Couples/family therapy billing can be tricky, and there are some grey areas. Below are the common questions regarding couples/family therapy and how to handle them.
No. In most cases, clients seeking couples therapy do not have medical/billable diagnoses. Insurance does not cover couples who are fighting or have infidelity issues. The same goes for family therapy. Family therapy usually consists of therapy about a family conflict in which no medical/billable diagnosis would exist. A Z code is typically used to diagnose the IP in these cases.
In light of the above, clients seeking couples/family therapy are set up as self-pay. Here are typical service codes used: Couple/Family Service Codes.
Suppose a client has Medicaid and wants couples/family therapy. In that case, they cannot self-pay, as explained above, even if they want to because there is no billable diagnosis, even if the service code used in couple/family therapy (90847) is a billable service code. This is a tricky area when it comes to couples/family therapy. In these cases, the couples/therapy client cannot be seen at Overcomers.
However, as a workaround, we can set the Medicaid member to be seen individually (if medical necessity exists), and then the partner, spouse or family members can join the occasional individual therapy session. The individual therapy services codes (90791, 90837) would be used for every session in this scenario.