Couples Therapy CPT Codes are frequently misunderstood, misused, and misbilled in mental health practices. The result is predictable: claim denials, delayed payments, payer audits, and frustrated providers. Couples therapy billing is not the same as individual psychotherapy billing, and assuming otherwise is a costly mistake.
This guide explains which CPT codes apply to couples therapy, how payers interpret them, common billing errors, documentation requirements, and best practices to ensure clean reimbursement.
What Is Couples Therapy in Medical Billing?
Couples therapy involves psychotherapy sessions where two individuals are treated together to address relationship issues, communication problems, or emotional conflicts. From a billing perspective, the clinical focus matters more than the number of people in the room.
Payers look at:
- Who is the identified patient
- Whether a mental health diagnosis exists
- If the session is medically necessary
- How the service is documented
Billing couples therapy incorrectly can result in non-covered service denials, even if the session itself was clinically appropriate.
Couples Therapy CPT Codes Explained
There is no CPT code labeled specifically as “couples therapy.” Instead, providers must use psychotherapy codes based on session structure and patient identification.
Most Common Couples Therapy CPT Codes
CPT 90847 – Family Psychotherapy (with patient present)
This is the primary CPT code used for couples therapy.
Use CPT 90847 when:
- Both partners attend the session
- One partner is the identified patient
- The session addresses the patient’s mental health diagnosis
- The partner participates as part of treatment
This is the most widely accepted code for couples therapy billing.
CPT 90846 – Family Psychotherapy (without patient present)
This code applies when:
- The identified patient is not present
- Therapy focuses on family or partner dynamics affecting the patient
Important: This code is often not covered by insurance, so coverage must be verified before billing.
CPT 90834 or 90837 – Individual Psychotherapy
These codes should not be used for couples therapy unless:
- Only one patient receives treatment
- The partner’s presence is clearly documented as supportive
- The session primarily focuses on the identified patient
Misusing individual psychotherapy codes for couples sessions is a major audit trigger.
Why CPT 90847 Is the Correct Code for Couples Therapy
Payers consider couples therapy a form of family psychotherapy, not individual therapy. CPT 90847 aligns with payer definitions when:
- There is one diagnosed patient
- Treatment goals relate to that diagnosis
- The partner is part of the therapeutic process
Billing CPT 90847 without a diagnosis will usually result in denial.
Diagnosis Requirements for Couples Therapy Billing
Most insurance plans require:
- A valid DSM diagnosis
- Diagnosis assigned to one patient
- Treatment goals linked to that diagnosis
Relationship problems alone (such as marital distress) are typically not covered diagnoses. If no mental health diagnosis exists, couples therapy may be considered self-pay.
Modifier Usage in Couples Therapy Billing
Modifiers are rarely required for CPT 90847, but billing accuracy still matters.
Key points:
- Do not bill both partners separately
- Bill under the identified patient only
- Do not split charges between two patients
- One claim per session
Incorrect modifier usage often leads to claim rejection or payment reversal.
Common Couples Therapy Billing Mistakes
These mistakes cost practices money every month:
- Billing couples therapy as individual therapy
- Assigning diagnoses to both partners
- Billing two claims for one session
- Using non-covered relationship diagnoses
- Failing to document medical necessity
- Ignoring payer-specific policies
Most denials come from coding logic errors, not payer bias.
Documentation Best Practices for Couples Therapy
Documentation must clearly support the CPT code used.
Clinical notes should include:
- Identified patient name
- Mental health diagnosis
- Session participants
- Treatment goals linked to diagnosis
- How the partner contributes to treatment
- Time spent in session
If documentation does not support CPT 90847, payers will deny payment.
Payer Rules for Couples Therapy CPT Codes
Coverage varies by payer.
Medicare
- Generally does not cover couples therapy
- CPT 90847 may be denied
- Verify before billing
Commercial Insurance
- Many plans cover CPT 90847
- Diagnosis and medical necessity required
- Preauthorization may apply
Medicaid
- Coverage varies by state
- Some states allow CPT 90847 with restrictions
Never assume coverage. Always verify benefits.
Self-Pay vs Insurance Billing for Couples Therapy
When couples therapy is:
- Not medically necessary
- Not diagnosis-based
- Excluded by payer policy
…it should be billed as self-pay, not insurance.
Trying to force insurance billing creates:
- Compliance risk
- Refund requests
- Audit exposure
Best Practices to Avoid Denials
To bill couples therapy correctly:
- Use CPT 90847 when appropriate
- Verify payer coverage in advance
- Assign diagnosis carefully
- Document medical necessity clearly
- Train clinicians on billing rules
- Audit claims regularly
Correct billing starts with education, not rework.
Revenue Impact of Incorrect Couples Therapy Billing
Incorrect use of Couples Therapy CPT Codes leads to:
- Denied claims
- Lost revenue
- Increased AR days
- Compliance investigations
Consistent errors signal poor internal controls to payers.
Final Takeaway
Couples Therapy CPT Codes require precision. There is no shortcut, no creative billing, and no “close enough” coding. CPT 90847 is the correct code in most cases, but only when documentation, diagnosis, and payer rules align.
If couples therapy is billed incorrectly, insurance will not pay and they are right not to.
