptional medical billing services, please don't hesitate to email us at info@billingfreedom.com or call us at +1 (855) 415-3472. 

Your financial tranquility is our priority!