Couple/Family Service Codes
This article explains the different service codes billed for couples or family therapy, couples diagnosing, couples therapy with insurance, and more. Other FAQs about couples/family therapy billing can be found here: Billing for Couples/Family Therapy.
Couple/Family Intake Code: 90791 COUPLES
| CPT Code | Description | Duration |
|---|---|---|
90791 COUPLES  |
Psychiatric Diagnostic Evaluation | 15+ minutes |
Couples/Family Sessions: 90846, 90847
| CPT Code | Description | Duration | Examples |
|---|---|---|---|
| 90847 (1 unit) | Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | 50 minutes | An example of when a therapist would bill using the 90847 CPT code is when they meet with a child and their parents for a therapy session, and the child is the IP. |
90847 (mult-unit)  |
Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes | 1, 2, 3+ hours | The therapist meets with the couple for multiple hours. |
| 90846 | Family psychotherapy (without the patient present), 50 minutes | 50+ minutes | Examples of when to bill a 90846 CPT code are when a therapist is meeting with one partner in a couple about the other partner who isn't present or when a therapist is meeting with the parents of a child who is the IP but who is not present at the session. |
If the intake determines that the proceeding sessions will be either Couples/Family counseling sessions, then all future sessions will need to be scheduled as 90847 when two or more people are in session.
Common Dx for Couples/Family Therapy
A dx like Z63 is usually applied for self-pay couples therapy. Here are some presenting problem examples:
- The couple is working on communication.
- The couple is discussing financial situations/hardships.
- The couple is working on infidelity.
- The family is discussing moving.
Adjustment disorder is not a diagnosis applicable for couples counseling except in rare cases where the couple truly meets the criteria for adjustment disorder. Infidelity, communication, finances, becoming parents, and fighting etc. are not appropriate for the use of adjustment disorder.
Couples/Family Therapy Billing with Insurance
Couples/family therapy should be scheduled and billed as self-pay; we cannot bill insurance because most couples/family treatments do NOT have billable diagnoses. Learn more: Billing for Couples/Family Therapy.
Scenario for Couples/Family Therapy (SELF-PAY)
|
Scenario: Couple calls in for couples counseling. Wife is the IP. |
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|
Appts |
Who’s present |
Service Code |
Dx |
Time (m) |
| 1st Appt. | Husband & Wife (IP) | 90791 Couples  |
Z or F code | 50+ |
| 2nd Appt. | Husband & Wife (IP) | 90847 (1 or multi-unit) | Z or F code | 50+ |
| 3rd Appt. | Husband & Wife (IP) | 90847 (1 or multi-unit) | Z or F code | 50+ |
Scenario for Couples/Family Therapy (MEDICAID)
All couples with Medicaid CANNOT self-pay - ever - no matter the Dx.
90839 Crisis Code - Can be used for Couples/Families Appts.
Key Facts for Utilizing the Crisis Codes
- CPT code 90839 is the principal code for a crisis psychotherapy session requiring urgent assessment and history of the crisis state, mental status exam and disposition. It is billed for the first 60 minutes of psychotherapy for a patient in crisis.
- If/when the crisis psychotherapy session lasts longer than 60 minutes, the add-on code, 90840, can be billed for each additional 30 minutes of psychotherapy for a crisis.
- For the new crisis codes to apply, the presenting problem must typically be life-threatening or complex and require immediate attention to a patient in high distress.
- Medicaid does not cover 90839 via Telehealth.
- Best practices state that clients in crisis should be seen in person.
FAQs
Can we bill 90837 for ONGOING couple/family sessions?
No. The key word is "ongoing." If continuous/ongoing couples therapy is happening, we must bill 90847 or 90846.
Can we bill Individual and couples/family sessions on the same day?
Yes, because the couples/family session should be self-pay with a 90847, and the individual session (90837) would be billed to insurance.
In the rare case of billing insurance for both the couple and individual sessions on the same day. The 90847/90846 session code must have a 59 modifier attached to demonstrate that the service is “separate or unique” from the 90837 session. Email the Billing Team if this scenario arises.