Couples therapy, also known as marriage counseling or relationship therapy, is a specialized form of psychotherapy designed to help intimate partners resolve conflicts, improve communication, and strengthen their emotional bond. It plays a critical role in promoting mental health—not just for each individual, but for the relationship as a whole. From clinical delivery to insurance billing, providers must understand the therapeutic process and the proper procedures to ensure ethical and profitable practice.
This guide offers a comprehensive overview of couples therapy and the associated billing practices, ensuring providers can deliver high-quality care while navigating complex reimbursement systems.
What Is Couples Therapy?
Couples therapy is a structured form of psychotherapy focused on relationship dynamics rather than individual mental health diagnoses. While individual issues may surface during sessions, the relationship itself is considered the “client.”
Common Goals of Couples Therapy:
- Enhance communication skills
- Resolve recurring conflicts
- Address intimacy or sexual issues
- Rebuild trust after infidelity
- Navigate life transitions (e.g., parenting, illness, loss)
- Support in managing one or both partners’ mental health conditions
Techniques Used:
- Emotionally Focused Therapy (EFT)
- Gottman Method Couples Therapy
- Cognitive Behavioral Therapy for Couples (CBCT)
- Imago Relationship Therapy
- Narrative Therapy
Who Can Provide Couples Therapy?
Couples therapy is typically conducted by licensed professionals trained in relationship counseling, such as:
- Licensed Marriage and Family Therapists (LMFTs)
- Licensed Professional Counselors (LPCs)
- Licensed Clinical Social Workers (LCSWs)
- Psychologists (PhD or PsyD)
- Psychiatrists (in less common cases)
Training in couples therapy models is strongly recommended and sometimes required by ethical boards and licensing bodies for those offering these services.
Session Structure and Duration
Sessions usually range from 45 to 60 minutes, though some models allow for extended or intensive sessions. Both partners are generally present, though some sessions may involve one partner individually, depending on the treatment plan.
The therapeutic approach should be collaborative, neutral, and balanced. Therapists must avoid forming alliances with one partner over the other and maintain clear ethical boundaries.
Billing Guidelines for Couples Therapy
Billing for couples therapy is more nuanced than billing for individual psychotherapy. It is essential to understand CPT codes, payer policies, and documentation requirements to ensure reimbursement and avoid denials.
1. Common CPT Code Used:
- 90847 — Family Psychotherapy with the Patient Present
This is the most appropriate code for couples therapy when one or both individuals have a mental health diagnosis and the therapy is primarily focused on treating the diagnosed individual within the context of the relationship.
Key Point: Although both partners attend, the claim is billed under one individual—the identified patient, who must have a billable mental health diagnosis.
2. Alternate Code (When No Patient Is Present):
- 90846 — Family Psychotherapy without the Patient Present
Used when the therapist meets with a partner alone to discuss the therapy goals or relationship concerns, without the presence of the identified patient.
3. Insurance Considerations:
Most insurance plans do not cover couples therapy unless it is being used as part of the treatment for a diagnosed mental health condition. To ensure coverage:
- Identify the primary patient (the one with the diagnosis).
- Document the diagnosis using ICD-10 codes.
- Clearly explain how the couple’s interaction affects the patient’s symptoms.
- Link the therapy goals to the treatment of the identified patient’s condition.
4. Documentation Requirements:
Each session note should include:
- Identified patient’s name and diagnosis
- Session participants (e.g., “Client attended with spouse”)
- Purpose of the session (tied to the treatment plan)
- Interventions used
- Progress toward treatment goals
- Clinician’s observations and clinical decision-making
Note: Avoid documenting the session as purely “marital therapy” unless the insurance company specifically allows for this service under the member’s benefits.
5. Private Pay Option
If the couple prefers not to involve insurance, or if insurance denies coverage for couples therapy, providers can offer private pay options. This gives more flexibility in:
- Session length
- Content (non-diagnosis-based issues like communication or parenting)
- Treatment focus without insurance restrictions
Make sure clients sign a Good Faith Estimate if required by law (per the No Surprises Act in the U.S.) and clearly outline payment terms.
6. Ethics and Confidentiality
Couples therapy introduces unique ethical considerations, especially around confidentiality. Clinicians must:
- Establish clear informed consent from both partners
- Define what happens if one partner discloses a secret (e.g., infidelity)
- Set boundaries for individual vs. joint sessions
- Be transparent about record-keeping and access to session notes
Having a couple-specific informed consent form is highly recommended.
Maximizing Profit Without Compromising Ethics
To maintain a healthy and profitable couples therapy practice:
- Use proper coding (90847) with diagnosis documentation
- Verify coverage before sessions begin
- Use electronic billing systems for faster reimbursement
- Reduce no-shows with automated reminders
- Offer package deals for private pay clients
- Periodically review insurance contracts for fee updates
Conclusion
Couples therapy is a vital service that strengthens mental and emotional well-being within relationships. While billing for it can be more complex than individual therapy, proper documentation, correct coding, and ethical practices can ensure both reimbursement and positive outcomes. Providers who master both the clinical and administrative sides of couples therapy are best positioned to grow a sustainable and impactful practice.
