Billing for couples therapy can often feel confusing and complex. Many mental health providers struggle with questions about insurance coverage, the correct CPT codes to use, and how to handle billing when clients receive both individual and couples therapy. Having a clear understanding of these topics is essential for maintaining smooth billing practices and avoiding claim denials. If you provide couples counseling as part of your practice, knowing how to navigate insurance reimbursement and documentation requirements will help you run a more efficient and financially stable practice.
In this post, we will cover the most important information you need to know, including whether insurance will cover couples therapy, the appropriate CPT codes to use for couples counseling, how to bill when a client is participating in both individual and couples therapy, and documentation tips to maximize reimbursement. Let’s explore these topics in detail.
Will Insurance Cover Couples Therapy?
The straightforward answer is that insurance coverage for couples therapy is generally limited and varies significantly depending on the client’s insurance plan. Most insurance companies do not provide coverage for therapy sessions that are solely focused on improving the relationship or marital counseling unless there is a diagnosable mental health condition affecting one of the partners. To maximize the chances that insurance will cover couples therapy, providers need to:
- Identify one partner as the primary client with a valid diagnosis
- Document how the therapy is medically necessary to address that client’s mental health symptoms
- Use treatment plans that clearly link the couples sessions to the client’s clinical needs
It is important to understand that many insurance plans explicitly exclude coverage for:
- Pre-marital counseling
- General relationship coaching
- Couples therapy focused purely on communication enhancement without an underlying mental health diagnosis
When verifying benefits with insurance carriers, always ask:
- If CPT code 90847 is covered
- What conditions or restrictions apply to that coverage
Setting accurate expectations with your clients upfront helps prevent confusion and surprises later.
What CPT Codes Should You Use for Couples Counseling?
When billing for couples therapy, the most commonly used CPT codes are:
- 90847: Family or couples psychotherapy with the identified client present
- 90846: Family or couples psychotherapy without the identified client present
In most couples therapy sessions where both partners are present and one partner is the identified client with a diagnosis, CPT code 90847 is appropriate. Keep in mind:
- Only one client’s insurance information should be billed per session
- The diagnosis and treatment goals must pertain to the identified individual
- CPT code 90846 applies when therapy involves family members or partners without the identified client present
Accurate use of these codes and thorough documentation reduce claim denials and ensure proper reimbursement.
Can Clients Be in Both Individual and Couples Therapy?
Yes, many clients benefit from having both individual and couples sessions to address different mental health and relationship needs. To bill correctly when a client participates in both:
- Use CPT codes 90834 or 90837 for individual therapy (depending on session length)
- Use CPT code 90847 for couples therapy
- Maintain separate progress notes clearly reflecting the focus of each session type
- Verify with payers about billing multiple therapy sessions on the same day, as some plans restrict this
What to Include in Documentation for Couples Therapy
Thorough documentation is critical for supporting reimbursement and defending against audits. Your clinical notes should include:
- The primary client’s full name and diagnosis
- Explanation of the medical necessity for involving the partner in therapy
- Description of how relational dynamics impact the client’s mental health symptoms or functioning
- Clear links between session interventions and the client’s treatment goals
Avoid language that frames sessions as purely for relationship enhancement or marital enrichment, since insurers typically do not cover these. Instead, focus on the clinical relevance of the therapy.
Example note language:
“Today’s session addressed communication difficulties contributing to the client’s anxiety. Partner participation was utilized to practice assertive communication and emotional regulation to reduce symptom severity.”
Final Thoughts: Billing Couples Therapy with Confidence
Navigating the complexities of couples therapy billing requires:
- Understanding correct CPT codes
- Identifying the primary client for billing purposes
- Documenting medical necessity carefully
- Verifying payer policies regularly
Following these best practices will help you maintain compliance, maximize reimbursement, and avoid administrative headaches. If you’re unsure about billing or documentation, professional billing support can be a valuable resource.
Let Anchor Point Billing Solutions Help
At Anchor Point Billing Solutions, we specialize in helping mental health providers navigate billing challenges, including couples therapy reimbursement. Our services include:
- Insurance benefit verification and eligibility checks
- CPT code guidance tailored to therapy types
- Claims submission and proactive follow-up
- Denial management and appeals support
- Customized client communication resources and superbills
Partner with us to reduce your administrative burden and focus on providing excellent care.
Ready to simplify your couples therapy billing? Contact Anchor Point Billing Solutions today and learn how we can help you bill with confidence and accuracy.