Current Procedural Terminology (CPT) codes are standardized five-digit numbers used in the United States healthcare system to describe medical, surgical, and diagnostic services. Maintained by the American Medical Association (AMA), these codes serve as the universal language for insurance billing and reimbursement. For psychotherapy, CPT codes allow therapists to document the exact type and length of service provided to a patient. This standardization is necessary for health insurance payers to process claims and determine coverage.
The Primary Code for Family Psychotherapy
The CPT code most frequently used for couples therapy is 90847, officially titled “Family Psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes.” This code is designed for sessions where the therapist works with a family unit or a couple, and the person identified as the primary client is present. Conjoint psychotherapy focuses on relationship dynamics as they relate to the treatment of a mental health condition in one partner. The code is structured around a typical 50-minute session, though it can be billed if it lasts for a minimum of 26 minutes.
The service is billed only once per session, regardless of the number of people present, as it represents a single therapeutic intervention on the family or couple system. Code 90847 falls under “family psychotherapy,” not a standalone “couples therapy” category. The primary patient’s presence distinguishes 90847 from 90846, which is used when the therapist meets with family members without the patient. The core purpose of the session, even when addressing relationship issues, must be tied to the treatment plan of the identified individual.
Using the Identified Patient Concept
Successful insurance billing for couples therapy requires designating an “Identified Patient” (IP), who must have a diagnosable mental health condition. The clinical focus of the 90847 session must be on how the couple’s interaction affects the IP’s symptoms and progress in treatment. If the session’s primary goal is the treatment of the IP’s specific, billable diagnosis (e.g., Major Depressive Disorder), 90847 is the appropriate code. The partner’s presence is considered necessary collateral support for the IP’s treatment, not treatment for their own condition.
If the therapist meets with the IP alone, an individual psychotherapy code like 90834 (45-minute session) or 90837 (60-minute session) is used instead of 90847. The distinction between 90847 and an individual code hinges entirely on the clinical content and the IP’s presence. If a partner attends primarily to provide information or receive coaching on supporting the IP’s treatment plan, the session remains billable under the IP’s diagnosis using 90847, provided the IP is present. This billing decision reflects that the service benefits the individual patient who holds the qualifying diagnosis.
Insurance Coverage and Reimbursement Challenges
A challenge with CPT code 90847 is that it is often not covered by insurance plans due to the requirement for “medical necessity.” Insurance payers define medical necessity as treatment for a diagnosable mental illness found in the DSM (Diagnostic and Statistical Manual of Mental Disorders). Relationship problems, such as communication breakdowns or partner conflict, are classified using “Z codes” in the ICD-10 system, like Z63.0 (“Problem in relationship with spouse or partner”).
Z codes are considered non-medical conditions and are typically not reimbursable when used as the sole or primary diagnosis on a claim. Consequently, if the couple seeks therapy simply for relationship improvement without one partner having a billable mental health diagnosis, the 90847 claim is likely to be denied. Some insurance policies contain specific exclusions for “marital counseling” or “couples therapy,” even if the CPT code is for family psychotherapy.
When insurance coverage is denied or unavailable, clients utilize financial alternatives such as private pay or out-of-network benefits. With private pay, the client pays the therapist’s full fee directly, foregoing insurance use entirely. For out-of-network benefits, the therapist provides the client with a specialized receipt called a superbill, which the client submits for potential partial reimbursement. However, even when submitting a superbill, the claim must still include a billable mental health diagnosis for the Identified Patient to be covered by the plan’s out-of-network benefits.