Wiki Couples Therapy CPT coding

[dcanthony]

I'm new to Mental Health services. Is there a CPT for couples therapy?
Visit with both partners in therapy session.
One partner is being seen for individual therapy with a separate provider.

 

[CBLENNIE]

Is the "couples therapy" addressing just their relationship and any issues in the relationship? If so, most commercial insurance companies are not going to cover "couples counseling". In fact most plans have an exclusion for couples and/or marriage counseling.

However, if one member of the couple has a covered mental health diagnosis, family therapy, may be covered and the claim would be submitted to the commercial insurance company under the patient who has the covered mental health diagnosis. CPT 90847 would probably be the code you would be able to bill, assuming your provider meets the requirements of the commercial insurance plan as a covered provider. When billing 90847 it is important that provided services meet the definition of the CPT code, which per Encoder Pro is:

The therapist provides 50 minutes of family psychotherapy in a setting where the care provider meets with the patient and the patient's family jointly. The family is part of the patient evaluation and treatment process. Family dynamics as they relate to the patient's mental status and behavior are a main focus of the sessions. Attention is also given to the impact the patient's condition has on the family, with therapy aimed at improving the interaction between the patient and family members. Reviewing records, communicating with other providers, observing and interpreting patterns of behavior and communication between the patient and family members, and decision-making regarding treatment, including medication management or any physical exam related to the medication, is included.​