Couples and Family Therapy CPT Codes for Billing

Looking for couples and family therapy CPT codes, such as the CPT code for couples psychotherapy for billing? 

One of the most common topics of my therapist coaching consultations is how to bill for couples therapy and family therapy using CPT codes. 

FAQ on billing for couples and family therapy

If you’re wondering how to bill for couples therapy and family therapy, these frequently asked questions about couples and family therapy CPT codes, including the CPT code for couples psychotherapy, may be helpful. 

Do insurance plans cover couples and family therapy?

When considering how to bill for couples therapy and family therapy, my experience is that most health insurance plans include coverage for these services. However, that said, it’s important to avoid making assumptions. 

For example, one client with Blue Cross Blue Shield insurance coverage may have couples and family therapy benefits included in their plan, while another client with Blue Cross Blue Shield coverage might not.

I recommend that you call the client’s insurance payer directly to verify that couples and family therapy is covered. 

If couples and family therapy sessions 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. 

In this case, 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. 

When you call the insurance payer to check coverage, rather than asking if they cover couples or family counseling—which may sound personal-growth-oriented to the insurance company—instead 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 choose the client with the more severe symptoms to be the identified patient. Or,if you might choose the client who is the primary holder of their insurance.

Put the name of your IP 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. Put only your IP’s diagnosis on the claim. 

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?  

When trying to determine which couples and family therapy CPT codes to use, no, 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 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 identified patient. 

For example, if your client is a child and you bring his or her 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. 

All that said, in most cases, you should primarily use code 90847 for ongoing couples or family therapy with the identified patient present.

When I see a couple, can I bill each of their insurance plans for a 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, 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?  

I have never found this to be a problem, as long as couples counseling is a covered benefit for the particular insurance plan. 

Of course, 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 (e.g., a child covered by both parents’ plans, or a wife covered by her own plan and her husband’s)?

Billing insurance for clients covered by multiple plans can be complicated. You’ll need to contact the insurance plans involved and figure out which plan is primary, bill that plan first, and then bill the secondary plan, enclosing a copy of the Explanation of Benefits (EOB) from the primary plan which outlines how much they paid. 

Therapists who use SimplePractice as their EHR 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 identified patient (IP) alone for an individual therapy session, use a psychotherapy CPT code as you would for an individual therapy session (e.g. CPT codes 90832, 90834, or 90837). 

If you see one of the IP’s family members alone for an individual session, you would continue to list your IP as the patient on the claim form, but use the 90846 CPT code, which is for “family/couples therapy without patient present,” as I mentioned earlier.

What is the time length on the 90847 or 90846 couples/family therapy CPT codes?

These couples and family therapy CPT codes historically had no time length, but in 2016, the AMA clarified that these sessions were 50 minutes long. 

Alas, there is no way to indicate on a claim that a session was longer than 50 minutes. If couples and family therapy are covered under a particular insurance plan, the plan will typically pay the therapist the same amount for a couples/family session, whether it lasts 50 minutes or two hours. 

However, this does not prevent therapists from contracting directly with the client to pay for the extra time. Be sure to do this with the client 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, read my post on Billing Best Practices for Extended Therapy Sessions.

A final thought: Many insurance plans reimburse at a higher rate for couples and family therapy sessions and for couples and family intake sessions than for individual therapy. With that in mind, you might consider charging more for these services.  

Sources

• American Psychological Association (APA) Office of Health Care Financing, Practice Update, November 17, 2016, Psychotherapy coding clarifications, telemedicine code modifier added to CPT manual: The American Medical Association revises coding manual for 2017.

• 

How SimplePractice streamlines running your practice

SimplePractice is HIPAA-compliant practice management software with everything you need to run your practice built into the platform—from booking and scheduling to insurance and client billing.

If you’ve been considering switching to an EHR system, SimplePractice empowers you to streamline appointment bookings, reminders, and rescheduling and simplify the billing and coding process—so you get more time for the things that matter most to you.

Try SimplePractice free for 30 days. No credit card required.

READ NEXT: Couples Therapy Questions for Better Understanding, Communication, and Connection